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View from the Hill

North Carolina's new Medicaid proposal — Part Two of NC's health care summit

In the second half of the North Carolina Health Care Media Summit, a panel convened to discuss the state's new Medicaid proposal. 

Last year, the N.C. General Assembly passed a law mandating the state Department of Health and Human Services to come up with a proposal to change the state's Medicaid system.

One of the main proposals of the new Medicaid proposal is to change from a fee-for-service model, where health care providers are paid based on how much treatment they provide to more team-based approaches to health care.

"Fee for service is you do as much as you do as efficiently as possible and take home as much as possible," said Dr. Grace Terrell, president and CEO of Cornerstone Health Care.

One of the proposed alternatives was to move toward using Accountable Care Organizations, organizations of doctors, hospitals and health care providers who work to provide coordinated care to patients and are paid based on their performance.

The goal of ACOs is that when providers spend money wisely, they share in the savings. 

The plan proposes ACOs for Medicaid to have a target start date of July 2015 and will have to meet yearly benchmarks related to access, reducing cost and quality.

But some of the panelists did admit there would be challenges to enacting ACOs.

"This is way out of everybody's comfort zone," said Julian Bobbitt, a legal partner at Smith Anderson on the panel who is a health policy expert. "This is difficult for doctors and difficult for hospitals."

One of the difficulties in changing from the fee-for-service model is that providers would have to change not only how they receive pay for care but also consider how they deliver their care.

With changes to the way health care is administered, some journalists at the panel wondered if this could affect people interested in working in the health sector.

But Terrell said she was optimistic about people getting into the health profession.

"This is best time ever to get into health care," she said.

Two state legislators were also in attendance and spoke about the chances of a bill passing in the coming session.

"In my view, I think we need to help momentum moving forward," said Rep. Nelson Dollar, R-Wake.

But Sen. Louis Pate, R-Lenoir, who also on the panel, said the process should take time.

"I'd rather get it right than do something rapidly and get it wrong," Pate said. "We've had too many wrong steps in past."

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