North Carolina medical journal
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The Affordable Care Act played a major role in transitioning American health care away from fee-for-service payment. We explore the spread of payment reforms since the implementation of the ACA, both nationally and in North Carolina; the corresponding effects on health care costs and quality; and further steps needed to achieve greater transformation.
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Place-a confluence of the social, economic, political, physical, and built environments-is fundamental to our understanding of health and health inequities among marginalized racial groups in the United States. Moreover, racism, defined as a system of structuring opportunity and assigning value based on the social interpretation of how one looks (i.e., race), has shaped the places people live in North Carolina. This problem is deeply imbedded in all of our systems, from housing to health care, affecting the ability of every resident of the state to flourish and thrive.
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Medicaid transformation in North Carolina marks the next step in a lengthy history of caring for individuals with behavioral health challenges. "Tailored" health plans will cover people with severe mental illness, substance use disorders, intellectual/developmental disabilities, and traumatic brain injury, a vulnerable population that North Carolina's LME/MCOs are uniquely qualified to serve.
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North Carolina's move to Medicaid managed care is part of the larger move to value-based care nationally. Keys to value-based care guide how practices and health systems can navigate the new payment model. The experience of North Carolina's Area Health Education Centers with primary care practices that work on value-based care can serve as an important case study.
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As North Carolina's Medicaid program transitions from fee-for-service to managed care, the Department of Health and Human Services is committed to building an innovative, whole-person-centered and well-coordinated system of care that addresses both medical and non-medical drivers of health. Delivering on that vision, and improving the health and well-being of North Carolinians, means shifting from thinking of payers as exclusively buying medical services to thinking of them as buying health for their beneficiaries. Operationalizing this complex work will require strong partnership from stakeholders across the state and will also provide North Carolina an opportunity to help drive a national agenda centered around how to buy good health.