Health Reform Ideas for North Carolina

I am releasing a white paper with some health reform ideas for North Carolina (pdf Don Taylor NC Health Reform Proposal 1 14 14). The North Carolina Medicaid Advisory Commission is discussing options that will culminate in their recommendation from the North Carolina Dept of Health and Human Services to the General Assembly on March 17, 2014.

I propose three main ideas:

  • Expand health insurance coverage while reforming Medicaid by seeking both a Medicaid waiver and developing a Basic Health Plan option under section 1331 of the ACA
  • Reform the State’s Medical Malpractice system while addressing patient safety, using Medicaid and the Basic Health Plan as a pilot population; I think the “Michigan Model” holds the most promise
  • Increase the Supply of Health Care Providers by Safely Reduction Regulation; essentially expanding the practice scope of non-physician providers to increase the effective care delivery supply

In the longer run, I suggest North Carolina consider

  • Seeking a more comprehensive waiver that would allow the full cost of the dual eligible population to be federalized, with State savings put towards insurance coverage expansions
  • Seek permission to pilot a competitive bidding demonstration in Medicare Advantage plans sold in North Carolina, two to three years after a Basic Health Plan is up and running in a North Carolina run health insurance exchange

I will spend time over the next few weeks blogging about these and other ideas that emerge (the N.C. Medicaid Advisory Commission meets tomorrow, 9am-4:30pm at the State Library, 109 Jones St., Raleigh, NC). Note that the white paper is a pdf that has hyperlinks to sources (mostly blog posts) in lieu of more traditional citations.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

13 Responses to Health Reform Ideas for North Carolina

  1. Brad F says:

    The Michigan med mal model only works when providers and hospitals share liability and work within the same BHP tent. Would all the providers affiliate and share liability in the model you envision?

    • Don Taylor says:


      Good question.

      I am much less certain of exactly how to go ahead in the medmal area than the insurance side of the BHP. Two thoughts. First, if Duke, UNC, ECU etc all did this, and it includes all their affiliated docs, then that starts to be a pretty big change statewide. And they could start this by offering a BHP plan, perhaps with some incentive. How someone like BCBSNC or another insurers would do this in a BHP plan (they are putting together a network of multiple providers) is trickier.

      Second, you could seek to apply the principles of the Michigan model onto the state generally, but this would be quite a change (a no fault statewide approach, presumably docs and hospitals etc buying into one large insurance pool….I am sure you could implement it using private insurers a la the federal flood insurance program, and I would be open to this, but that really is quite a big change. Whole lotta folks would have to have a say about that first.

      If you sole sourced the BHP to a regionalized delivery system (Duke + partners take this part of the state, UNC that, ECU this, Carolinas in Charlotte this part etc and then members of their network would have to be a part of the Michigan model approach through that large delivery network, that would move a long ways towards a big change. The issue there is whether what is anti-competitive per the Dept of Justice.


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