Time to hit re-set button on Medicaid program

It’s been a tough week for the Department of Health and Human Services and especially the Medicaid program.  The news reports by Rose Hoban detailing how the State Auditor’s Medicaid report was redacted to withhold key information on administrative costs and the Community Care NC program were damaging.

The constant barrage of inquiries from legislators at the Joint Legislative Oversight Committee hearing on Tuesday was bruising.

The fact that the $800 million computer program NC TRACS is a total disaster is downright embarrassing.

And the insurers, hospitals and doctors who responded to the department’s request of information earlier this year have to be concerned knowing that Ms. Steckel has seen all their confidential business plans and pricing models for providing care to Medicaid patients.

It’s easy to understand why some folks would be upset knowing that she is going to work for WellCare, a Tampa, Florida company that wants to do business with the state.  Ms. Steckel knows all her competitors’ secrets and will clearly have an advantage when “pitching” for business in North Carolina.

It’s rather clear that the Governor and the Department of Health and Human Services need a victory and they need it right now – even if it’s a small victory.  The last thing the GOP can stand is an all-out war with the house of medicine.

The Governor and Secretary Wos can’t afford a long drawn-out fight with Senators Jeff Tarte and Tommy Tucker.  They need to find a way to deliver Medicaid reform, get a handle on their risk factors and work with the provider community to control costs.

One solution – talk to Senator Richard Burr. The Governor and Secretary Wos should spend some time with Republican Senator Richard Burr, who has been a major advocate for the Community Care of North Carolina program.  Senator Burr has been pushing for a collaborative effort between the state’s doctors, nurses, hospitals and pharmacies since 2002.

CCNC is a shared risk program where the doctors and hospitals have a financial stake and risk in taking care of Medicaid patients.  CCNC has registered nurses who do home visits with Medicaid patients to make sure they have their medicines, they are controlling their blood pressure and they are managing their health.  The one-on-one care is collaborative between the doctor and the hospital.  The goal is to improve care and focus on the patient – enhancing patient outcomes.  A healthy patient means fewer visits to the Emergency Room or readmissions to the hospital.

CCNC has strong support from the house of medicine in North Carolina.    It just makes sense for the Governor and his team to work to include CCNC in the Medicaid Reform plan, embrace the house of medicine and deliver on a campaign promise – Reform Medicaid.

Bringing in the house of medicine as a part of the solution means failure isn’t an option.  You can’t have failure when everyone is in the same boat.