NCMS Board De-Briefed on Important Health Care Issues of the Day

The North Carolina Medical Society (NCMS) Board of Directors had a full agenda when they met in Wilmington last weekend. Besides meeting with physicians from the eastern region of the state, the Board also heard from prominent guests who brought them up to speed on several important issues.

Workforce: NCMS Board Member Michelle Jones, MD, along with Warren Newton, MD, MPH, Director of the North Carolina Area Health Education Centers (AHEC) Program and Vice Dean for the UNC School of Medicine and senior medical advisor to the NC Department of Health and Human Services on Medicaid reform, spoke to the board about health care workforce issues in North Carolina.

“Care transformation will require a very different workforce,” Dr. Newton told the Board. AHEC is pushing for additional investment by the state in General Medical Education, he said, adding that focusing that investment on the residency experience is key to keeping doctors in the state after they finish their training.

Physician wellness: The Board also heard from Warren Pendergast, MD, and Joseph Jordan, Ph.D. from the NC Physicians Health Plan (PHP). They delivered their annual report to the NCMS, offering statistics on the number and type of referrals to PHP.

For 2015 there were 171 individuals referred to PHP. Of those, the breakdown for type of referral is:

  • Substance use disorders: 63 percent
  • Psychiatric: 11 percent
  • Behavioral: 14 percent
  • Professional Sexual Misconduct: 2 percent
  • Other: 10 percent

The North Carolina Medical Board is the biggest source of referrals at 35 percent with self-referral next at 26 percent. Total percentage of those successfully completing the program is 88 percent.

PHP also is spearheading a wellness initiative through the newly formed NC Coalition for Physician Resilience and Retention of which the NCMS is a part. The goal is to develop programs to help physicians experiencing issues with stress and burnout.

Updates from Blue Cross and Blue Shield of North Carolina: BCBSNC Senior Vice President and Chief Financial Officer Gerald Petkau spoke about the much-publicized problems the insurer has been having with verifying eligibility for their members.

“We recognize the issues with NCMS members as well,” Petkau said. “We’re sorry for that disruption.” He also commented on the NC Department of Insurance investigation of BCBSNC, noting that they are cooperating fully and are conducting their own internal review as well.

He also spoke about the challenges BCBSNC is facing with the Affordable Care Act (ACA). The company lost $282 million on their ACA business, he said. ACA patients are less healthy, use expensive health services and visit the ER at twice the rate of other customers. The sickest 5 percent incurred $1.29 billion in claims, he said.

To meet these challenges, Petkau said the options are to modify the products or withdraw from the ACA marketplace completely. The final determination will be made late in summer, he said.

“There are a lot of challenges and a lot of turmoil,” he said. “We are still optimistic. At Blue Cross Blue Shield we’ve seen some success with bundled payments and with ACOs.”

Petkau also advocated for more data exchange as practices move away from fee-for-service to value-based models.

“We have claims data; you all have encounter data. We need to share data,” he said.

 
 

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