Raleigh, N.C. — Doctors clad in white lab coats gathered with Gov. Pat McCrory outside the Governor’s Mansion at a news conference Wednesday to back the governor’s Medicaid reform plan.
Physicians criticized a provision in the state Senate budget that would task an outside entity with managing North Carolina’s Medicaid program, removing Medicaid from the domain of the state’s Department of Health and Human Services.
McCrory and Senate leaders differ on the best way forward for the state’s thorny Medicaid overhaul, but the governor said he is working with lawmakers on alternative plans, though he would not reveal any specific details.
The governor’s plan groups health care providers into clusters called accountable care organizations, which place the onus of cost-cutting on doctors by incentivizing preventative care.
“We need to start taking steps forward to save money while, at the same time, improving service,” McCrory said.
He said his reform plan gets doctors more actively involved in decisions about patients’ care.
“What I’m trying to do with both education and medicine is get the input from people who are actually practicing education and practicing medicine,” he said.
Senate Majority Leader Harry Brown, the Senate’s budget chairman, said Medicaid is a costly behemoth that strains already strapped state coffers.
“It is the absolute driver of the budget today,” said Brown, R-Onslow. “We’ve had to cut every other department of state government, pretty much, to pay for Medicaid.”
The governor’s plan does not cut enough costs or make the changes necessary to repair a system fraught with problems, Brown said.
“His plan is more in line of what we have today,” he said. “We think it has to be more of a dramatic change.”
DHHS Secretary Aldona Wos said the plan meets the needs of both doctors and patients.
“We have an obligation both as public servants and physicians … to take care of those in need,” Wos said. “We must, at the same time, balance that with our obligation towards the taxpayers and our limited resources.”
Dr. Conrad Flick, a family physician in Raleigh, said the governor’s plan would improve the state’s Medicaid system from within.
“In North Carolina, we have a unique system that was built from the ground up that allows the physicians to be part of the solution,” he said.
Flick said, under the Senate budget plan, doctors would have to cut through a thick layer of red tape to get patients’ procedures covered by Medicaid.
“The hassles that come along with doing that are just impediments to getting the best care,” he said.
He said state Medicaid systems managed by an outside insurance entity place too much focus on the business of medical care without incorporating the perspective of providers.
“One thing I really liked about what the governor said is that, when there’s a problem with health care, let’s talk to people who know health care,” Flick said. “I think (the Senate is) looking to the business community to solve the problem.”
Dr. Paul Grundy, global health care transformation director at IBM, said it’s more expensive for states to hire outside entities to manage Medicaid than for states to manage their own systems.
“It costs 11 percent more than states that manage it themselves because somebody’s going to make a profit,” Grundy said, adding that the health care and business communities have been collaborating on their approach to Medicaid reform.