Cape Fear Valley, 10 others to start Medicaid insurance company

Feb. 23--Cape Fear Valley trustees voted Wednesday to spend $11.2 million to start a Medicaid insurance company with 10 other health systems.

The 11 largest health care systems in North Carolina are forming the company to compete for service under the state's Medicaid reform efforts. Bart Fiser, Cape Fear Valley's vice president of revenue cycle and managed care, said the Medicaid managed care organization could start by July 2019.

State lawmakers want to change the Medicaid system to programs that can "provide budget predictability," according to hospital documents.

Each health care system is providing money to use as "risk based capital" as the company is getting going and for other startup funds, Fiser said.

The health care systems plan to spend 90 percent of revenues to provide care, Fiser said. Some national health maintenance organizations might choose to only use 85 percent of their funds for care, he said.

"We're trying to do it as a North Carolina provider system versus national, for-profit HMOs," he said.

The health systems hope to save money and improve patients' experiences. They will submit a proposal to provide Medicaid care statewide, providing service into six regions.

Fiser said the systems will be able to provide care in urban and rural areas.

Presbyterian Health, a New Mexico company, will operate the Medicaid insurance company for the 11 healthcare systems and own 25 percent of it. Cape Fear Valley trustees voted to let CEO Mike Nagowski sign the needed documents for the system to be part of the company.

Cape Fear Valley trustees also heard a report about improvements to the hospital's cancer center.

Eight new chairs in Cape Fear Valley's infusion care area will let the hospital provide chemotherapy treatments to 20 more patients daily, Nagowski said. Renovations to Cape Fear Valley's Lung Nodule Clinic will give doctors the opportunity to diagnose the early stages of lung cancer, he said.

"We're really excited about the growth and expansion right here on the medical campus," he said.

Cape Fear Valley trustees also met in closed session for 24 minutes to talk about a legal issue and to discuss competitive health care information. No action was taken after the session.

Staff writer Steve DeVane can be reached at [email protected] or 486-3572.

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