Payer Roundup—North Carolina pays out $6B in Medicaid contracts

Pushpin showing North Carolina on a map
North Carolina has awareded $6 billion in contracts to five payers for its Medicaid managed care program, plus more insurance news. (Getty/Creative RF)

North Carolina awards $6B in Medicaid managed care contracts to 5 payers

North Carolina officials have reached agreements with five insurers to offer Medicaid managed care in the state, with the deals totaling $6 billion.

The insurers—AmeriHealth Caritas, Blue Cross and Blue Shield of North Carolina, UnitedHealthcare, WellCare and Carolina Complete Health, a consortium of Centene Corp. and state provider groups—will be paid a flat fee per beneficiary per month and can share in profits if costs are kept low but will face a loss if costs run over.

It’s the largest amount ever spent by the state’s Department of Health and Human Services. The updated Medicaid program will be rolled out in geographical phases.


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North Carolina also rejected a proposal from the state’s 12 largest health systems to run its Medicaid program, much to the frustration of patient advocates.

“I was very surprised that the hospitals’ bid was rejected, and that two plans that have no real North Carolina experience and bad track records in other states were accepted instead,” said Douglas Sea, senior attorney at the Charlotte Center for Legal Advocacy. (News & Observer)

24 companies eye role in Oregon’s Medicaid coordinated care program

Twenty-four companies have notified Oregon officials that they want to get into the state’s Medicaid coordinated care organizations.

New bidders include big names like Kaiser and Providence Health & Services, while established insurers in the state, such as Moda, are looking to grow their share of the state’s $5 billion in Medicaid CCO money.

Complete applications are due to state officials in April, and contracts will be awarded in July. The 24 companies that have submitted letters of intent are not obligated to submit full applications.

Oregon first launched the coordinated care organizations in 2012. (The Oregonian)

Study: Preventive cardiac care leads to decreased spending among Medicare beneficiaries

Spending by Medicare beneficiaries has dropped significantly since 2005, and this trend can be attributed in part to much lower spending on cardiac care, according to a new study.

Harvard researchers found that by 2012, reduced spending on cardiovascular care was saving beneficiaries an average of $3,000 a year. Across the entire senior population, that equates to about $120 billion in savings, about half of which is in traditional Medicare, the study found.

The study highlights the value in investing in preventive care, lead author David Cutler, an economics professor at Harvard, said. This extends to people who are too young to enroll in Medicare, he said.

“There’s no reason to think this would be limited to the elderly,” Cutler said. “And in fact, getting people who are 58 now to take medications could save Medicare a lot of money because they will be healthier when they enter that population.” (The Harvard Gazette)

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