NCMS Morning Rounds 4-9-19

Make it a terrific Tuesday!

Here’s your NCMS Morning Rounds to get you started.

Medicaid Transformation Update

To keep you in the loop on the latest news in the state’s move to Medicaid managed care, and the NCMS’ important role in making this an opportunity to showcase physician leadership and improve health for NC citizens, we offer the following updates:

  • Back in February, the NC Department of Health and Human Services (NCDHHS) awarded contracts to four statewide health plans (AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, UnitedHealthcare and WellCare). One regional physician-led entity, Carolina Complete Health, which is a joint venture between the NCMS, the NC Community Health Center Association and Centene Corporation, was awarded a contract to serve regions 3 and 5. See the regional map here.
  • Work continues toward ‘going live’ with the new program this November in regions 2 and 4, which encompasses the Triad and Triangle. The rest of the state is slated to move to managed care in February 2020.
  • In March, protests of the contract awards were filed with NCDHHS by four bidders – Optima, Aetna, My Health By Providers, which is a coalition of North Carolina health systems, and Carolina Complete Health. Carolina Complete Health, the only successful bidder among the protesters, is seeking to expand its regional award.
  • On March 27, Centene announced it is moving to acquire WellCare. Read Centene’s announcement. The closing of the Centene/Wellcare transaction is not expected to occur until the first half of 2020. In the meantime, Centene and WellCare will continue to operate as separate companies. Both Carolina Complete Health and WellCare, as they go about implementing their Medicaid managed care contracts with the state, will continue to have separate networks, provider contracts and IT interfaces.

Check out the NCMS’ Medicaid transformation webpage for more information about the NCMS’ part in Medicaid transformation as well as resources.

See the Learning Opportunity section of this edition of your NCMS Morning Rounds for upcoming webinars and other planned sessions for you to learn more about the transition to Medicaid managed care. Watch future editions of this newsletter for updates on the Medicaid transformation process.

Emergency Physicians Engage with Legislators

A strong contingent of the NC College of Emergency Physicians spent last Wednesday at the NC General Assembly as part of their legislative day. The group, pictured above with Sen. Floyd McKissick (D-Durham), center, specifically addressed three bills: support of HB 184–Study State Health Plan Design; oppose HB 267– Require Safety Helmets/Under 21 and oppose SB368–Greater Transparency in Health Care Billing.

NCMS Board member at-large Michael J. Utecht, MD, FACEP, (third from left) commented that legislators signaled their support for the group’s position on each of these bills.

Thank you NCCEP members for taking time to advocate on behalf of your patients and colleagues.

An Evening of Honors

Congratulations to several prominent NCMS members: past NCMS President Darlyne Menscer, MD, and NCMS member and NC House member Rep. Gregory Murphy, MD, (R-Pitt). Both were honored with University of North Carolina School of Medicine alumni awards last weekend.

Dr. Menscer received a Distinguished Medical Alumna Award for her “many contributions to geriatric health care and physician education” over her nearly four decades of caring for patients. Dr. Murphy received a Distinguished Medical Alumnus Award for his clinical and administrative leadership positions and his dedication to public service.

Congratulations Dr. Menscer and Dr. Murphy!

In the News

How the NYU School of Medicine is Going Tuition Free, CBS News, 60 Minutes, 4-7-19

Learning Opportunity

NC Medicaid recently launched a webinar series to support providers and practices during their transition to NC Medicaid Managed Care. “General” webinars are overviews of significant changes and features of the managed care program. “Topical” webinars are in-depth reviews of specific managed care topics.

Upcoming topics:

  • Provider Payment and Contracts, NC Medicaid Managed Care 102
    Thursday, April 11, Noon-1 p.m.
  • Value Based Payments and Quality Measurement in Medicaid Managed Care, NC Medicaid Managed Care 103, Thursday, April 25, Noon-1 p.m.
  • Provider Policies, NC Medicaid Managed Care 104, Thursday, May 9, Noon-1 p.m.

For additional information on previous and upcoming topics, including registration, visit:

Prepaid Health Plan Meet and Greet Sessions
Regional sessions will offer providers an opportunity to meet with health plan representatives, ask specific questions about provider network participation and Medicaid Managed Care transition. Health Plans and NC Medicaid subject matter experts will be on hand to respond to provider inquiries. For more information, visit:

Virtual Office Hours
Virtual office hours (VOH) will provide an interactive format for providers to have their questions answered. For the first VOH session, the focus will be on Medicaid provider enrollment and credentialing. A panel of NC Medicaid subject matter experts on this topic will be available to answer questions. For more information, visit:


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