New joint venture for NC Medicaid managed care

News & Observer (Raleigh, NC)

Jan. 10--The state's professional organization for doctors, a health insurance company, and community health centers are creating a health plan to provide medical care to low-income residents under the state's proposed Medicaid reorganization.

The N.C. Medical Society on Tuesday announced a partnership with Centene Corp. and the N.C. Community Health Center Association The joint venture, Carolina Complete Health, would offer a health care plan to Medicaid patients after the state changes the way it pays providers for patient care.

The state has asked the federal government to move to Medicaid managed care. The state wants to enter into contracts with companies that would offer statewide health insurance plans for Medicaid recipients, as well as contracts with "provider-led entities" -- networks of doctors and hospitals that would offer regional plans.

Carolina Complete Health wants be one of the provider-led entities. Doctors will own and run the health plan, according to the Medical Society. Centene will manage daily and financial operations. The Carolina Complete Health Network would be jointly owned by the Medical Society, doctors, physician assistants, nurse practitioners, and Federally Qualified Health Centers. The network will provide medical management services, oversee medical policies, and hold most of the seats on the board of directors.

The state submitted its application to switch the Medicaid program to managed care last year, and the transition is expected to take several years.

Under the proposal, the state would no longer pay health care providers for each procedure, but would give the statewide and provider-led entities a payment for each patient enrolled. The health-care entities would be responsible for cost overruns.