North Carolina’s Move to Medicaid Managed Care

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This interview is part of a new collaborative series made possible by Business of Healthcare (BOH) and the North Carolina Medical Group Management Association (NCMGMA). These interviews further our mission to provide high-level continuing education content for our members while highlighting key players and issues in North Carolina’s healthcare industry.

In this interview:

cohen300aMandy K. Cohen, MD, MPH
Secretary, Department of Health and Human Services
State of North Carolina

Mandy Cohen, MD, MPH, Secretary of the Department of Health and Human Services for North Carolina, spoke with Business of Healthcare about the state’s transition to Medicaid managed care as well as efforts to impact social determinants of health and curb opioid abuse. The interview was recorded live with 200 physician practice leaders at the North Carolina Medical Group Management Association Fall Conference. Dr. Cohen will also be one of our Advocacy Days speakers on March 13, 2019 in Raleigh, NC.

Follow this link to view the interview video

Continuing Education Credit

By reading, watching or listening to the full interview, you may self-report to earn 0.5 hours Continuing Education Credits for Certified Medical Practice Executive (CMPE) or Fellow of the American College of Medical Practice Executives (FACMPE) credentials.

NCMGMA and BOH thank Mako Medical Laboratories
for helping to make this interview series possible.
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About the Business of Healthcare

BOH was founded as a forum and information exchange for the 40,000 decision makers leading hospitals and health systems, physician practices, pharma, device, and senior living as well as government and commercial payers. These leaders, and innovators serving them, join Business of Healthcare interviews to solve the complex issues they face together.

Hosted by Matthew Hanis, each interview balances Margin & Mission: making good healthcare accessible to all. New subscribers come to BOH through your referrals. Please share our content with your colleagues and invite them to join our expert community.

Upcoming Interviews

Upcoming interviews in the series feature Jeff James, Chief Executive Officer of Wilmington Health; and Chad Price, Founder and Chief Executive Officer of Mako Medical Laboratories.

Interested in Participating?
If you are interested in being interviewed or have a tip on someone who would be a great interview candidate, please contact Melissa Klingberg in the NCMGMA offices at melissa@ncmgm.org.

Takeaways from the August 9th DHHS Stakeholder Call with Mandy Cohen, M.D.

By Leah, Paraschiv, NCMGMA Board Member

On Thursday, August 9th, the NC Department of Health and Human Services (DHHS) held a stakeholder call led by DHHS Secretary Mandy Cohen, M.D. The call addressed DHHS’s upcoming issuance of the Request for Proposal for Prepaid Health Plans (PHP) in Medicaid Managed Care.

In short, DHHS has issued an official RFP for managed care carriers. They will accept proposals until October and announce their final selections in February. Managed care will officially begin in the fall of 2019.

Here are the most important takeaways from the call:

  • PHPs cannot refuse to contract with you.
  • Physicians and physician extenders are guaranteed payment at current rates.
  • DHHS has worked to mitigate administrative burden for clinicians.
  • PHPs will have real accountability and rigorous oversight.
  • You will receive education and support during and after the transition to managed care.

Anticipated Timeline:

  • Now and ongoing — PHPs may start to reach out to initiate contract discussions with clinicians.
  • February 2019 — DHHS will announce which health plans will be PHPs in managed care.
  • Summer 2019 — PHPs must have contracted with enough care providers to meet DHHS network standards.
  • July 2019 — PHPs must have all call centers operational and all relevant staff located in North Carolina.
  • July – September 2019 — Managed care will start in two phases. For regions of the state in Phase 1, this will be the window in which beneficiaries select a PHP.
  • November 2019 — Medicaid Managed Care program will launch in regions in Phase 1.
  • October – December 2019 — For regions of the state in Phase 2, this will be the window in which beneficiaries select a PHP.
  • February 2020 — Medicaid Managed Care will launch in regions in Phase 2.

For additional information on Prepaid Health Plans in Medicaid Managed Care, there is a two page fact sheet available on the NC DHHS website which contains more details specific to the provider community, with even more information for all stakeholders on the full website.

Public Input Requested for Medicaid and NC Health Choice Program

The North Carolina Department of Health and Human Services is seeking public input from April 25 to May 25, 2017, at 11:59 p.m. on the Medicaid and NC Health Choice programs transformation (also known as “Medicaid reform”).

While all comments are welcome, the Department is specifically looking for input on the following topics:

  • Integrating Primary Care and Behavioral Health Services
  • Supporting Provider Transformation
  • Care Management and Population Health
  • Addressing Social Determinants of Health
  • Improving Quality of Care
  • Paying for Value
  • Increasing Access to Care and Treating Substance Use Disorder

For specific information and sample questions on each of these topics, refer to the Request for Public Input document on the DHHS Medicaid Reform website.

I strongly encourage you to share your expertise with the Department as we consider whether modifications are needed to the Section 1115 waiver application submitted June 1, 2016, to the Centers for Medicare and Medicaid Services. Your input is crucial to ensure Medicaid is transformed to support North Carolina health care professionals as they strive to improve the health for people in our state.

Comments will be accepted at one of four public input sessions to be held during May (pre-registration is not necessary):

  • May 1, 5:30-7:30 p.m., Greensboro – Guilford County DHHS Building, 1203 Maple St, Rooms 122 and 123
  • May 10, 3-5 p.m., Greenville – Greenville Convention Center, 303 Greenville Blvd SW, Emerald Ballroom
  • May 12, 2-4 p.m., Asheville – Asheville-Buncombe Technical College, 340 Victoria Rd., Ferguson Auditorium
  • May 16, 6-8 p.m., Raleigh – McKimmon Conference & Training Center, 1101 Gorman St.

You also may provide comments in writing:

  • Email: MedicaidReform@dhhs.nc.gov
  • U.S. Mail: Department of Health and Human Services, Division of Health Benefits, 1950 Mail Service Center, Raleigh NC 27699-1950
  • Drop-off: Department of Health and Human Services, Dorothea Dix Campus, Adams Building, 101 Blair Dr., Raleigh.

Thank you for partnering with the Department and the North Carolina General Assembly on this significant transformation effort. For Medicaid transformation information and progress updates, visit https://www.ncdhhs.gov/nc-medicaid-reform.