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New report highlights early experiences with North Carolina’s transition to Medicaid Managed Care 

Health Management Associates, on behalf of North Carolina for Better Medicaid, conducted qualitative interviews with key stakeholders to assess how the transition is going.

(Raleigh, N.C., February 28, 2022) – Today, North Carolina for Better Medicaid (NCBM) and Health Management Associates (HMA)released a new report on North Carolina’s transition to Medicaid Managed Care (MMC). Policymakers, beneficiaries and the entire health care community have closely watched the transformation since it began on July 1, 2021, bringing North Carolina’s method of managing Medicaid in line with that of 40 other states. 

HMA produced the report after interviewing key health care stakeholders in North Carolina, including advocates and care managers who work with Medicaid beneficiaries and have first-hand experience with the recent transition to Managed Care. The report highlights these stakeholders’ early experiences with Managed Care and identifies key successes and opportunities for going forward. 

“Our early experience with Medicaid Managed Care shows just how positive it can be for beneficiaries and those who serve them,” said Sheree Vodicka, member of NCBM and chief executive officer for the North Carolina Alliance of YMCAs. “While we are less than a year into the transition, MMC’s emphasis on whole-person care is already providing us with opportunities to address the social determinants of health that so often go overlooked in the health care system,” she added. 

The report’s key findings include:

  • MMC addresses the social determinants of health – MMC helps beneficiaries by addressing the social determinants of health, such as access to nutritious food, safe housing and reliable transportation. For example, if a beneficiary cannot pick up a prescription because they cannot drive, a care manager can connect them with local organizations that provide transportation. 
  • More accountability for health care providers and plans – There are performance incentives for plans to meet certain standards and key metrics, such as timely access, wait times and the maintenance of an accurate provider directory.
  • Greater coordination – Care managers frequently work with clinical staff to help members navigate the health care system, schedule appointments and understand their medications. 
  • Local expertise and networks help build trust – Multiple care managers said their local expertise and familiarity with the community helped them get both beneficiaries and providers to trust the health plan. It also enables the care managers to more quickly and efficiently connect members with churches or community groups that provide clothing, healthy meals or financial assistance. 
  • Flexibility and choice – When compared to fee-for-service, MMC allows beneficiaries a greater range of choices and the ability to review and compare the benefits of prepaid health plans. Some beneficiaries find this empowering and see plan competition as likely to improve quality and service. 

“This report reflects important feedback on Medicaid Managed Care in North Carolina from key stakeholders who have direct experience with the transition,” said HMA Regional Vice President Kathleen Nolan. “These early experiences can help inform opportunities for the program as implementation continues.”

This report contributes to the growing body of evidence suggesting that MMC’s flexibilities offer strong opportunities for community-based care through a whole-person approach that doesn’t just save the health system money but can also make a meaningful difference in beneficiaries’ daily lives.  

To read the full report, visit the North Carolina for Better Medicaid website here

 

About North Carolina for Better Medicaid

North Carolina for Better Medicaid is a multi-stakeholder, consensus-based group of organizations committed to building a better Medicaid system that improves access, quality, outcomes and affordability in North Carolina.Our members include patient advocates, community-based organizations, health care leaders, health plans and others who are champions of Medicaid and Medicaid Managed Care. Current members include credible and diverse voices in healthcare including Mt. Zion Baptist Church, Mountain Projects Community Action Agency, I-CARE, Inc., the Economic Improvement Council, North Carolina Community Action Association, the North Carolina Black Alliance, the North Carolina Senior Living Association, the YMCA of the Triangle, NC Child, Blue Cross and Blue Shield of North Carolina (Healthy Blue), and UnitedHealth Group, who are working to ensure a successful transition to Managed Care and improve health care in the state. Learn more at northcarolinaforbettermedicaid.org

 

About Health Management Associates

The HMA team is over 225 colleagues strong and growing, with experience that spans the healthcare industry and stretches across the nation. Dedicated to serving vulnerable populations, HMA successfully tackles a wide variety of healthcare issues, working directly with federal, state, and local government agencies, health systems, providers, health plans, foundations, associations and others to effect change. Our colleagues have held senior level positions in medical and behavioral health provider systems, public health agencies, community-based organizations, state and federal agencies, managed care and accountable care organizations. We offer a breadth and depth of experience we believe is valuable to our clients in helping them achieve their goals and effect change. Founded in 1985, HMA is a private, for-profit “C” corporation, incorporated in the State of Michigan in good standing and legally doing business as Health Management Associates, Inc.

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