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NC DHHS Delays Tailored Plans Implementation
PRACTICE MANAGEMENT
MEDICAID
NC DHHS Delays Launch of Tailored Plans
In late September, NC Medicaid announced the decision to delay implementation of Tailored Plans until April 1, 2023, in order to ensure beneficiaries can seamlessly receive care on day one. Tailored Plans, originally scheduled to launch Dec. 1, 2022, will provide the same services as Standard Plans in Medicaid Managed Care, and will also provide additional specialized services for individuals with significant behavioral health conditions, intellectual/developmental disabilities and traumatic brain injury.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations, which will operate the Tailored Plans, more time to contract with additional practices to support member choice and to validate that data systems are working appropriately. The decision is supported by the leadership of the state’s six LME/MCOs.
While the start of Tailored Plans will be delayed, specific new services will still go live Dec. 1, 2022. NCDHHS and LME/MCOs will support providers of Tailored Care Management to launch their services on Dec. 1. Through Tailored Care Management, eligible beneficiaries will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the beneficiary’s whole-person health needs.
Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health services and I/ DD and TBI supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today.
More information regarding the beneficiary choice period and other key dates leading up to the April 1, 2023, launch will be shared by NCDHHS.
BREAST CANCER
October Awareness
By Lib Campbell
October is National Breast Cancer Awareness Month. Katie Couric made the decision to lead a charge for awareness in revealing her journey with breast cancer that began last summer. Her story takes you through diagnosis, treatment and all the things that happen with a breast cancer diagnosis. If you remember, her husband died with cancer. She obviously felt it important to elevate awareness and concern for any of us who are at risk. I think it is important too, for I have also lived that journey over the last year.
On December 23 of 2021, I was on the phone with a young colleague. I had just had a routine mammogram. I expected a letter saying that I was good to go until next year. But I saw the film in the room. I saw the array of calcifications, and I knew something was different.
Like Katie Couric, I have dense breast tissue. My science self makes me wonder if this is because I did not breast feed my babies. My OBGYN for years used to call me “Lumpy Libby,” and he was right. I have been pretty diligent in getting yearly mammograms for that reason. There were two surgical biopsies for suspicious calcifications in the late 1990s. I think I always thought the other shoe would drop. It finally did.
They told me not to open the report that came on MyChart, but I couldn’t resist. Invasive Ductile Carcinoma. I told my friend on the phone, “That sounds like cancer to me.” Why, yes it does. So shortly before Christmas, my journey into the world of cancer began. More testing. Planting radioactive seeds. Surgery in February. Radiation until May 5, 2022. Cinco de Mayo in the treatment room with glitter, leis and intermittent music was a celebration to remember.
The experience of cancer and all that surrounds it is a roller coaster of emotion to begin with. Then the routine of driving to the UNC Rex Cancer Center became pretty normal. I liked the people there. The guys doing valet service, the women on the front desk. Sandy in the radiation treatment lobby always had flowers and a big smile. Martha, Tim and the others in the treatment room were friendly and competent. I always felt at ease.
It’s funny how many people coming and going in the center were either former neighbors or former co-workers. There is a real sisterhood among the patients who share the same routines of treatment. I found blessing in it all.
person visit, and 81 percent used it when offered.
The North Carolina Provider Experience Survey was developed and administered across all North Carolina primary care practices or their corporate parent to evaluate the influence of the North Carolina Medicaid Transformation on primary care and obstetrics/ gynecology (Ob/Gyn) practices that contract with NC Medicaid. This assessment also explored the experience of providers in early contracting with prepaid health plans (PHPs), as it overlapped with the launch of Standard Managed Care Plans on July 1, 2021. The baseline assessment will serve as a comparison against PHP performance in future years. The full report and a twopage summary are available. Some key findings include:
• Systems and practices were generally satisfied with North Carolina’s pre-existing Medicaid program (prior to managed care). Respondents conveyed excellent/ good satisfaction with provider relations and the logistics of claims. Items with the lowest satisfaction prior to managed care go live were access to behavioral health and the process for managing grievances and appeals.
• When considering contracting with one of the managed care plans, respondents resoundingly prioritized claims and reimbursement, as well as access to specialists and behavioral health for patients.
