As North Carolina Moves Towards Medicaid Managed Care, Its Leaders Approach the Operational Issues | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

As North Carolina Moves Towards Medicaid Managed Care, Its Leaders Approach the Operational Issues

October 11, 2017
by Mark Hagland
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As the state of North Carolina moves to shift its Medicaid program into a managed care program, its operations leaders are tackling the operational and IT challenges involved

The state of North Carolina is progressively and actively working to reform Medicaid services and payment across the healthcare landscape.  That effort inevitably involves many layers and facets, from policy and payment elements, to very operational ones. How is that state’s government moving forward to make the interactions of physicians, clinics and medical groups, hospitals, and other providers, with state government, easier?

Between collaborative payer exchange initiatives, health information exchange (HIE) efforts, and other collaborative approaches, North Carolina is actively creating a network of collaboration between top providers across the diverse regions of the state.  But what is next for these programs?  Where will the state turn its attention next as we move forward?

One absolutely key element in the state government’s overall strategic plan is for the transformation of the North Carolina Medicaid program, with the aim of shifting it into a fully managed-care format, as most state Medicaid programs have been transformed or are in the process of being transformed. On Aug. 8, NCDHHS published its announcement of that plan, inviting public comment. In making that announcement, NCDHHS quoted Mandy Cohen, M.D., Secretary of DHHS, as saying, “We have put forward a detailed proposed design for a Medicaid managed care system that will deliver an innovative, whole-person-centered, well-coordinated system of care. We are grateful for the thoughtful insights provided by hundreds of health care professionals, beneficiaries and other stakeholders, and DHHS welcomes feedback on this proposal,” Dr. Cohen said.

As the announcement noted, “Medicaid managed care will be a significant change for the North Carolina Medicaid system. DHHS is releasing its proposed program design to ensure stakeholders have an opportunity to comment on managed care specifics.” “Our proposed Medicaid managed care program design reflects the specific strengths and needs of North Carolina,” said Dave Richard, deputy secretary for medical assistance, in that announcement. Richard noted that “[T]he proposed design supports: integrating services for physical health, behavioral health, intellectual and developmental disabilities, and substance use disorders; addressing unmet social needs and their effect on overall health; and building on and strengthening what is working well today, such as care management, while supporting providers and beneficiaries through any changes during the transition and beyond.”

Further, the announcement noted, “The proposal touches on a variety of topics related to the design and implementation of Medicaid managed care in North Carolina. The paper lays out a timeline for transition of key functions and highlights how managed care can meet the needs of complex populations (e.g., people dually eligible for Medicaid and Medicare). It discusses how certain aspects of today’s Medicaid program, like beneficiary appeals and care management, will transition under managed care. Further, the program design describes how providers and plans will contract with each other consistent with protections in North Carolina law, how data will move through the system, and how DHHS will hold plans accountable for meeting standards and delivering high quality care.”

Sam C. Gibbs, deputy secretary for technology and operations in the North Carolina Department of Health and Human Services (NCDHHS), and Charles Carter, in the Secretary’s Office, Technology and Policy, at NCDHHS, will share the innovative work that they and their colleagues are pursuing, on October 19, in a spotlight presentation at the Health IT Summit in Raleigh, sponsored by Healthcare Informatics, and to be held at the Sheraton Raleigh Hotel Downtown, on Oct. 19 and 20.

Sam Gibbs

And, in anticipation of that presentation, Gibbs spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the innovation taking place in North Carolina government right now. Below are excerpts from that interview.

What are the basic functions that the Technology and Operations division manages, within the Department of Health and Human Services?

In broad-stroke terms, the DHHS in NC has a $20 billion budget per year, and 17,000 employees, and we’re organized into about 30 different divisions that provide services to millions of North Carolinians, from traditional Medicaid health insurance and the services of the Department of Public Health, and the Department of Social Services (including temporary assistance for needy families, support for low-income families, jobs and vocational rehabilitation), the Department of Mental Health—and one of the larger departments is our Department of Health Care Facilities; we run three state mental health facilities, as well as alcoholism and addiction and other services; we’re a provider of services for millions of NCs in needs. And those services are organized under three different deputy secretaries. So we provide all the technology services, grant services, procurement services; it’s a technology and operations component, what my department does.”

What are the broad goals involved in this initiative, overall?


2018 Raleigh Health IT Summit

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September 27 - 28, 2018 | Raleigh