Interview by Melanie Raskin
It’s a busy time in the NC legislature where “some days feel pretty good and some days don’t,” says freshman House of Representatives District 75 (Forsyth County) Republican Donny Lambeth. Lambeth is charged with the big (and, yes, tough) task of leading Medicaid reform in the state. North Carolina’s Medicaid program uses a blend of federal and state monies to cover healthcare costs for 1.7 million of the state’s most vulnerable citizens: seniors, people who are blind or disabled, and low-income children and their parents. It’s said politics makes strange bedfellows, but, in this case, maybe not: Lambeth, a devout Moravian with more than 40 years in hospital administration, feels that now, more than ever, is the right time to bring faith communities into the healthcare process.
As a committed layman in Hopewell Moravian Church in Winston-Salem, what connections do you see between faith and health?
For many years, churches have been somewhat of a refuge for those with health issues or needs —from taking people to doctor’s appointments to sitting with someone in the hospital to providing meals. Churches have been active in healthcare, informally, for a long time. Wake Forest Baptist Medical Center [FaithHealthNC] is formalizing it and coordinating it better in the broader faith community.
As former COO, President and CEO of Wake Forest Baptist Medical Center in Winston-Salem, what was your experience of how faith affected the delivery of healthcare in the hospital?
Actually, one of the things that attracted me to Baptist Hospital and retained me there for a 40-year career was the Baptist heritage and faith-based values. It was a great fit to my values and the things I stood for and believed in. I very much appreciated the outreach programs to ministers and the hospital chaplains who visited not only patients and families but also employees. There was a culture around a faith community that was very much a part of the organizational values we designed at that time.
In your new role in the NC House, how has your background in healthcare helped you shape policy?
It’s an excellent fit. A substantial part of the state budget is about people’s health–whether it’s prisoners or state employees. The most visible part is Medicaid, a state-federal partnership that provides healthcare programs for people in North Carolina. With my background in the hospital world, I’ve seen a lot of patients who were a part of Medicaid.
As a freshman congressman, I, normally, would have had to spend a little time learning and paying my dues, but, because I came in after a long tenure in healthcare, I’ve been moved along into leadership roles much quicker. I’m one of the chairs of the Health & Human Services Committee which includes Medicaid and I’m the only freshman member on the budget negotiating team. Quite frankly, there’s not a lot of depth of knowledge, not many elected officials who can talk about Medicaid eligibility, payment rates and how the program works. I can because I lived it for a long time. I know it’s a complex problem. Medicaid reform is a place I have expertise.
In the current policy environment, what are the opportunities for faith communities to become an asset to our healthcare delivery system?
I think we spend more time on the cost of Medicaid than on coming up with creative programs that improve care and lower costs. Programs like the one in Memphis [Congregational Health Network] coordinate healthcare support throughout the faith community to create better outcomes. The Memphis program trained liaisons in congregations to help patients with medical issues. [FaithHealthNC] is a similar pilot program started at Baptist Hospital in Winston-Salem about two years ago that’s part of an initiative in areas where there’s a high concentration of ER visits. This program, brought from Memphis by Dr. Gary Gunderson [now a Vice President at Wake Forest Baptist Medical Center], is a very successful, creative solution to a complex process. It will improve quality and reduce costs.
What’s the role of faith communities in NC’s Medicaid reform?
In North Carolina, 1.7 million of our 10-million population are covered by Medicaid. Half of the ER visits paid for by Medicaid over 12 months were non-emergent care—it wasn’t an emergency. This isn’t anybody’s fault; it’s a fault of the system, which encourages ER visits with no penalty. Right now, if a person is eligible for Medicaid, there’s no incentive or reward—and there’s a lack of coordination—to make sure that person is in the right place at the right time. If we can organize faith communities as part of our Medicaid reform efforts the way they did with the Memphis program [Congregational Health Network] and fund and incentivize this support, the cost of ER visits would go down.
A simple example would be a clinic with heavy Medicaid no-pay patients. These patients schedule appointments and yet 30 to 40 percent are no-shows. Liaisons in churches could help make sure patients in their congregations get to their appointments, get treated, take their medications, get refills at the pharmacy—the basics. The no-show rate would go down, money is saved and health outcomes would improve. Here’s another example: Half of the births in NC are paid for by Medicaid; 20 percent of those births are complex or compromised and consume 80 percent of the costs. The faith community could help a pregnant woman with doctor’s visits, diet and other programs that would enable her to have a healthy baby.
I’m a big believer in showing up for appointments, taking medicines and avoiding unnecessary ER visits. This could all be improved if we coordinated faith communities within the Medicaid reform effort. It would benefit patients and save the state money, especially in our urban areas.
What has shaped your leadership in policy, particularly in the area of health?
Because I spent most of my career in finance and then management at a hospital, my transition to the legislature was easier because I understood healthcare from the operational point of view. I’m able to blend finance—making sure we have a healthy operation—with the need of the patient. I talk more about patients, quality and good outcomes. If we focus on that, the cost will take care of itself. In the General Assembly, I feel we talk too much about costs. If we save in one area, it may cost us in other areas. For instance, if we change eligibility for older, medically-fragile adults in adult care and force them out because they no longer qualify, they don’t go away. They go live with family or in other institutions, which could be more expensive. Families will miss work due to medical problems and those patients will more likely be seen in the ER, with more medical problems. By changing eligibility, access is affected. So, we have to look at whole-person care and not silo care. This is hard for elected officials to understand–they tend to gravitate toward costs, revenues and tax rate rather than quality and outcomes.
I believe we should reward quality care. If Hospital A compared to Hospital B has improvements in some quality indicators and reduces the number of patients because of fewer infections and bedsores, their revenues go down–they’re penalized for having better quality. We need to reward better quality, better behaviors and better outcomes and take away the culture of driving volume into hospitals and replace it with home care, hospice and alternative lower-cost settings such as group homes. When Medicaid is paying the bill, there should be a way to offset expense by moving to a less costly setting that delivers quality care. The reform effort I’m advocating is about quality and outcomes rather than volume and costs. If done, we’ll create very good, innovative models of care.
Can you summarize where we are right now in the state of NC Medicaid reform process?
It’s still very early. We have a concept of where we’re going but not a lot of details, and the Devil is in the details. We’re reasonably consistent on the concept and we agree on the need and goals. Over the next six months to a year, there will be a lot more detail. We can’t solve everything overnight so we’re planning a multi-year phase-in of three to five years. What I’ve found is, whether I’m at Baptist Hospital or here in the legislature, it takes a lot of mediating.
When faith and health are working together, what’s the right and perfect outcome?
I think it comes back to quality. I’m a very big believer in, if we do the right things in the right way, then quality care will begin to emerge as the highest priority: patients will be cared for better and the cost for higher quality outcomes will go down. Before, NC hospitals didn’t have the right focus. Instead of focusing on quality outcomes, they focused on volume and market share, streamlining processes to get more patients in the door and keep them longer. It’s time to shift to an outcomes-based model. In a perfect world, we’d have Medicare reform and the faith community engaged in programs to get patients enrolled, monitored and bench-marked. Patients will be better medically and costs to the taxpayers will go down by a substantial amount.
An award-winning writer since 1982, highlights of Melanie Raskin’s career include spending a week with the Hollywood police department, riding with a long-distance trucker, channeling her inner chicken to sell breakfast bagels, publishing her first short story and working out with fitness guru Richard Simmons.
