The North Carolina Medical Society announced this week it has signed an agreement to collaborate on a patient-focused approach to Medicaid under North Carolina’s reform plan to privatize its Medicaid program.
Under the agreement, the organization, working in conjunction with the N.C. Community Health Center Association, and Centene Corporation, will create Carolina Complete Health, a joint venture to establish, organize and operate a physician-led health plan to provide Medicaid managed care services in North Carolina, the announcement said.
The NCMS declined a request to question its officials about the joint venture, but the announcement said a key feature will be the active participation of physicians in the ownership and governance of the health plan.
Centene will manage the financial and daily operations, while the Carolina Complete Health Network, which will be owned jointly by NCMS, physicians, physician assistants, nurse practitioners and federally qualified health centers, will provide medical management services, hold a majority on the Board of Directors and oversee the medical policies for the health plan.
Federally qualified health centers is a reimbursement designation from the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services for organizations receiving federal grants. Center such as primary care outpatient clinics qualify for enhanced reimbursement from Medicare and Medicaid and other benefits. They must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.
“With the changes taking place in our health care system at the state level with Medicaid reform and new programs at the national level, the NCMS remains committed to ensuring that physicians are the ones making the clinical decisions in the best interest of their patients,” CEO Robert W. Seligson said. “Our leadership views this partnership as a unique opportunity to help lead the reform process and to put patients’ needs first.”
When the General Assembly in September 2015 passed Medicaid reform legislation privatizing the state’s Medicaid program, the NCMS began pursuing ways to keep patients at the forefront, according to the announcement. The NCMS established key criteria for a partnership including financial strength, experience with statewide Medicaid networks and an openness to a patient-focused approach.
Centene president and CEO Michael F. Neidorff said his company believes the physician-directed health plan can be an ideal model when properly executed to ensure providers are leading health care decisions and contributing toward a value-based reimbursement system that results in better health outcomes for members at a lower cost to the state.
“We have seen this type of health plan model work, and we look forward to bringing this approach to North Carolina,” Neidorff said.
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