NCMS Morning Rounds 10-9-19

Already Wednesday and time for your

NCMS Morning Rounds

Oct. 9, 2019

Carolina Complete Health Awarded Additional Region in Medicaid Managed Care

Yesterday the NC Department of Health and Human Services (NCDHHS) announced an additional region has been awarded to Carolina Complete Health, Inc., one of the prepaid health plans (PHP) selected to provide services to Medicaid patients as part of the state’s move to Medicaid managed care. Carolina Complete Health (CCH) is a joint venture between the NCMS, Centene Corporation and the North Carolina Community Health Center Association.

Last February, the state awarded CCH, a provider-led health plan governed by physicians, a contract to serve regions 3 and 5 beginning in February 2020. Yesterday the Department expanded the area served by CCH to include region 4. View the region map.

“Our physicians are committed to providing leadership and governance for Carolina Complete Health to ensure that providers continue to have a central role as DHHS partners in improving the health and well-being of North Carolinians,” said NCMS CEO Robert W. Seligson, MBA, MA.

The NCMS’ partnership with Centene and the NC Community Health Center Association is unique and will bring an innovative, patient-focused, physician-led option to Medicaid beneficiaries with the ultimate goals of improving health for our most vulnerable citizens.

“Our top priority is meeting the health care needs of the people we serve, while being good stewards of public resources. As a physician, I understand the unique perspective that providers can bring to the health insurance market,” said NCDHHS Secretary Mandy Cohen, MD. “We look forward to our continued partnership.”

Open enrollment for Medicaid managed care currently is underway in 27 counties in the state and will launch statewide on Oct. 14 and continue until Dec. 13. Medicaid managed care is slated to be operational in February 2020.

The change comes due to legislation enacted in 2015 by the NC General Assembly directing the NCDHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the State contracts with insurance companies, which are paid a predetermined set rate per person to provide all services. Transforming North Carolina’s Medicaid program to managed care is the most significant change made since its inception.

Keeping Up with the Medicaid Transition

As noted in the previous article, the state’s transition to Medicaid managed care is a huge and complex undertaking for everyone involved. NC AHEC is trying to help medical practices that serve Medicaid patients in this transition by providing weekly one-page updates containing news, reminders and helpful resources.

This week’s issue includes a note about expanded hours for the enrollment broker as well as contact information and a reminder that open enrollment begins statewide on Monday, Oct. 14, among other newsy tidbits.

Read the NC AHEC practice support document for the week of Oct. 8.

Kudos to Dr. Brian Klausner!

At the NCMS’ Leadership Dinner last Friday evening, NCMS Past President and chair of the Board of Directors for The Carolinas Center for Medical Excellence (CCME) John R. Mangum, MD, presented the CCME’s 2019 T. Reginald Harris Memorial Award to Brian Klausner, MD. The award is given to a physician leader for outstanding achievements in the areas of health care quality and service to the medical community and honors the life and memory of Dr. Harris, a founding member of CCME’s Board of Directors.

Dr. Klausner is a practicing internist with WakeMed and Medical Director with its ACO, WakeMed Key Community Care, and for WakeMed’s uninsured/homeless outreach program. Dr. Mangum noted his outstanding efforts in the medical field and community outreach programs to ensure the underserved – and all patients – receive the best possible care.

Known for his meticulous work with payers on quality metrics, Dr. Klausner is driving change by negotiating fair and reasonable metrics and laying the groundwork for other ACOs and groups.

One testimonial in support of Dr. Klausner’s nomination stated: “Brian Klausner has shown unparalleled dedication to improving the health and well-being of patients and families in Wake County. He has championed population health…and he has partnered with local community outreach programs and tackles head-on the social determinants of health that make caring for these patients a challenge.”

Congratulations, Dr. Klausner!

In the News

Waste Gobbles Up 25 percent of US Health Care Spending, JAMA Study Finds, Healthcare Dive, 10-7-19

Learning Opportunity

Adverse Childhood Experiences (ACEs) Southeastern Summit 2019 will be held Nov. 2-3 in Asheville. Local, regional and national speakers will focus on evidence-based practices that prevent and address the intergenerational transmission of ACEs. Learn more and register.


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