DURHAM, N.C., Oct. 24, 2022 /PRNewswire/ — New Duke-Margolis suggestions urge the North Carolina Division of Well being and Human Providers (NC DHHS) to pursue essentially the most complete stage of integration of the state’s Medicaid program with Medicare to make sure the 275,000 eligible North Carolinians have entry to the “whole-person care” that can handle the variety of their bodily, behavioral and social care wants. North Carolina is on the cusp of a serious transition of its state Medicaid program from fee-for-service (FFS) to managed care and NC DHHS is remitted to transition eligible NC residents, also called dual-eligible beneficiaries, into Medicaid managed care by 2026. 

The Duke-Margolis report, “North Carolina Medicare-Medicaid Integration: Advancing Entire-Particular person Care,” developed with assist from a grant by Arnold Ventures, gives NC DHHS with pragmatic, evidence-based choices for Medicare-Medicaid integration within the state. The report is accompanied by a sensible information for states focused on growing a tailor-made, evidence-based Medicare-Medicaid integration technique. These suggestions construct on the state’s 2017 report, and handle key coverage design and implementation questions, together with eligibility, construction, plan design, phase-in of populations and providers, and program oversight.

“We’re excited to strengthen our partnership with our educational colleagues within the state to make sure that our strategy is an revolutionary and evidence-based mannequin that makes North Carolina a nationwide chief in offering prime quality, coordinated, and built-in take care of Medicaid and Medicare beneficiaries,” stated Dave Richard, Deputy Secretary for North Carolina Medicaid.

The report lays out a whole-person care imaginative and prescient for the state’s dual-eligible beneficiaries that prioritizes their wants and preferences and people of their households, leading to higher well being, well being fairness, and improved experiences.

“Too usually in well being care we don’t concentrate on what actually issues to folks, particularly essentially the most susceptible. Growing new person-centered approaches to delivering and financing take care of dual-eligible beneficiaries, just like the suggestions provided by the Duke-Margolis crew on this paper, will assist enhance well being and well being take care of this essential group throughout North Carolina,” stated Dr. Mark McClellan, Director of the Duke-Margolis Middle for Well being Coverage.

“Our imaginative and prescient and advisable technique for Medicare and Medicaid integration in North Carolina aligns with the state’s total transformation efforts and creates pathways for revolutionary collaborations within the state that may assist ship whole-person care and higher well being outcomes for dual-eligible beneficiaries,” stated Aparna Higgins, Senior Fellow, Duke-Margolis Middle for Well being Coverage and mission co-lead.

The report describes choices for growing ranges of Medicare-Medicaid integration for the state, and recommends essentially the most built-in strategy, together with key components wanted to assist beneficiary-centered, whole-person care:

• Use of major care and interdisciplinary care groups with fashions of care tailor-made to the distinctive wants of the dual-eligible beneficiary.
• Enhanced beneficiary protections and providers, reminiscent of help with complaints and appeals or making connections to community-based assets.
• Integration of current state efforts by means of Medicaid transformation and the Wholesome Alternatives Pilots with Medicare Benefit supplemental advantages to deal with beneficiary social wants.
• Assist for the sturdy information and infrastructure functionality, state administration capability, and broader workforce assets wanted to efficiently implement and maintain integration.

The suggestions had been knowledgeable by a 21-month, multi-component Duke-Margolis mission encompassing in-depth evaluation of mixed NC Medicaid and Medicare information and intensive enter from NC stakeholders and nationwide consultants in Medicare-Medicaid integration.

“As North Carolina continues care transformation for Medicaid beneficiaries, our report brings into focus the distinctive experiences and challenges confronted by twin eligible beneficiaries and the way integration with Medicare plans has the potential to enhance care and outcomes for these people and their households,” stated Dr. Brystana Kaufman, Duke-Margolis Middle for Well being Coverage Core College Member and mission co-lead.

In regards to the Duke-Margolis Middle for Well being Coverage

The mission of the Robert J. Margolis, MD, Middle for Well being Coverage at Duke College is to enhance well being, well being fairness, and the worth of well being care by means of sensible, revolutionary, and evidence-based coverage options. For extra data, go to healthpolicy.duke.edu and comply with us on Twitter @DukeMargolis.

Media Contacts:

Patricia Inexperienced, Duke-Margolis Middle for Well being Coverage
[email protected]
+1 301 520 6482

SOURCE Duke-Margolis Middle for Well being Coverage