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The role of private managed care in Medicare and Medicaid has been growing at a rapid pace in recent years. The Center for Medicare Advocacy has written widely on the dangers of turning these successful community health care programs over to profit-driven private insurers.  Despite the efforts of the Center and other advocacy groups, however, privatization-creep continues.

Many states – including Illinois, Florida and South Carolina – have recently ended their fee-for-service program for all or most Medicaid enrollees.  For policymakers in search of quick health care savings, capitated managed care has been sold as the only game in town for cost containment and care coordination. For decades, North Carolina has been bucking the trend towards privatization with its own highly effective, innovative managed fee-for-service program… until now.

On April 3, Governor Pat McCroy announced a plan to largely privatize North Carolina’s Medicaid program (known as Community Care). According to Governor McCroy, the current system "does not work and it is not sustainable." He believes managed care will bring budget predictability and accountability for outcomes to the state’s Medicaid program. However, North Carolina’s current Medicaid program is already exceeding expectations and improving care for families and vulnerable populations who rely on the program for their health coverage.

Community Care of North Carolina (CCNC) has improved quality, reduced cost and improved patient experience – all through an innovative fee-for-service delivery and payment system.  CCNC consistently ranks as one of the most cost-effective Medicaid programs in the country. According to an outside evaluation by Milliman, Inc., CCNC saved North Carolina $1.5 billion from 2007 to 2010 and has the lowest Medicaid spending growth in the nation. CCNC ranks in the top 10% of the nation in HEDIS scores (a widely accepted health care quality measures) for diabetes, asthma and heart disease when compared to commercial managed care. It has broad support from providers and community members, and was recently awarded the Annie E. Casey Foundation Award for Innovations in American Government.

Over a million people rely on CCNC and have come to expect high quality, consumer friendly care. These include some of North Carolina’s poorest and medically neediest citizens, including people with disabilities, individuals needing long term services and supports, children and expectant mothers. A move to managed care could disrupt long-standing relationships between patients and their doctors, all in the name of quick savings.

From the beginning of the Wilson County Health plan in 1983 – the pilot program that would become CCNC – the motto has been "quality first." This founding principle, which posits that if you deliver high quality care, cost savings will follow, has been a success by all measures. A capitated managed care model flips this winning formula upside down and instead demands "savings first." There's little to support Governor McCroy's decision to move a successful Medicaid program toward a private managed care model which has been shown  to be less efficient.

North Carolina's move would set a troubling precedent. If a program as acclaimed and successful as CCNC is in danger of being ousted by  private managed care companies, then anything – including Medicare – seems up for grabs.  

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