N.C. Considers New Model for Medicaid Value-Based Care Program

The North Carolina Hospital Association and the North Carolina Medical Society, hoping to break the deadlock between proponents of a provider-led state Medicaid system and supporters of straight Medicaid managed care, in May unveiled a plan for “provider-led entities,” or PLEs, that would take capitation in the Medicaid program.

The proposal, which came at the behest of state lawmakers, would create accountable care organization-like groups that would be responsible for meeting the triple aim of reducing per-capita cost, improving the health of populations, and improving the patient experience of care, including quality and cost.

Provider-led entities formed under the plan would need to be both provider-owned and provider-controlled, although “local management entities/managed care organizations” could be members “and will serve as an important partner in achieving integrated patient care and managing quality and costs for special populations,” according to the proposal.

The PLEs “would build on the existing foundation of the patient-centered medical home model and on successes such as primary care and pediatric care case management, coordinated preventive care, non-medical care options that avoid higher cost medical care, increased data sharing, and other initiatives already begun by North Carolina and its Medicaid providers,” the two provider organizations said in a summary of the proposed legislation.