NC House Considers Giving Doctors And Hospitals More Responsibility Over Medicaid
Leaders on health policy in the North Carolina House are pushing their version of a bill to overhaul the state's most expensive health care program: Medicaid. The lawmakers rolled out the bill in committee Wednesday.
House leaders want to overhaul Medicaid by putting groups of doctors and hospitals in charge of managing the program. The state would give them a set amount of money based on who they treat, and the doctors would face financial penalties or rewards based on how they do.
Republican Representative Nelson Dollar is one of the bill's sponsors.
"This plan will provide greater budget certainty and long term cost savings, which is one of the goals that we've had for some time," he said in committee. "Very important, this plan will improve long-term health outcomes for our citizens. That's really where you control cost."
The idea is that better care can also be cheaper care.
To understand how, think about the emergency room. Representative Donny Lambeth says too many poor North Carolinians are showing up in the ED, or emergency department, even though they don't have emergencies.
"The goal is simply moving them out of the ED, which is a very expensive care site, into the primary care office," he said. "Many of these patients don't have a primary care doctor."
The overhaul would make sure a provider is coordinating their care.
Associations representing doctors and hospitals in the state support the plan. Chip Baggett of the North Carolina Medical Society addressed the committee.
"We think this bill represents the essential framework for where we need to go," he said. "This is good, and we need to get started."
It also has its critics. Representative Marilyn Avila, also a Republican, questions whether lawmakers should determine how the groups of doctors and hospitals are set up.
"We are prescribing, and our pharmacy degree in the General Assembly is lacking sometimes in the success of our prescriptions," she said.
In the past, leaders in the state Senate have also been critical of this approach. Last year, they said putting insurance companies in charge would result in better cost savings.
Proponents of the House bill acknowledge it faces "a long road" to becoming law.