“While provider-led health plans should be part of North Carolina’s Medicaid solution, relying exclusively on newly created Medicaid health plans offered by doctors and hospitals falls short of the goals of real reform. A hybrid approach that allows provider-led plans and traditional managed care organizations to participate in Medicaid administration will protect taxpayers while improving quality of care for Medicaid recipients.
“Provider-led models are new and may prove to be effective. In most states where Provider-led models have been employed, they are part of a comprehensive strategy that incorporates seasoned Managed Care organizations who have a history of extensive experience across 39 states where they are currently in use. Unlike Provider-led plans, Managed care plans can be implemented in a matter of months resulting in budget predictability and taxpayer savings at a much faster rate than novice entities led by providers. Managed care plans also provide consumer choice and competition among plans and must guarantee that patients have access to doctors and hospitals statewide.
“Reform that includes both managed care and provider-led plans will provide Medicaid beneficiaries with greater choices and will give the state more options to ensure quality of care and budget predictability.”