Putting Health into Healthcare: North Carolina Leads the Way

Putting Health into Healthcare: North Carolina Leads the Way

The Covid pandemic has exposed the limitations of the U.S. health care system. Unlike socialized health care in Canada, France or the Scandinavian countries, U.S. health care is tied to employment. Lose your job and you’ve just lost your health care. In the year of Covid, this has had tragic outcomes for millions of Americans. North Carolina (NC) has embarked on an ambitious effort to transform the way health care is defined and paid for. Could this be a model that other states can emulate?


The NC goal: Keep people healthy; save money on healthcare

North Carolina is turning away from the traditional fee-for-service model where doctors and hospitals are paid for each office visit, test or operation. Instead, providers will often be paid based on health outcomes like controlling diabetes patients’ blood sugar or heart patients’ cholesterol. It’s a meritocracy model; the better the providers do, the more they can earn. If they perform poorly, money could eventually come out of their pockets.


The NC project: an emphasis on buying health rather than health care

The new model is being championed by the state’s Department of Health and Human Services, which oversees payments for two-thirds of the state’s insured population. The effort is led by Obama administration officials: Dr. Mandy Cohen, the secretary of the state’s health department, and Dr. Patrick Conway, the nonprofit insurer’s chief executive, who also served in the Bush administration. “I want to buy health with our dollars, not necessarily buy health care,” Dr. Cohen said.


A focus on primary care: Building relationships with patients

Primary care clinics are at the front line of the NC campaign. Physicians and nurses are expected to play a larger role in managing care and stand to gain financially. One clinic has built deep roots in the community. Dr. Robert Rosen, one of the physicians, delivered Catherine Vickers, now a practice manager, 24 years ago. Another physician, Dr. Amy Sapp, cares for people over the long haul, knowing them, their families, their living circumstances and life changes. They’ll ask about what’s going on with their families and jobs. They want to know about depression, alcohol consumption, food and housing. On annual wellness visits, the doctors now spend more time with patients. They also receive an extra $20 for doing this workup.


More dollars to primary care physicians

NC is looking at the big picture, taking on health-related risks in our daily lives—stress, jobs, access to healthy food, housing and transportation. NC’s changes will increase the health care dollars that go to primary-care physicians, as opposed to specialists and hospitals. There’s an emphasis on proactive care–identifying problems at the beginning, monitoring them and finding solutions before they become a long-term drag on the health care system.


NC’s new approach includes big insurance providers

This year, Blue Cross announced that it had signed five of the largest health systems in NC to contracts linking payments to total costs of care for their patient populations. Duke University Health System is one of those big groups. It has made several efforts in recent years to curb costs through health practices, including pushing preventive programs and prescribing generic drugs.


Being proactive about good health includes financial matters

Many of our clients are scheduling appointments to create or update their Living Trusts. Covid-19 is still very much a reality, and a Trust, with a Power of Attorney and Advance Healthcare Directive is providing peace of mind to many. Best of all, we guide you through it and we prepare the legal documents. Schedule an appointment with Guideway today.


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This story is based on an article in The New York Times, Aug. 26, 2019