United Providers of Health’s Post

Transcript

Welcome to Chatting with U Oh, I'm your host for the evening, Carolyn Mayo. I'm the managing partner for the United Providers of Health. We're an IPA and independent providers association. We're sustaining small and minority behavior behavioral health providers serving the rule in underserved areas of North Carolina. Today we have two. On our show is missus Pam Perry, who's the vice president. Of governmental affairs for Carolina Complete, that's an insurer who was a part of Medicaid transformation with the state of North Carolina about five to six years ago. So we'd like to welcome Pam Perry to the show and also Carolina Complete to the state of North Carolina. Welcome Pam Thank you Carolyn ready to be with you so good to have you. This is our first insurer to be on our show so we want to go into a lot about how that actually. Happens via Medicaid transformation and also what was what is the primary focus of having a a large insurer to address Medicaid to address the healthcare for Medicaid beneficiaries. What do you think North Carolina was thinking we're going through and and select team making this process for new and private insurances to come to the state. Well, Carolyn it was a long process you've been in the state a while and so you're probably familiar with the. Out of that history, the original legislation that allowed for Medicaid transformation was passed way back in 2015. It seems like a long time ago, but yeah, it was a long process in terms of yes, pre COVID and it largely driven by the states interest and I'll note that. In North Carolina, a lot of the infrastructure for programs, health programs and other types of programs in the state is driven by the General Assembly very active and involved and engaged in setting policy and programs here in North Carolina. And through that process, they looked at the spending in Medicaid and saw some cost overruns in past years. They saw some inefficiencies in ways that the program could be improved, the delivery of. Services and the outcomes for Medicaid beneficiaries in North Carolina, they look to other states that had implemented Medicaid managed care and said, OK, could we do it better from moving from a what at the time was a fee for service program to a capitated program or managed care program that we have today. So the original legislation was passed on a bipartisan basis way back in 2015, way back 20, bipartisan at the time that we ended up having sex. Pieces of legislation to roll in with that because it was a brand new program for the state and some changes need to be made to things like licensure for the very first time, behavioral health and physical health services, we're going to be integrated. So there are some steps that need to be taken legislatively to accommodate those changes. Ultimately, the program was implemented in 2021, so it was a competitive process to bid. Request for proposals was put out in 2019. In the state selected five health plans known as standard plans or prepaid health plans for the state to deliver the care. So we are contracted with the state. Our state customer is the Department of Health and Human Services. We hold a PHP license from the Department of Insurance. And we are contracted to deliver care for Medicaid beneficiaries in the state. I will say that when the program initially rolled out in 2021, it was considered a fairly smooth rollout. And a lot of that had to do with the experience that the state had gained in terms of developing the program, observing other states experience with managed care, how to do it right basically and lessons learned. That's exactly right. And so they had a competitive bid, we were selected. And I'll tell you a little bit about Carolina Complete Health. We are a joint venture model. So we are the only provider LED entity and Medicaid managed care, the legislation that allowed for Medicaid transformation. Allowed for two different types of plans, commercial insurance plans and provider LED entities. And the provider LED entity model was really something that distinguished North Carolina from other States and really rested on some of the successes that North Carolina had seen with recruiting providers to participate in Medicaid and many other states. Because Medicaid is the payer of last resort, you have providers that are unwilling to see Medicaid beneficiaries in many states. However, in North Carolina there was a program called Community Care of North Carolina that really helped to increase provider capacity and Medicaid and was seen as a very successful from that perspective. And so, so one of the hallmarks of the program was to kind of capture some of the provider centric areas that North Carolina led on and want to continue to lead on. And so they allowed for a provider LED entity model. Uh, we came in along with a couple of other provider lead plans in the bidding. We were ultimately selected as the only people that was selected to operate in North Carolina. So we are a joint venture between the North Carolina Medical Society, the North Carolina Community Health Center Association, which represents.