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Spotlight on the NC Collaborative on Medicaid Transformation

September 23, 2020
By: Care Share Health Alliance

Care Share Health Alliance collaborates for health equity with a focus on coordinating health care resources to serve low-income and uninsured North Carolinians. Their initiative, the NC Collaborative on Medicaid Transformation, is part of their ongoing commitment to convene and educate stakeholders, and elevate the consumer's voice to ensure systems work for everyone. While the work as initially planned was paused due to the suspension of Medicaid Managed Care and the delay of Healthy Opportunities pilots, Care Share continues to utilize this network to support one another throughout COVID-19.

1. Can you tell us more about your organization?

Care Share Health Alliance’s (Care Share) mission is collaborating for health equity, and we envision communities that are healthy and committed to health equity for all. We believe that everyone should have a fair and just opportunity for health. We recognize that income inequality and racism are two of the biggest factors contributing to health inequity, so we prioritize our efforts on improving the health of low-wealth individuals and communities, particularly people of color and women. We do this by convening and collaborating for greater access to health care, community, and social resources (Collaborative Networks); connecting people to insurance coverage programs (NC Get Covered); and supporting systems change (Community Food Strategies and Community-Centered Health). Care Share has acted as a conduit between state and community-level partners to bring greater voice to people and communities experiencing health inequities since our inception in 2008.

2. Your team has been working to develop a Medicaid Collaborative in the state. Can you tell us more about it?

Our friends at the North Carolina Department of Health and Human Services (NCDHHS), under the thoughtful leadership of Secretary Mandy Cohen and Governor Roy Cooper, have laid out a clear vision for North Carolina’s pending move to Medicaid Managed Care. The vision is to “[improve] the health and well-being of North Carolinians through an innovative, whole-person centered and well-coordinated system of care that addresses both medical and non-medical drivers of health.” In other words, North Carolina is moving away from a fee-for-service model where providers are rewarded for the number of health care services delivered to a system that incentivizes health care innovation, improved quality of care, and better health outcomes.

The move to managed care will also give Medicaid members greater choice in the care they receive by enabling them to choose from five prepaid health plans or insurance companies. A select number of communities across the state will even address social determinants of health through Healthy Opportunities Pilots, made allowable by the 1115 waiver approved by the Centers for Medicare and Medicaid Services in 2018. Through these pilots, non-medical interventions related to housing, food, transportation and interpersonal safety will be tested, evaluated, and hopefully replicated statewide and across the country if found to be effective.

Care Share fully supports NCDHHS’ vision and their commitment to replacing the status quo with strategies that are patient-centered and focused on treating the whole person – mentally, physically and emotionally. Still, we understand there may be unintended consequences for Medicaid members during this transition. They may have difficulty understanding all of the changes and will need to adjust to a new way of enrolling in and receiving services. As a result, Care Share was awarded funding from the Blue Cross and Blue Shield of North Carolina Foundation and Kate B. Reynolds Charitable Trust to convene and educate interested stakeholders around Medicaid Managed Care and to elevate the consumer’s voice to ensure the system works for everyone. We will collaborate with community-based organizations, advocacy groups, NCDHHS’ Ombudsman program, the Prepaid Health Plans’ member advisory councils and more to create a bidirectional flow of information related to beneficiary experiences. By bringing different consumer-engaged organizations together with NCDHHS representatives, we hope to strengthen communication channels across the state; rapidly respond to any issues identified by beneficiaries; increase consumer satisfaction by advocating for enhanced policies, procedures and services; and ultimately improve health outcomes. The name of this new initiative is the NC Collaborative on Medicaid Transformation or NC COMeT for short.

The COVID-19 pandemic has underscored the importance of moving toward NCDHHS’ vision for Medicaid Transformation, particularly as it relates to addressing non-medical drivers of health through the Healthy Opportunities Pilots.

Care Share Health Alliance
3. What has community engagement looked like in the development process? How did COVID-19 impact your work?

It goes without saying that the suspension of Medicaid Managed Care, which was announced back in November of 2019, had a significant impact on our work. However, we could have never imagined that COVID-19 would soon become an even greater hurdle for Care Share and our partners (and much of the world) to contend with.

