Provider Perspectives on NC Medicaid Transformation: An interview with Dr. Anna Miller-Fitzwater

North Carolina’s Medicaid delivery system will transition to managed care July 1, 2021 offering a different experience for providers and beneficiaries as Prepaid Health Plans (PHPs) replace the historically single-payer design. Though helpful resources are available, the preparation for this shift involves many questions- what changes can patients expect? What are Medicaid providers most concerned about? What are clinics doing to prepare? In the video below, these questions and more are explored between Emtiro Health’s Heather Rothrock and Dr. Anna Miller-Fitzwater. See the transcription of the interview below, following the video.

Interview Transcription

Rothrock: As a part of our Patient Facer Series, today we gain perspective from a provider on the Medicaid Transformation coming to North Carolina this July. I’m Heather Rothrock, part of the Provider Services and Data Analytics teams at Emtiro Health. Joining me today is Dr. Anna Miller-Fitzwater, Emtiro Health’s Chief Medical Officer and a practicing Pediatrician in the Winston-Salem community in a high volume Medicaid practice. Thank you, Dr. Miller-Fitzwater for joining me today.

Miller-Fitzwater: Thanks for having me.

Rothrock: To get us started, in your own words, give us your definition of Medicaid Transformation.

Miller-Fitzwater: Medicaid Transformation is a change in the way that the state of North Carolina is going to provide medical insurance through the program Medicaid to approximately 2.3 million North Carolinians that it insures. At go live date on July 1 of this year, approximately 1.6 million residents of North Carolina that are insured by Medicaid will see a change in the way that their Medicaid is delivered to them. Instead of coming direct from the state, it will now go through one of five different private companies. Each will offer a basic set of services, however, they each will do things a little bit differently and have some really unique additions as well.

Rothrock: So certainly a big change in the program across the state. From your perspective and what you know of your colleagues’ perspectives, what are some of the most positive aspects of this transition?

Miller-Fitzwater: I think some of the most positive aspects is in those offerings that each plan is able to provide. We’ll be able to offer unique add-ons, such as the ability to help pay for an exam for the GED or the ability to help provide for necessary baby supplies through sort of add-on programs. These will really help with what we call the social drivers of health, or those things outside in the environment that affect the way that patients can receive help or can take their medicines and things like that. I also think it’s going to be real exciting because there’s going to be a new found interest on value, so we’re going to really be tracking metrics to make sure that we are delivering the quality of health that we should be delivering and that we’re delivering it in an equitable fashion across the state with a special emphasis on making sure that we are closing disparity gaps.

Rothrock: So certainly positive to think about the add-on services for the patients and then a new emphasis on value as go live begins and in the future. But on the flip side what do you consider some of the more anxiety-producing components of this transition?

Miller-Fitzwater: Sure. Well this is a giant project as you may imagine and anytime we go at a project this size there’s gonna be bumps along the way. I will say that North Carolina Department of Health and Human Services has been very good at getting provider input and sharing data and getting patient input. They’re having chats, Fireside Chats, every week and trying to make sure that they’ve heard all of the concerns to address all of these issues before they arise but I do expect it is going to be a little bit rocky. So I think the biggest thing that providers are worried about is will my patients still have the access to the care they need, will they be able to get their medicines. What happens when they go in and out of different Medicaid plans, what happens when they go in and out of the hospital? I think that’s one thing and the main thing that most providers are worried about. Another thing is sort of billing, will our claims be able to be submitted in a similar way across all the plans? Will we get reimbursed? We have to keep our shingles on our roof as they say. So that’s something else I think a lot of providers are worried about.

Rothrock: Certainly. So all good things to consider and be aware of as we move closer. For patients, of course them being at the center of this transition, what do you expect will be some of the more noticeable differences for them?

Miller-Fitzwater: I think probably on a basic level, the most notable differences, you have to choose a plan now; before there was only one and you got enrolled into it. Now patients have the ability to choose which plan fits them the best. It will be a little bit complicated because you also have to make sure your doctor accepts the plan- not all providers will accept all four or five plans. So, I think the biggest difference is just going to be enrollment and making sure that they’re getting enrolled into a plan that serves their needs. I do think another noticeable difference will be those add-ons that people have never been eligible for in the past such as, again, testing for GED, participation in Weight Watchers, reimbursement for breast pumps. So I think they’ll be a lot of really positive differences as well.

Rothrock: Great. So, as we’ve mentioned with go live approaching in less than a hundred days, July 1st, what would you say clinics are doing in preparation for this?

Miller-Fitzwater: On a basic level, they’re contracting with health plans, so that’s a lot of work. They’re preparing to learn how to file with four or five different plans as well as Medicaid Direct. The other thing I think clinics are doing is making sure that their information is correct in the database lookup so that their patients will actually know how to choose a plan based on which plans their providers are taking. And then there are many practices that are testing their data loops, they’re getting their care management systems in place. So they’re doing a lot right now.

Rothrock: So clinics are certainly doing their part to get their contracts in place and prepare their patients and things like that. Any advice you would offer other providers as we approach go live?

Miller-Fitzwater: I think the biggest thing right now is to understand what plans are offered in your area, understand what plans you’re contracted with and the differences between them so that you can help your patients sign up for the correct plans. The Department of Health and Human Services has a really great website where you can compare the plans side-by-side. There’s a phone number that patients can call to get help with enrollment, there are handouts you can give patients to let them know about the different plans and then you can send something out if you have electronic medical records just letting the patients know these are the plans we are contracted with, if you want to take that into consideration when you choose a plan. I think also providers may want to think about the fact that as this rolls out, patients may have extra questions or need extra help making sure they get the services they need at the go live. So making sure that your nurse triage systems and your clinic is open and available to help navigate your medications and getting appointments, and things like that as we do actually go live in July.

Rothrock: Great, so yeah. So Emtiro Health is also making an effort to keep providers informed through our social media platforms, specifically Twitter and LinkedIn, about Need to Knows, things to do in preparation, and things to be aware of from the patient’s perspective in our most recent series. So certainly providers can continue to follow Emtiro Health and let us know, reach out if there are questions or concerns or things we might be able to assist with as this transition approaches and then once we are live. So good, great information. Thank you for talking with me today and continue to follow us on social media.

Miller-Fitzwater: Thanks.