Safety net clinics collectively served 351,000 Medicaid patients over a recent 12-month period and plowed the proceeds from those encounters back into serving another 485,480 people who are uninsured.

By Tim Gallagher

North Carolina has had a rich history of caring for people without health care insurance through a loosely organized group of providers known colloquially as the “safety net.”

The prospects of Medicaid Managed Care reform in North Carolina provided the momentum for safety net providers to start thinking about working together for the common good. More than a year ago, many of these providers began organizing into a “system of health.”

The primary consideration for starting the endeavor was to prepare safety net providers for negotiating favorable Medicaid provider contracts with managed care organizations (MCO).

Why is this important?

Safety net clinics collectively served 351,000 Medicaid patients over a recent 12-month period and plowed the proceeds from those encounters back into serving another 485,480 people who are uninsured. That’s roughly 44 percent of the state’s 1.1 million uninsured being seen within the safety net primary care health system.

Medicaid revenue is the single most important revenue source to safety net primary care clinics. Without the revenue collected through it, the system would collapse.

How Medicaid MCO contracts are negotiated will have a profound impact on the financial health of safety net providers and a corresponding impact on where the state’s uninsured can be accommodated.

In acknowledging the importance of Medicaid revenue on access for the uninsured, it also becomes important to recognize the common thread and patient demographic shared between the Medicaid and uninsured populations.

In the most recent period on record, there were 710,000 new Medicaid enrollees while 626,000 people unenrolled. Almost certainly, most of those who enrolled/unenrolled either came from or returned to being uninsured, although that statistic is not presently tracked. How future Medicaid contracts are awarded will in part determine whether patients must change primary care providers as they transition on and off Medicaid.

A strong history of collaboration

The N.C. Safety-Net Health System (NCSNHS) emerged from a strong history of collaborative activities among the state associations for community health centers, local health directors, free and charitable clinics, rural health centers and school-based clinics.

The jointly sponsored annual primary care conference and collaboration with the N.C. Office of Rural Health on its Community Health Grant program are two examples of collaboration by safety net providers.

In fact, the increased level of collaboration by N.C. safety net providers is already paying dividends for safety-net providers in significant areas:

• Safety-net providers from across the state successfully joined voices and advocated for increased funding of the critically important Community Health Grant program; the North Carolina General Assembly rewarded their efforts with a $7.5 million increase effective July 2017.
• Discussions with the N.C. Health Information Exchange, known as N.C. HealthConnex, have resulted in important concessions involving the process and deadlines with connecting safety net clinics to the state’s central health data repository and their concomitant ability to query data.
• The effort has engaged MCOs around their interests in creating pilot projects or other efforts to demonstrate innovative approaches to serving N.C. Medicaid beneficiaries.
• Safety-net providers are getting to the negotiating table with MCO/PLE representatives and reviewing participating provider contracts or letters of intent, as well as forging relationships that allow each side a better understanding of what would make a contract mutually beneficial.

Today, the safety net and NCSNHS are poised to play an important role in addressing social determinants of health — the structural drivers and conditions in which people are born, grow, live, work and age.

Innovative approaches that are routinely housed in the safety net have the chance to help lead the way on using non-medical dollars to impact health. NCSNHS aims to help the safety net continue to meet its role of setting a welcoming table where all are cared for in equal measure.