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11 health systems to form Medicaid managed care company


Eleven health systems in North Carolina are teaming up to establish a Medicaid managed care company, The Fayetteville Observer reports.

Here are six things to know.

1. The health systems are forming the organization to compete for service under North Carolina’s Medicaid reform efforts, according to the report. Hospital documents show state lawmakers want to change the Medicaid system to programs that can “provide budget predictability,” the report notes.

2. Cape Fear Valley Medical Center in Fayetteville, N.C., plans to spend $11.2 million to start the company with 10 other systems, according to the report.

3. Bart Fiser, Cape Fear Valley’s vice president of revenue cycle and managed care, told The Fayetteville Observer each of the company’s health systems is providing money to use as “risk based capital” as the company is starting and for other startup funds.

4. Mr. Fiser also told the publication the health systems plan to spend 90 percent of revenues on providing care.

5. Albuquerque, N.M.-based Presbyterian Health Plan is slated to operate the Medicaid insurance company for the 11 healthcare systems and own 25 percent of it.

6. Mr. Fiser told The Fayetteville Observer the Medicaid managed care organization could start by July 2019.

More articles on payer issues:
8 Humana executives sell $66.4M in company stock
UnitedHealth Group to lay off 119 Optum employees
CMS proposes delaying file deadline for 2018 ACA exchange plans

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