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NC DHHS unveils new Medicaid reform plan

After nearly 15 months of discussions, and three public meetings with the Medicaid Reform Advisory Group, the North Carolina Department of Health and Human Services (DHHS) presented its Medicaid reform plan to the General Assembly this month.


"We have an obligation - an obligation we have willingly accepted as a state - to help those in need. And we must, at the same time, be good stewards of taxpayer resources," said DHHS Secretary Aldona Z. Wos, M.D. "We believe this Medicaid reform plan is responsive to both those obligations."

Monarch CEO Dr. Peggy Terhune served on the five-member advisory group to help collaborate and provide input for the reform.

“The whole plan is very exciting, and the final report reaches the three goals that we were given to achieve: budget predictability and sustainability, efficiency for providers and whole person patient care that unites physical and behavioral health,” Terhune said.

The plan proposes that providers collaborate through Accountable Care Organizations (ACOs), a model that allows physicians and other providers who care for patients to take control of improving quality and healthy outcomes by collaborating together.

“For example,” Terhune explained, “If you go to your primary care doctor who orders blood tests, it is likely that later in the month when you visit your endocrinologist or cardiologist, that doctor will also order the same tests. With an ACO, there is a shared record, so instead of duplication, the second doctor can look at the results from the first doctor’s order, and can take action from there. This eliminates extra tests or waiting.”

On top of the new plan, DHHS is also leading efforts to improve the Division of Medical Assistance (DMA) operations to support Medicaid reform. Secretary Wos recently named Deputy Secretary of Health Services and Acting State Health Director Robin Gary Cummings, M.D., to lead the DMA transformation.        

Photo Credit: Rose Hoban                       

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