• In rating satisfaction with the managed care plans prior to go-live with the transition, most respondents rated their interactions as good to excellent, but the survey was administered prior to implementation of managed care.
• When asked about the anticipation for the transition to managed care, most practices felt largely ambivalent to hopeful.
Both of my oncologists are women, helpful, always compassionate, and they are smart! Having excellent medical teams right across town is a blessing. Across North Carolina, there are good medical facilities offering cancer care. Breast cancer research is yielding more targeted, less invasive treatment options. Great strides are being made to prolong life and lessen side effects and unintended consequences of various treatments.
Shortly after my diagnosis, we were at Reynolds Coliseum for a women’s basketball game. It was Kay Yow Night. Survivors walked onto the court at halftime. Oneyear survivors. Two-year survivors on up to ten years and beyond survivors. They were raising awareness and money for the Kay Yow Cancer Research Foundation. I leaned over to my friend and told her that I had survived for one week. I am still surviving, thriving. I will likely always be a little nervous at mammogram time. But I will not miss a mammogram. I encourage you not to miss one either.
In North Carolina there are 6,000 women diagnosed with breast cancer every year. An average of 1,000 women will die every year from breast cancer. One in eight women has a risk for breast cancer. Some men have that risk too. Be aware. breast cancer. I wanted to hold it close and deal with it without gnashing of teeth and rehashing of story. Having lived this experience, my compassion for all who deal with cancer has increased. I know what it’s like now.
I give thanks for good insurance, the availability of good medical facilities, the blessing of competent and welltrained doctors and technicians. I also give great thanks for my friends who have gone through this. Their tips, like Jean’s Cream, their encouragement and advice were precious. And for those who don’t have insurance, county health services can help locate places for anybody to get a mammogram. I stand with Katie Couric, and all the many who have walked this path, in encouraging you to get a mammogram yearly. Early detection improves outcomes. Until this disease is eradicated, we all have a part to do in our own health watch.
If you are going through this now, you have my email. I will walk with you.
Lib Campbell is a retired Methodist Pastor, retreat leader and columnist who blogs at www.avirtualchurch. com. You may contact her at libcam05@gmail.com
And I would be remiss if I didn’t mention our involvement in an effort to move the Collaborative Care Model of integrating behavioral health into primary care forward in North Carolina. In late September, partners in the project (from the NC AHEC Program to CCNC to the Pediatric Society to the NCAFP) came together in Asheville just before the NC Psychiatric Association Annual Meeting to celebrate our process so far and continue to make plans to move the model forward. Look for more information on this effort in the sidebar on page 7. The bottom line: NCAFP is undertaking a breadth of activities to help our members today and in the future. Many solutions don’t come easy, but we continue to take one step at a time to address the issues most impacting your day-to-day practice, following our strategic plan to improve the Practice Environment, Advocate on your Behalf and increase the Workforce of tomorrow.
'NCAFP Goes to Washington,' continued from p12
Postpartum care: The COD adopted a reaffirmation of AAFP’s existing policy advocating for dedicated support of postpartum care in the Family Medicine setting noting the crucial role family physicians play in caring for parents and families, especially in the first year after birth.
Practice Enhancement
Prior Authorizations: The Reference Committee combined two resolutions seeking to rein in the administrative problems and reverse delays in patient care associated with prior authorizations and recommended the adoption of a measure that called for the AAFP to “advocate for the reduction of prior authorization requirements of health insurance companies through the creation of and adoption of standardized prior authorization criteria.”
Stakeholder Metrics: Delegates adopted a measure that called for the Academy to collaborate with stakeholders to develop metrics that measure the physician’s experience with the health insurance company, similar to how CMS measures the patient experience with physicians and to report their performance on those metrics annually. Impact of Retail Medicine: The COD referred a resolution to the AAFP Board of Directors seeking a way to evaluate the impact of retail medicine’s incursion into primary care.
After attending my first in-person meeting of the Congress of Delegates, I left with an enhanced appreciation of the many unique issues that affect our physician members and the specialty practice of Family Medicine, a better understanding of AAFP policy making process, and immense pride in our state Chapter and how well we are regarded and represented at a national level.
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