Welcome back!

Enjoy Monday’s NCMS Morning Rounds.

July 8, 2019

NCMS Weekly Legislative Round-Up

With the Governor’s veto of the legislature’s budget, it’s a bit of a waiting game to see if the legislators can rally enough votes to override the veto in the coming days. Thanks to legislation passed in 2016, the state will continue to operate under last year’s spending plan until a new one is adopted.

While NC House members were essentially out last week for the holiday, NC Senate members were at the legislative building working to push bills through, including several health care related proposals.

SB681—Rural Health Care Stabilization Act Senate leader Phil Berger (R-Rockingham) is pushing this bill, which would establish the Rural Health Care Stabilization Program to provide loans for the support of eligible rural hospitals that are in financial crisis. This proposal has bi-partisan support and passed through the Senate Rules Committee before the July 4 holiday break.

HB 220 – Insurance Technical Changes A provision in this bill, Section 12, prompted our Action Alert to you last week. Section 12 establishes Exclusive Provider Benefit Plans aimed at small businesses. This type of plan creates a narrow network and requires a patient who sees any physician or health care provider outside of that network to bear 100 percent of the cost. This not only limits a patient’s choice, it also shifts cost from the employer to the patient. Rather than simply shifting the health care cost burden, we are advocating for solutions that lower costs for everyone through moving to value-based arrangements.

Thanks to your response to the Action Alert, Section 12 was removed, but legislators are still weighing it as an option. If you haven’t yet sent your representative a message about this, please let them know that Exclusive Provider Benefit Plans are not the answer. Access the Action Alert.

HB 228/SB178 – Modernize Medical Board Laws This bill, which updates provisions in the laws governing the NC Medical Board, is slowly but surely making its way through the various committees and appears likely to make it through into law this session.

In non-legislative news the July 1 deadline for signaling your intent to contract with the State Health Plan has passed. At this point, it’s unknown how many practices and hospitals have indicated they will be part of the State Health Plan network other than those highlighted in press releases issued by State Treasurer Dale Folwell. The treasurer has revamped the payment model for the plan by moving it to reference-based reimbursement. Learn more about the Treasurer’s new model.

In Medicaid transformation news, a judge ruled that the implementation of the state’s new Medicaid managed care program would proceed as scheduled in response to lawsuits asking for a stay of the implementation. The suits were filed by the pre-paid health plans (PHP) that did not receive a contract award from the state to provide services as part of Medicaid managed care program. The roll-out of the new Medicaid program is scheduled to begin this November in the Triangle and Triad areas with the rest of the state ‘going live’ in February 2020. See the regional map and phase-in timeline.

The NC Department of Health and Human Services (NCDHHS) is forging ahead with the implementation and has opened its enrollment call center and website for Medicaid beneficiaries to select a plan. The Department, however, is not sending beneficiaries their enrollment materials until it becomes clear if the legislature will delay the roll out. There is some question because of language introduced in SB212 — NC FAST/Early Child/Transformation/ACH Assess stating that if the state’s budget does not become law by July 15, 2019, NCDHHS “will delay until at least March 1, 2020,” the implementation of the new Medicaid managed care program. And the waiting game continues.

Watch your NCMS Morning Rounds for updates on action at the General Assembly as the Legislative Session draws to a close at least for the moment. Based on the many outstanding issues yet to be resolved around the budget and other matters, it is likely legislators will be back for interim sessions in the coming months.

Hear Your Colleagues’ Stories at LEAD

This year’s NCMS LEAD Health Care Conference will feature a new and innovative session we’re calling ‘Tell Your Story.’ This is a chance for your colleagues to share their success stories about what’s working in health care transformation, health system redesign and innovation in our state.

Two recently confirmed ‘storytellers’ and innovators are:

Diego Garza, MD, MPH, director of telehealth at Carolina Partners in Mental HealthCare in Durham. Dr. Garza plans, implements and monitors the Direct Care program, aimed at increasing access to mental health care services in the state. Direct Care is one of the largest teleconferencing mental health programs in the region, offering online telepsychiatry and teletherapy appointments to more than 400 patients in North Carolina each month.

As Dr. Garza told the Triangle Business Journal when he accepted their ‘Health Care Hero’ award last year: “Telehealth, a relatively new and emerging field in health care, is one of the most effective and low-cost vehicles to increase access to health care for vulnerable populations. People in jails and prisons, children and adults in rural areas, the elderly in retirement communities, communities of color and victims of domestic violence all have increased access to care. Telehealth also allows working people and others who don’t have time to attend a doctor’s appointment to receive medical advice online from their homes or workplaces.”

Ryan Bayley, MD, an Emergency Medicine and Emergency Medical Services physician and adjunct faculty at the Duke University School of Medicine. Dr. Bayley offers physician coaching because he believes that “every physician deserves work that is engaging, challenging and makes a difference in other peoples’ lives – and this should not come at the cost of being able to honor what is important to us outside of work.”

Learn how Dr. Bayley coaches physicians to personal wellness and fulfillment at the LEAD Health Care Conference.

The conference will be held Oct. 3-4 in Raleigh and offers a variety of educational opportunities as well as the chance to connect with your colleagues and to be inspired by their passion and the many health care innovations taking place in North Carolina. Watch your NCMS Morning Rounds for the opening of registration later this month.

In the News

10 Big Medical Myths, Busted, The New York Times/The Advisory Board Forum, 7-3-19

Learning Opportunity

This month’s free Lunch and Learn Webinar, presented by the NCMS Foundation in cooperation with the NC Medical Group Management Association, will be on Tuesday, July 16 from noon to 1 p.m. and will feature Micheline Tocco, head of customer success for NCCare360, speaking on how NCCare360 is transforming care delivery in North Carolina. Learn more and register.