Real health care reform in North Carolina – Dzau and McClellan

Victor Dzau
Victor Dzau

The Better Care Reconciliation Act proposed by the Senate could mean major changes for how North Carolina and the other states pay for and deliver health care.

It is envisioned that the states will have more flexibility and responsibility for their Medicaid programs, while federal funding would be reduced. Irrespective of the outcome of the Senate bill, North Carolina needs to be better prepared and must do more to improve and preserve the health of its residents.

While North Carolina has much to be proud of – leading research universities and top-rated medical centers and healthcare systems – the health status of our state unfortunately remains poor. In the 2016 America’s Health Rankings, North Carolina ranked 32 across all states.

This low rating is fueled by high rates of obesity, smoking, illicit drug use, and other preventable causes. Deaths from chronic disease and injuries make up over two-thirds of all deaths and the state has one of the highest rates of infant mortality in the country. What’s more, within these statistics are stark disparities by education, race, income, and geography. And more North Carolinians are struggling with their health costs, with 1 in 9 North Carolinians lacking health insurance.

Our citizens deserve better – all North Carolinians deserve the opportunity to thrive in healthy communities and have access to affordable, prevention-oriented, quality care. In North Carolina and nationwide, bitter political debates are ongoing about the best way to provide affordable coverage. These debates are important, but a major reason they are so contentious is the high and rising cost of health care, and missed opportunities to help Americans live healthier lives. We have a set of proposals that should be able to generate bipartisan support to change that.

Eighteen months ago, the National Academy of Medicine (NAM), formerly known as the Institute of Medicine (IOM) – an independent, nonprofit institution that provides national guidance on issues of health, medicine, and biomedical science – launched a major initiative, Vital Directions for Health and Health Care. The initiative identifies the most pressing health challenges facing Americans, and presents the most promising, evidence-based solutions. The NAM assembled a nonpartisan steering committee of 18 prominent health care experts, and commissioned papers from 150 leading health policy specialists, scientists and researchers.

Published recently in the Journal of the American Medical Association, the steering committee’s final framework provides evidence-based, actionable insights, and recommendations for advancing health, health care, and scientific progress. Overall, it provides the foundation of what we believe would be an optimal health system.

Among the Vital Directions policy priorities:

▪ shift payments away from fee-for-service to focus on value and outcomes, reward high-quality care that is accessible and affordable for all;

▪ support initiatives that activate local communities, because good health begins where people live, work, and play; better serve patients and families by ensuring that care is linked to each individual’s goals;

▪ promote telehealth to benefit disadvantaged or rural residents; and better integrate medical services with essential social and behavioral supports.

Policy reforms should also help foster a skilled, integrated clinician workforce operating in teams to provide the best care for our most medically complex individuals and communities.

North Carolina could benefit immensely from action on these ideas, and we have a timely opportunity for bipartisan action. The state’s recently approved framework for Medicaid reform envisions new public-private collaborations to advance both quality improvement and fiscal responsibility. With nearly 20 percent of the state population covered under Medicaid and the Children’s Health Insurance Program, Medicaid reform could have a fundamental impact on health and health care costs in the state. Through collaboration with private insurers and the state’s role in providing coverage for state employees and retirees, even more leverage is possible.

North Carolina’s private sector is ready for these reforms. North Carolina’s health systems include some of the best clinicians and researchers in the country, and they are already implementing a wide range of innovations in care. To enable higher-quality care through small providers, especially in rural areas, programs like the state’s primary care support services and telemedicine programs can be updated. Employers and health plans like Blue Cross of North Carolina are taking steps to support these efforts.

We have what it takes to provide better health for everyone at a sustainable cost, but it requires state and local action now. The Vital Directions initiative makes clear that a set of bipartisan reforms can be implemented to cut through our deeply polarized politics, and achieve our longstanding goals of better health and higher-value, quality care. Vital Directions can serve as a blueprint for lawmakers in North Carolina seeking to build bipartisan policies that will deliver the best outcomes for all now and in the future.

Victor Dzau, MD is president of the National Academy of Medicine (formerly the Institute of Medicine), James B. Duke Professor of Medicine, and former president and CEO of Duke University Health System. Mark McClellan, MD, PhD, is director of the Duke-Robert J. Margolis Center for Health Policy at Duke University. They are the co-chairs of the Vital Directions for Health & Health Care Initiative.