North Carolina medical journal
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North Carolina's upcoming shift to Medicaid managed care will present the opportunity to build on the current quality of services in a system that is focused on whole-person treatment. WellCare of North Carolina, Inc. intends to use innovative approaches that combine aspects of successful programs in other states, tailored to fit North Carolina and improve the quality of care.
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Federal managed care rules require that the services delivered through Medicaid prepaid health plans are available, accessible, and continually being evaluated for improvement. Working with stakeholders, NC Medicaid created a Quality Strategy that serves as a roadmap to measure and oversee performance. NC Medicaid will make a variety of quality reports available including network access, annual quality measures, and provider survey results.
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Medicaid transformation in North Carolina marks the next step in a lengthy history of caring for individuals with behavioral health challenges. "Tailored" health plans will cover people with severe mental illness, substance use disorders, intellectual/developmental disabilities, and traumatic brain injury, a vulnerable population that North Carolina's LME/MCOs are uniquely qualified to serve.
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As North Carolina's Medicaid program transitions from fee-for-service to managed care, the Department of Health and Human Services is committed to building an innovative, whole-person-centered and well-coordinated system of care that addresses both medical and non-medical drivers of health. Delivering on that vision, and improving the health and well-being of North Carolinians, means shifting from thinking of payers as exclusively buying medical services to thinking of them as buying health for their beneficiaries. Operationalizing this complex work will require strong partnership from stakeholders across the state and will also provide North Carolina an opportunity to help drive a national agenda centered around how to buy good health.
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North Carolina's transformation to Medicaid managed care is projected to improve health outcomes for the state's Medicaid population and elevate patient experience by integrating the social determinants of health into the state's care model and aligning state, provider, and health plan goals. This will increase access to timely, localized care services for members.