N.C. Program A Model For Health Overhaul?

As lawmakers wrangle over the best way to overhaul the health care system, a program in North Carolina is getting attention. The state Medicaid program is helping people stay healthier — and saving the state money. North Carolina Public Radio's Rose Hoban reports.

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STEVE INSKEEP, host:

The national debate over health care is contentious in part because it's seen as a risk. Congress is tinkering with a huge part of the economy, and it's hard to be sure what works.

RENEE MONTAGNE, host:

Lawmakers do have some past experience to call on. There's the experience of states, and there's the experience of individuals. This morning, we'll hear from one of each.

INSKEEP: We begin with the state of North Carolina. That state made a change to its version of Medicaid, the health program for the poor. Doctors like it, patients stay healthier, and the state saved hundreds of millions of dollars. Rose Hoban reports from North Carolina Public Radio.

ROSE HOBAN: Every day is busy for nurse Juanita Larkens(ph).

Ms. JUANITA LARKENS (Nurse): Good afternoon. This is Juanita. How can I help you?

HOBAN: She's one of three nurses who manage Medicaid patients at Goldsboro Pediatrics. Goldsboro is a growing town surrounded by old tobacco fields that are being converted to suburbs. About 15,000 Medicaid-eligible children come to the clinic.

Ms. LARKENS: All of them are not known to us, I mean, but those that are introduced to us by whatever means, we will attempt to help them if we can.

HOBAN: One family Larkens does know well is Bergita Archie(ph) and her five children, who qualify for Medicaid.

Ms. BERGITA ARCHIE: Come on, Boo(ph).

HOBAN: Archie stays home with the kids while her husband attends community college. She and four of the five children have asthma. The fifth has a genetic disorder. Archie says she couldn't have handled her kids' health care without help.

Ms. ARCHIE: I learned the proper way to do exercise for people with asthma. I learned how to take control of it, not let it control me. One way is to watch the stuff that we eat, as far as what can cause your asthma, what can cause your symptoms.

HOBAN: Archie can't remember the last time any of her kids went to the emergency room. Care manager Juanita Larkens works hard to make that possible: visiting the Archie home, joining them during appointments and giving advice over the phone.

Ms. LARKENS: Mom knows if he's have exacerbations, she will call. And if she can't get through up there to make an appointment, she knows to call us and we will get her in.

HOBAN: Goldsboro Pediatrics does not pay Larkens' salary. It's covered by Community Care of North Carolina, the state's Medicaid program. Joe Ponzi is a doctor at Goldsboro Pediatrics.

Dr. JOE PONZI (Goldsboro Pediatrics): We need these people who can help us to make sure we can dot all the dots and cross all the Ts and get people to come in if they need additional help, get them resources, they need those resources, and make sure they are consistently following evidence-based care.

HOBAN: The program covers all of North Carolina's 950,000 Medicaid patients. And Community Care has garnered national attention. Vermont used the model to restructure its health care delivery, and Ponzi says it works because care managers like Larkens save Medicaid money.

Dr. PONZI: You know, one hospital ER visit - is it $1,200, $1,000? You know, it's just unbelievable, one admission, 10, $15,000. You could - you save two or three hospital admissions for asthma, you've paid for her salary.

HOBAN: Some say doctors should do case management, but it takes a lot of time, and they don't get reimbursed for it. So it makes sense for Medicaid to pay for the state's 400-plus care managers. After all, that's who pays when patients land in the hospital. For Community Care to work, doctors have to buy into the model, says Allen Dobson. He's a primary care doctor who was the state Medicaid director. Dobson says he knows doctors don't want bureaucrats to tell them what to do. Instead, physician panels decide what constitutes quality, and they monitor how well their peers are doing.

Dr. ALLEN DOBSON (Primary Care Doctor, Former North Carolina Medicaid Director): And so when you go to physicians and say, we would like to improve the quality. We would like to provide you with help in taking care of some of the most difficult patients when you're talking about Medicaid, the poorest and the sickest that we have in North Carolina. They usually embrace it with open arms.

HOBAN: An independent financial analysis shows the program saves North Carolina Medicaid up to $170 million a year, and people are noticing. Dobson had to interrupt his summer vacation when the White House called to ask about Community Care.

For NPR News, I'm Rose Hoban in Durham, North Carolina.

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