North Carolina healthcare might currently rank in the bottom third among all U.S. states, but new moves prove that’s all about to change. In fact, the Tar Heel State has embarked on one of the country’s most ambitious efforts to change the way healthcare is defined, as well as paid for.
So writes The New York Times’ Steve Lohr anyway. And though his beat is primarily technology and economics, there’s good reason to believe what he writes. In the first place, The Times remains a national “newspaper of record,” not to mention winner of more Pulitzer Prizes than any other paper in the country. In the second place, Lohr himself won one of those 127 Pulitzers. And in the third, well, healthcare increasingly goes hand-in-hand with both technology and economics. And it’s crucial we understand that symbiosis and what it means for Americans.
Witness North Carolina:
“North Carolina is in the early stages of turning away from the traditional fee-for-service model,” writes Lohr. So, rather than paying doctors and hospitals for each office visit, test or operation, providers will now be paid based on health outcomes. Doing a good job controlling a diabetes patients’ blood sugar or a heart patients’ cholesterol? Then you get paid. Doing a really good job? Then you’ll get paid even more. Perform poorly however, and money could come out of your pocket.
The goal is to keep people healthy and out of the hospital and to save money on North Carolina healthcare spending. It’s also a great way to hold healthcare providers accountable.
A New Idea?
No, the idea is not entirely new. Some hospital systems have already moved toward outcome-based payments. So have some other states. And all have seen improvements in patient health.
The North Carolina healthcare project ups the ante even further. It’s advocates include the state’s Department of Health and Human Services (which oversees Medicaid payments), as well as Blue Cross Blue Shield of North Carolina (the state’s largest private insurer).
Together, HHS and NC Blue oversee payments for about two-thirds of the state’s insured population. That gives them considerable sway over how North Carolina healthcare is delivered and considerable leeway to go beyond what has been tried elsewhere.
“No state is moving as far as fast as North Carolina,” said Dr. Mark McClellan, a head of Medicare and Medicaid during the George W. Bush administration and a professor of health policy at Duke University.
The North Carolina healthcare effort is led by two former officials in the Obama administration: Dr. Mandy Cohen, the secretary of the state’s health department, and Dr. Patrick Conway, the nonprofit insurer’s chief executive, who also served in the Bush administration. There is no formal coordination between them. But they share similar views on the health care industry, and decided to make the move to the new payment model around the same time.
“I want to buy health with our dollars, not necessarily buy health care,” Dr. Cohen said.
North Carolina is also taking on health-related risks in a person’s daily life — like access to food, housing and transportation. In fact, the Trump administration has approved the state’s plan to spend $650 million of state and federal funds for pilot projects to address these so-called social determinants of health.
A demonstration project in Greensboro is the prefect example of the kind of effort state officials want to replicate and expand.
A hospital group, a housing nonprofit and university researchers identified 41 families with children who made frequent hospital visits for asthma. They visited the homes; identified potential asthma triggers like mold, dusty carpeting and poor ventilation; and made recommendations and repairs. Afterward, asthma-related hospital costs for those children dropped by more than 50 percent.
“The future is trying to do that across the system, not just for a few dozen families,” said Kathy Colville, healthy communities director at Cone Health, the hospital group that participated in the asthma project.
What’s good for treating asthma will also be good for treating addiction and other ailments. And here technology is helping to lead the way. North Carolina has introduced a free online service called NCCARE360 to better connect public health departments and doctors and hospitals. This will significantly expedite the way help gets to people in need.
“It could be a game-changer,” said Stacie Saunders, director of public health at the Alamance County Health Department in Burlington. Much better than “just sending people out of here with a brochure.”
Blue Cross is pushing another tech-centered effort which will share claims information with health care providers, as well as to permit doctors and hospitals to share clinical data. The information collected will be the fuel for data analysis software that flags patients most in need of care or counseling.
Applauding North Carolina Healthcare
We at ALEF wholeheartedly applaud the new and expansive North Carolina healthcare initiatives. We too see the need for both outcome- and evidence-based treatment. And the more robust the efforts to achieve the two will greatly benefit everyone.