DHHS Vision & Priorities for the Future M3 Conference NC Medical Society September 15, 2017
EXPENDITURE AS % OF GDP Buying Health: Health & Social Services Expenditure by Country 50 45 40 35 30 25 20 15 10 5 0 Health Expenditures Social Service Expenditures Bradley EH. BMJ Qual Saf 2011
Buying Health Other 10% Health Care Spending Behavioral Patterns 40% Drivers of Health Health Care 10% Environmental Exposures 5% Direct Medical Care 90% Genetic Predisposition 30% Social Circumstance 15% Schroeder SA. N Engl J Med 2007 The single greatest opportunity to improve health lies in addressing a person s unmet social needs.
DHHS Priorities Medicaid Transformation Opioid Crisis Early Childhood Health and Education
Medicaid Transformation
Medicaid covers more than 2 million people 45% 30% 15% 6 people with a disability children seniors
Medicaid Proposed Program Design for Managed Care Advances high-value care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs. Improve the health through an innovative, whole-person centered and wellcoordinated system of care, which addresses both medical and non-medical drivers of health.
1 Creating an innovative, integrated, and wellcoordinated system of care Integrate physical health, behavioral health, SUD, and I/DD services DHHS will continue to work with legislators to advance whole-person care Address unmet social needs as part of overall health Standardized screening for social needs Leverage existing investments in addressing these through Medicaid Build upon efforts to map and codify resources to help identify gaps and opportunities Strengthen and support care management Advanced Medical Homes
2 Supporting providers & beneficiaries during transition Support for Clinicians Education and training Regional Support Centers Credentialing Centralized credentialing process with uniform policies and a single electronic application. Contract negotiations will be directly between PHPs and providers, using state-approved contracts with standardized language for select sections - Ensure transparent and fair payments to providers - Ensure provider access/ Network adequacy - Benefit Coverage Requirements
3 Promoting Access to Care Support workforce initiatives Continue existing loan repayment, community grant, and AHEC residency programs. May also create new programs to support provider retention and may seek federal funds to support community-based residency programs. Support telehealth initiatives Increase access to Medicaid Carolina Cares Combat the opioid epidemic
4 Promoting quality and value Statewide quality strategy Singe set of statewide quality measures and metrics to assess performance and drive progress Value-based payment (VBP) Focus care on population health, appropriateness of care, and other measures of value Care management and provider supports Advanced Medical Homes Data collection and sharing capabilities Address health-related social needs and reduce health inequities
How will managed care affect clinicians? 1 2 3 4 5 6 You will receive education & support during the transition to managed care. You can still be a Medicaid provider. There will be a rate floor at 100% of the current Medicaid fee-for-service rate. The same services will still be covered by Medicaid. There will be efforts to minimize administrative burdens on providers. There will still be a focus on care management.
Opioid Epidemic
In 2016, over 1,200 North Carolinians DIED from opioid overdose, an over 20% increase over 2015. In 2016, EMS reversed an opioid overdose using naloxone more than 13,000 times.
With unprecedented availability of cheap heroin and fentanyl MORE PEOPLE ARE DYING. 700 350% increase in deaths since 1999 600 500 Commonly Prescribed Opioid Medications Other Synthetic Narcotics 549 400 300 Heroin Cocaine Heroin deaths increase 800%+ since 2010 364 293 254 200 100 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
The epidemic is devastating our families From 2004-2015, NC has seen 893% increase in hospitalizations associated with drug withdrawal in newborns. In the last 5 years, NC has seen 25% increase in children in foster care (10,500 children).
North Carolina Opioid Action Plan Focus Areas 1. Create a coordinated infrastructure 2. Reduce oversupply of prescription opioids 3. Reduce diversion of prescription drugs and flow of illicit drugs 4. Increase community awareness and prevention 5. Make naloxone widely available and link overdose survivors to care 6. Expand treatment and recovery oriented systems of care 7. Measure our impact and revise strategies based on results
Addressing Opioid Crisis through Medicaid Proactive changes to NC Medicaid & Health Choice programs to promote safe opioid prescribing, non-opioid pain management, access to naloxone. Payer s Council Support providers in judicious prescribing of opioids; Promote safer and more comprehensive alternatives to pain management; Improve access to naloxone, substance use disorder treatment and recovery supports; and Engage and empowering patients in the management of their health.
Early Childhood Health & Education
North Carolina has an infant mortality rate of 7.2 30 Infant Mortality Rates 25 23.7 24.1 20 20.4 15 10 5 5.8 7.2 0 United States North Carolina Hyde County Bertie County Clay County
North Carolina has an infant mortality rate of 7.2 Infant Mortality Rate 30 25 23.7 24.1 20 20.3 20.4 21.8 15 10 5 5.8 6.7 6.9 7.2 0 United States Chile Russia North Carolina Algeria Hyde County Mongolia Bertie County Clay County
Give all North Carolina children a strong start Invest in high-quality child care that helps prepare children for school and life academically, socially, and emotionally Smart Start, NC Pre-K, child care subsidies Expand access to health care for our kids. One in every 11 children in North Carolina (9.4%) is uninsured Improve birth outcomes in North Carolina. Over half of all pregnancies are unintended Invest in prenatal and perinatal care Strengthening families and keeping children in their homes with their parents NC has seen a 25% increase in children in foster care in the last 5 years Social Services System Reform
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