After a long and competitive Request for Proposal (RFP) process, on Monday, February 4, 2019 the North Carolina Department of Health and Human Services (NCDHHS) announced awards to four statewide and one regional Prepaid Health Plans (PHP) that will administer the NC Medicaid and Health Choice programs.
Read MoreWhile it may sound obvious, much of medical care involves medication. In fact, medication accounts for 80% of the way in which practitioners prevent and treat disease. While medications can sometimes cause adverse reactions, the benefit of medication in improving health outcomes is overwhelming.
Read MoreThe term ‘Medical Home’ maintains rank among buzzwords in today’s health care industry, specifically as the term relates to seeking formal, national recognition from major accrediting bodies like the National Committee for Quality Assurance (NCQA), The Joint Commission (TJC), or the Utilization Review Accreditation Committee (URAC). However, the term itself dates back to a concept first-introduced by the American Academy of Pediatrics (AAP) in 1967.
Read MoreWe know that only a very small percent (10-20%) of our health is a by-product of what occurs when we visit our family physician or go to the hospital. We also know that chronic diseases consume a huge amount(1) of our health care budget. Why are these chronic diseases so prevalent? They are, for the most part, “lifestyle” diseases…
Read MoreIn recent years, we have witnessed a huge shift in recognition around the importance of data as an asset. As the world undergoes a digital transformation, the seemingly small details of our lives are tracked, recorded, and leveraged as data points to make decisions. This cascade of information is growing at a rapid rate, creating innumerable opportunities for organizations to innovate and better serve customers and clients.
Read MoreMedicaid’s transition towards Managed Care is complex and represents a fundamental shift in how care to beneficiaries is both delivered and paid for in North Carolina (NC). However, you do not have to digest all 700+ pages of the State’s recent request for proposal to understand how this transition will affect NC primary care providers (PCP). There is a handy shortcut that provides the essential principles and parameters guiding health care delivery under Managed Care: The Advanced Medical Home (AMH).
Read MoreWhen the state of North Carolina set out to transform Medicaid over 3 years ago, many in the behavioral health world cringed.
The public behavioral health community has undergone some form of change about every five years for the last 20 years; from the days of community mental health centers, to the formation of the Local Management Entity (LME) system and the current LME/MCO structure.
Each of these major changes have required flexibility and resilience on the part of those working in the public mental health arena, particularly as they seek to help confused consumers navigate the continual system changes. However, as Medicaid Transformation has unfolded, a little ray of sunshine has emerged, symbolizing that we just might be moving toward an era of better care for patients with behavioral health needs.
Read MoreWe each make over 200 decisions about food daily. Many of these decisions are strongly influenced by our food environment and may contribute to health status based on what is available. Limited access to nutritious foods, as well as overwhelming access to nutrient-poor foods, can be addressed by health professionals through motivational interviewing with tailored education and knowledge of community resources.
Read MoreWhen you hear the phrase integrated care, you probably think about a behavioral health clinician embedded in a primary care office. But, that’s not the only form of integrated care. Like all of health care, integration occurs on a continuum.
Read MoreToday, Maryland-based Aledade, Inc. and North Carolina-based Emtiro Health, LLC announced they are forming a new partnership to support independent providers in the North Carolina Foothills and Greater Piedmont-Triad area under Aledade’s newly formed, physician-led Accountable Care Organization (ACO). The Medicare Shared Savings Program (MSSP) ACO benefits North Carolina physicians and their patients by offering a model that rewards doctors for improving quality of care and patient health outcomes, while lowering costs.
Read MoreWe have all experienced a “gut feeling” about something or someone in our lives. These strong, intuitive instincts have likely lead us to act one way or another, perhaps even serving to protect. In a similar way, research is revealing that the beneficial microbes found in our gut may be influencing our mental state (via the gut-brain axis) and protecting us from a host of diseases and illnesses.
Read MoreIn 2003, Dr. Sajeev Arora, a liver specialist at the University of New Mexico School of Medicine, realized that his specialty clinic for the treatment of Hepatitis C was overrun with patients in need of care. Wait lists were long and many of the patients who were being seen struggled to keep their appointments because of the long distances they had to travel to Albuquerque to receive Interferon, a complicated and sole treatment available at the time.
Read MorePharmacists are truly the medication experts and, with a recent estimate putting the cost of hospital readmissions at over $40 billion annually and a Medicare readmission rate of nearly 20%, it’s long past time to invest in Pharmacists’ expertise.
Read MoreTechnology has done wonders for the medical world, enabling providers to sustain life in ways that were not imaginable 50 years ago. However, when there’s no hope of a reasonable recovery, why is every life sustaining option implemented in spite of what the patient may want?
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