By Project Director Alison Miller
On January 27, 2022, the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership & Innovation (FHLI), and the North Carolina Institute of Medicine (NCIOM) announced their partnership in launching an Oral Health Transformation Initiative, representing a multi-sector group dedicated to evaluating best practices and making recommendations for the potential inclusion of oral health in North Carolina Medicaid managed care.
The NCIOM will convene this Oral Health Transformation Task Force beginning in the summer of 2022, while the NCOHC will serve as overall project coordinator and both organizations will manage data collection, analysis, and reporting. Based on a systematic, evidence-based review of other state models for Medicaid managed care specific to oral health, the task force will issue a final report for consideration by policymakers in December 2023.
“Managed care” represents a system in which health benefits are administered by a third-party payer. Ideally, this approach to payment for health care services incentivizes quality outcomes and efficiencies, as opposed to a traditional “fee-for-service" model. While NC Medicaid has transitioned to value-based “managed care” for medical services in North Carolina, oral health has not yet been incorporated.
The partnership between NCOHC and NCIOM reflects the importance of stakeholder engagement and preparedness in making a possible shift to oral health managed care.
“The shift to managed care in oral health is rapidly expanding across the country, signaling the desire to reimagine our payment systems to improve patient outcomes, control costs, and support quality oral health care service delivery,” said Dr. Zachary Brian, Director of NCOHC and Vice President of Impact, Strategy, and Programs at FHLI. “Change is coming, and we’re thrilled to partner with NCIOM to help ensure that North Carolina’s providers, policymakers, and other stakeholders are ready to support a successful potential transition.”
The Oral Health Transformation Task Force will bring together key oral health and health care stakeholders, policymakers, academics, and other key influencers in the collaborative design, development, and messaging of oral health managed care opportunities. The task force and its recommendations will be informed by a systematic literature review, key informant interviews with oral health managed care experts in other states, and a statewide survey of North Carolina oral health stakeholders.
Upon completion of the task force’s work, NCIOM and NCOHC will jointly develop a final report, launch a communications plan, and distribute their findings to stakeholders throughout North Carolina.
“We look forward to gathering informed and thoughtful leaders to examine lessons learned from other states and from the rollout of Medicaid managed care in North Carolina,” said Kathy Colville, President and CEO of the NCIOM. “We seek to chart a path for Medicaid managed care that incorporates important perspectives from diverse stakeholders and ensures high quality oral health care for Medicaid beneficiaries.”
The innovative project is funded by The Duke Endowment, reflecting the nonprofit foundation’s longtime emphasis on improving oral health in North Carolina.
"We're excited to support this timely and innovative effort," said Stacy Warren, a program officer with The Duke Endowment's Health Care program area. "By incorporating oral health into the state's Medicaid managed care planning, this initiative can help drive innovation, boost health equity, and promote preventative care."
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More from the NCIOM:
Medicaid and CHIP in North Carolina (2020)