We were responsive to the needs of our partners and quickly realized that many of them wanted to stay informed and connected to one another, particularly during the statewide stay-at-home order. As a result, instead of focusing solely on Medicaid transformation, Care Share shifted to hosting virtual conversations on how COVID-19 was impacting local communities, partners’ organizational challenges, and how they were working to overcome some of those challenges. We continue to host bi-weekly meetings with donated care networks across the country as well as monthly calls with our Affordable Care Act and Medicaid Transformation partners.

In addition to highlighting the need for partner engagement across the state and country, the COVID-19 pandemic has underscored the importance of moving toward NCDHHS’ vision for Medicaid Transformation, particularly as it relates to addressing non-medical drivers of health through the Healthy Opportunities Pilots. Growing unemployment due to COVID-19 has resulted in higher rates of food insecurity and more people are now struggling to maintain stable housing. Many of our partners are working diligently to address these issues. NC COMeT will spotlight COVID-related success stories or best practices at the local level, with the understanding that these lessons could help to inform how we engage community members around transformation in the not-so-distant future.

4. How has your work increased collaboration between health care and community partners?

We are working to increase collaboration between health care and community partners by bringing them together on a regular basis to discuss issues related to Medicaid Transformation and COVID-19. As an example, we recently hosted a statewide call with NCDHHS staff regarding the status of Medicaid Managed Care and will soon learn more about the Medicaid Funding Act that was signed into law by Governor Roy Cooper. Also, we are examining those parts of Medicaid Managed Care that were not affected by suspension (e.g., NCCARE360’s closed-loop referral platform and the Community Health Worker Initiative), while using lessons learned from local COVID-19 relief efforts to create a framework for Medicaid beneficiary engagement in the future.

As partners continue to engage with NC COMeT on a monthly basis, we expect they will become more familiar with all of the key stakeholders in Medicaid Transformation and what their respective roles are, which will promote peer-to-peer communication and collaboration outside of NC COMeT meetings. We want to create a sense of camaraderie and shared leadership across the state during suspension so that, once Medicaid Managed Care is implemented in July of next year, we can shift our focus to learning how the system is impacting members and what policy changes, if any, need to be made to improve access to care and the quality of services rendered.

When we prioritize the health of communities, it makes us better overall – both individually and collectively.

Care Share Health Alliance
5. What has been most surprising for you all to learn?

We have been pleasantly surprised by the number of organizations expressing an interest in this effort during the suspension of Medicaid Managed Care and in the midst of a global pandemic. More than 100 organizations are already involved in NC COMeT and the list is steadily growing. We believe this is because partners find great value in having a place to come together for accurate, up-to-date information while connecting with others who have a vested interest in Medicaid Transformation across the state. COVID-19 has shined a light on health disparities that exist by race and ethnicity, making the collective will to transform systems of care in the pursuance of health equity stronger than ever before.

6. Tell us more about your vision for the future of North Carolina.

Much like the vision for Medicaid Managed Care set forth by the NC Department of Health and Human Services, Care Share longs for – and is diligently working toward – the day when every North Carolinian has access to quality, affordable, whole-person health care that is culturally and linguistically appropriate – regardless of one’s race/ethnicity, age, geographic location, or ability to pay.

When we prioritize the health of communities, it makes us better overall – both individually and collectively. Young people can concentrate on their studies and earn better grades in school. Parents can provide for their families instead of having to weigh rising health care costs against the most basic of human needs. Businesses can be more innovative and productive. Community leaders can shift their attention toward other salient issues, such as the economy, racial equality, civic engagement, and protecting the environment. Moreover, when communities are healthy and vibrant, it frees up limited resources to prepare for and respond to unforeseen public health emergencies, such as the one we are currently grappling with now. Health is indeed wealth…and so much more.

7. What are ways people or organizations can get involved or support?

If you wish to learn more about the NC Collaborative on Medicaid Transformation (NC COMeT) and/or join this statewide effort, please visit us online at www.caresharehealth.org/medtransform and request to be added to our listserv. You may also contact Care Share’s Executive Director, Linda Kinney, directly at lkinney@caresharehealth.org. Thank you in advance for your support! We look forward to working with you to create a healthier, more equitable North Carolina!

 

For more information about Care Share Health Alliance, please visit caresharehealth.org.