North Carolina a Leader in "Health Care Transformation"

A couple of months ago, I had posted here about the fact that the leader of the state Medicaid agency and the CEO of Blue Cross Blue Shield of North Carolina are both graduates of the Obama Administration. They lead organizations that altogether control the health care coverage of nearly 6 million North Carolina residents. I asked, tongue in cheek, what could possibly go wrong.

This week, a blog article at the Health Affairs website lustily proclaims that North Carolina is now a leader in "health care transformation":

Thanks to a convergence of public and private-sector health care leadership..., North Carolina is now on the verge of something different: a set of reforms that would create an unprecedented, accelerated shift in how health care is paid for in the state, and the way social risk factors are incorporated in health care payment and delivery systems. Over the next five years, the state is poised to make an estimated 70 percent or more of health care payments through alternative payment models. No other state is on track to reform payments so much and so fast with the goal of improving population health and care delivery while lowering health care spending.

The Hi-Tech Act and Obamacare, both passed and signed into law during the early years of the Obama Administration, set the tone for these changes. But Republicans in Congress and in the North Carolina General Assembly jumped eagerly aboard, passing measures that adopt many of the same techniques those two initial pieces of legislation encouraged.

The basic approach? Coerce physicians and health care facilities to adopt the use of electronic health records, and force them to make them available in cyberspace. Create proxy organizations that dictate how medical care will be delivered, or encourage insurers to do so. Structure things so that these proxy organizations or insurers will be at considerable financial risk if too much money is spent. And penalize health care providers if they violate the algorithms that dictate how care must be delivered.

Medicaid reform in North Carolina adopts this approach. But Blue Cross Blue Shield of North Carolina is now also encouraging it heavily; and is quickly trying to move all its insured members toward this model. Other insurers are jumping aboard to varying degrees. 

And health care consumers will have no clue it is happening. All the decisions are made behind the scenes; and patients will often have little basis for understanding what care is being withheld from them.

This is an inherently progressive approach; and has been granted the imprimatur of both major parties.

In fact, both parties benefit from this new approach. Republicans and democratic socialists alike receive ample campaign contributions from insurers, managed care companies, big data companies and health care systems. By adopting this approach, they also are able to avoid making the difficult political decisions associated with truly containing health care costs. That would require disentangling and deactivating 75 years of governmental intervention in the health care marketplace that created the problems with health care costs in the first place.

All of these types of businesses-- insurers, managed care companies, health care systems, big data companies-- potentially benefit from these changes being implemented.

Here in our state, the leadership of the North Carolina Medical Society quickly jumped aboard, much like lapdogs. Progressives captured the organization; and the society has received funding from the types of businesses listed above. The state medical society therefore felt no need to protect patients or physicians from these changes.

In any case, patients in North Carolina will be experiencing fairly dramatic changes in the near future. It remains to be seen to what extent it will be obvious that care is being withheld from them.

Comments

[Fred Gregory]

To the NCMS I would say, Medice, cura te ipsum

[Triad Conservative]

Precisely, Fred. Lawmakers look to the NCMS to provide the collective voice of the medical community. And the group chose not to advocate for physicians and patients when all of this mess was developing. In fact, it chose to advocate in the other direction. The organization is terribly conflicted with progressives and statists and socialists within its ranks; and having received lots of money from the corporate interests that think they benefit from this mess.