Health care leaders discuss reform impact on N.C.

"It's a major undertaking," said Pam Silberman, president of the North Carolina Institute of Medicine, an independent agency created by the General Assembly to provide balanced information on health issues affecting the state’s residents.

Dr. Donald Berwick, the administrator of the federal Centers for Medicare and Medicaid Services, recently compared the massive Affordable Care and Patient Protection Act to re-engineering a plane while flying it.

Silberman said North Carolina wants to be in the cockpit while the effort is underway.

"We're just at this point exploring what does the bill tell us we need to do (and thinking) about what the different options are," she said. "We've got more to do, but I think we can become a national leader as we move forward."

Although many of the reforms won't take effect until 2014, small pieces have already been implemented, and others will come online in the coming months.

State Secretary of Health and Human Services Lanier Cansler said finding ways to provide health insurance to uninsured people across North Carolina requires some advance planning.

"We'll have well over a million people come into the Medicaid program or go into (insurance) exchanges," Cansler said. "(We need to) figure out how to handle the volume of folks who may want to enroll in the program."

North Carolina could apply for federal grants that encourage new ways to deliver health care, Silberman said.

"Is it reducing health care costs? Is it improving health care quality? Once we know what works, then we can expand it across the country to other places," she said.

Patient advocates said cutting costs is critical to make health care affordable, but they acknowledged that change will take time.

"I think of it like doing a three-point turn with an oil tanker in the ocean," said Adam Searing, director of the North Carolina Health Access Coalition. "You're going to eventually change the system, but it will take a while to get there."

The Institute of Medicine has nine task forces addressing various aspects of health care reform, and Silberman said they will draft recommendations to send to Cansler and Gov. Beverly Perdue.

"This is going to be a major shift in how we do business," Cansler said, adding that the new law presents "opportunities and challenges" for the state.