Episode #63 “Buying Health” for NC Medicaid with Dr. Mandy Cohen

Creating a New Healthcare

This week we’ll be discussing some of the groundbreaking transformations being developed by the North Carolina Department of Health & Human Services (DHHS) under the leadership of Dr. Mandy Cohen.

The North Carolina DHHS is charged with the health and wellness of over 10 million people. This healthcare system, with an annual budget of $20 billion, is one of the largest state healthcare systems in the country. The NC Medicaid program within the DHHS directly serves nearly 2.3 million people - 1 out of every 5 people in North Carolina. It also serves approximately 1.2 million children in North Carolina.

Our guest on this episode is Dr. Mandy Cohen, who was appointed to the role of Secretary of the North Carolina Department of Health & Human Services (DHHS) in January 2017 by Governor Roy Cooper. Before coming to NC, Dr. Cohen served as the Chief Operating Officer and Chief of Staff at the Centers for Medicare & Medicaid Services (CMS). She was responsible for implementing policies for Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) and the Federal Health Insurance Marketplace. In February 2019 she was named one of the Top 25 Women Leaders in Healthcare.

In this interview, we’ll talk with Dr. Cohen about:

• Why North Carolina is shifting its statewide Medicaid program to Managed Care.

• How she is reframing and redefining healthcare within the NC DHHS - from “buying healthcare” to “buying health” services - a progressive shift that is consistent with the direction the healthcare market is heading.

• The highly innovative initiatives being launched in the Medicaid Managed Care program, with a particular focus on the social determinants of health, and some illustrative examples of how this is leading to markedly improved health outcomes and lower costs of health.

• How DHHS is integrating mental health with physical health - and the advantages of that integration.

North Carolina is one of the last of the large states to transition to Medicaid Managed Care. As a result, it’s also one of the most informed states making this transition. Dr. Cohen and her team have intentionally studied the successes of other state healthcare systems as well as the successes of healthcare systems within NC - attempting to build on those lessons.

As you’ll hear in the interview, the overarching plan is to fundamentally shift from “buying healthcare” to “buying health” - that is to purchase services that cost-effectively advance health outcomes - whether those services be clinical care, behavioral care, or social and community care. Another facet of the plan is to deploy outcomes-based payment models instead of the current volume-based, fee-for-service payment.

The systematic approach of the Medicaid Managed Care program will begin with the screening of individuals’ medical care needs as well as factors related to social determinants of health. The approach also includes rigorous testing of the numerous pilots & initiatives in order to determine which innovations work and which do not. It is a healthcare outcomes analyst’s dream, but more importantly, it’s what we need if we’re to advance the health and well being of North Carolina, as well as the country.

The success of this immense and critically important effort will require a multi-stakeholder approach. To that end, the DHHS has been, over the past couple of years, actively engaging the expertise of numerous physicians and administrators from across the state - drawing from the sophisticated world-class hospital systems and academic medical centers that call North Carolina home, as well as the independent providers and community-based organizations serving both urban and rural communities.

I applaud the legislature and political leaders of North Carolina for initiating this innovative transition to Medicaid Managed Care - for supporting it and funding it; as well as CMS for providing the waiver. As Dr. Cohen points out in this interview, health and well-being is not a partisan issue - it’s an issue that is fundamental to the overall health and well-being of our commonwealth and our nation.