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Message from the CEO – October 2018

Cardinal Innovations Healthcare — October 03, 2018
Happy fall, everyone. I want to talk to you today about communication. Specifically, listening. It’s something we’ve been focusing on over the last year – really taking the time to listen to our members and families, our providers and our stakeholders. We’ve been asking about your experiences, what’s working, what’s not working and what we can all do better together.
One topic I continue to get questions about is Medicaid transformation. It’s understandable, especially for our members and families, to have some anxiety around this issue. When is change coming? What will happen to my services? How can we prepare? These are real questions and concerns, and while we may not have all the answers today, I do want to share with you what we know is true, what we think we can expect and how to keep yourself well informed going forward.
To do this, let’s back up and start from the beginning. In North Carolina, Medicaid reform or transformation really refers to two things: combining both physical and behavioral health Medicaid benefits, and the move to a managed care model for all Medicaid services.
Medicaid behavioral health benefits in North Carolina have been using a managed care model since Cardinal Innovations began its five-county Local Management Entity/Managed Care Organization (LME/MCO) pilot back in 2005. That's not true for the medical and pharmaceutical parts of Medicaid in North Carolina. In 2015, the NC General Assembly enacted legislation that set in motion a plan to transform our state's Medicaid delivery system, over a period of time, from a primarily fee-for-service payment model to a managed care model.
Making changes to a system this big is not a simple process. Since the new law was passed in 2015, there have been many other bills passed that make small changes to what Medicaid transformation will look like (including two bills that passed this summer, H 403 and H 156).
That said, there is a lot of work happening to get ready for Medicaid reform. The state has issued the Medicaid standard plan request for proposal. LME/MCOs are determining how they might partner with standard plans and increase their capabilities to offer members integrated care. But you’re likely thinking – what does this mean for me?
I want to leave you today with four main points:
  • Cardinal is, and will continue to be, focused on you, our members, and your health and wellness. The transition to a Tailored Plan will not affect our core mission at all.
  • You have a voice in Medicaid transformation. The state welcomes and encourages feedback in this process. Learn more and submit your feedback here.
  • Legislation is not perfect. This is a process, which will continue to offer opportunities to get this right. Again, it’s critical that your voice is heard as a part of this.
  • Cardinal Innovations is actively planning for the future. We are putting strategies in place to ensure our members are well-covered in the future of Medicaid. While there are still questions to be answered, we will work with our partners at the Department of Health and Human Services and with lawmakers to address questions or concerns as we move forward.
The good news is, at the end of the day, people’s lives are going to be covered. Most of the changes that will come with “Medicaid reform” are on the backend and will most likely have little to no effect on the care you receive today, either for a broken arm or for mental health services. The big picture changes will not be felt in day-to-day healthcare delivery, but rather in the way your care is funded. The main goal of Medicaid reform is to help members achieve better health outcomes through coordination of physical and behavioral benefits.
As we move forward and learn more about Medicaid transformation, I commit to keeping you informed and up-to-date on all developments, whether it’s through these updates or other avenues on our website. We will share what’s known, what’s unknown, and what we may be able to expect as we all move forward in this together.
Be well,
Trey Sutten, CEO
Cardinal Innovations Healthcare

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