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State Treasurer Dale Folwell wants to change how health-care  providers are reimbursed by the State Health Plan in an initiative that  could save members up to $60 million initially. Folwell's proposal is  that the plan will shift on Jan. 1, 2020, from a commercial-based  payment model to a reference-based government pricing model based on a  percentage of Medicare rates. Medicare provides a standard reimbursement  measurement "that is transparent and adjusts for provider differences,"  Folwell said.

"Reference-based pricing is intended to provide transparency in  provider rates by indexing fees to a published schedule." It's an  initiative that Folwell says doesn't require legislative approval,  although "I have consulted with every branch of government." The  proposal is likely to draw pushback from health care providers, such as  hospitals and the N.C. Healthcare Association, and from Blue Cross Blue  Shield N.C., which is the third-party administrator of the plan.

Blue Cross' duties include processing claims, maintaining an  in-network listing of providers, and -- most pivotally -- establishing  medical provider rates. The insurer could not be reached for immediate  comment on the proposal. Anticipating that response, Folwell said  letters explaining the reimbursement strategy have been sent to  providers. "Once the new transparent rates are in effect, providers  choosing not to partner with the plan will no longer be considered  in-network providers for the plan and its members, which will result in  higher out-of-pocket costs for members who seek care with out-of-network  providers," Folwell said.

The plan is North Carolina's largest purchaser of medical and  pharmaceutical services at $3.2 billion in 2017. It represents more than  720,000 teachers, state employees, current and former lawmakers, state  university and community college personnel and their dependents, and  non-Medicare retirees and their dependents. The strategy represents  another prodding by Folwell to Blue Cross as part of his goal of  reducing overall expenses by $300 million.

Folwell said part of the impetus for his proposal comes from a  2011 state Auditor's Office report that determined "the Plan is at risk  for overpaying medical claims because the plan's auditors do not have  access to BCBSNC contracts and cannot independently verify that the plan  receives the proper contractual discounts from BCBSNC's provider  network." Currently, according to Folwell, Blue Cross and medical  providers consider fee schedules -- what they charge -- associated with  the plan network to be "confidential."

Steve Lawler, president of the health care association, said that  "once again, (Folwell) has proven he has neither an insurance nor a  health-care background and is unwilling to work with those who do."

"Health-care provider groups have offered to help customize  programs for the State Health Plan that would not only reduce costs, but  more importantly, empower employees, retirees and their family members  to reach their health care goals. Those who dedicate their life's work  to our state deserve more than a spreadsheet approach to care," Lawler  said.

Robert Seligson, chief executive of the N.C. Medical Society,  said he viewed Folwell's proposal as bringing "drastic changes in  healthcare plans (that) often create harmful unintended consequences for  patients."

Treasurer spokesman Frank Lester said that "once you reset the  reimbursement rates, you really wouldn't be saving that amount  year-to-year." Folwell's announcement came with an appeal to health care  providers "to help us sustain this benefit for teachers, public safety  officers and other public servants." Folwell expects that some providers  will see fee increases under the new rate structure, such as primary  care, mental health and critical access providers.

(Richard Craver, WINSTON-SALEM JOURNAL, 10/05/18) 

Teacher pay and other school issues have dominated the race between  two professional educators for the 94th House of Representatives seat.  The candidates are Republican Jeffrey Elmore of North Wilkesboro,  seeking his fourth two-year House term, and Democrat Dr. Diane Little of  Taylorsville. Both were unopposed in the primary.

Little, 69, is a former public school teacher and principal and  now works part-time as director of a faculty, staff and student  leadership training program she helped establish at Catawba Valley  Community College in Hickory. Elmore, 40, of North Wilkesboro teaches  art at North Wilkesboro and Mulberry elementary schools. He is  co-chairman of both the House Education K-12 Committee and House  Appropriations Subcommittee on Education.

Little accused the GOP-controlled General Assembly of waging "an  all-out war on public education. She said since Republicans filled the  majority of House and Senate seats, the legislature has shifted tax  dollars from public schools to private schools through vouchers and has  let charter schools increase in number while public school enrollment  has dropped. She supports a cap on state funding of private schools and  said continued growth of charter and private schools could lead to a  return to racial segregation. Little said the GOP-controlled legislature  let N.C. public school teacher pay drop to 47th in the nation, took  away the due process (tenure) that helped ensure fair treatment of  teachers and ended professional development funding and stipends for  teachers with master's degrees.

North Carolina's rank in teacher pay rose from 47th in 2013 to  39th now. Pay varies based on local supplements and years in the  classroom. Elmore said N.C. teacher pay averages a little over $53,000  after six years in a row of salary hikes. He said the legislature wants  to raise the average to $55,000 a year and make it the highest in the  Southeast. "We have made sustainable progress. You can make big  increases that aren't sustainable."

Elmore said only 11 states have lower average starting teacher  pay than North Carolina's $35,000. "In this next session, I want to look  into providing signing bonuses" for new teachers, particularly in low  wealth counties. He noted the 12 percent supplement paid to  board-certified teachers and that the Teaching Fellows program was  reinstated after being terminated. "I would like to pay bonuses for  teachers with master's degrees in specific subjects." He cited  state-funded pilot programs underway in several school districts that  pay a higher salary to people in advanced teacher roles and said he  supports providing block grants for this statewide.

Little said healthcare, tax and environmental policies in N.C.  are among issues in her platform. "There is much more our legislators  could do, besides dreaming up proposed constitutional amendments, to  draw certain voters to the polls," she added. Little supports expanding  Medicaid eligibility as allowed under the Affordable Care Act so  hundreds of thousands more North Carolinians can receive Medicaid.  "Every citizen, regardless of socio-economic status or race, has the  right to have quality healthcare."

Elmore opposes expanding Medicaid eligibility in North Carolina  and said cuts in core medical services have occurred in states where it  was expanded due to high volumes of patients trying to utilize a system  that pays less for care than actual costs. He said that instead of  "rhetoric that is unattainable" due to costs, he prefers the state's  current plan to reform Medicaid by utilizing preferred provider  organizations (PPOs) and health maintenance organizations (HMOs) and  establishing a state-funded high-risk insurance pool.

(Jule Hubbard, WILKES JOURNAL-PATRIOT, 10/05/18)  

You may know that it is illegal to use a cell phone to surf the web,  tool around with apps or do anything beyond making a phone call while  operating a vehicle in North Carolina. But a proposed law modeled after  one in Georgia seeks to toughen the laws on cell phone use, which,  presently, can be difficult to enforce.

Under a bill proposed by Sen. Jeff Tarte, R-Mecklenburg, any  touching of a cell phone or tablet or other mobile device while you are  behind the wheel will get you a ticket. In other words, you won't be  allowed to even have it in your hand, not legally. Any calls you make  will have to be through "hands-free" technology, such as through your  car's Bluetooth connection. Tarte plans to introduce the bill in a 2019  session of the N.C. General Assembly, and appropriately it is nicknamed  the Hands-Free bill.

Bill proponents are taking their gospel across the state and  speaking at a series of town halls. The most recent was held this week  in Raleigh. The third of four town halls has been scheduled for Nov. 14  in Asheville. One speaker at the Raleigh town hall was Tasha Hairton  Springs, who crashed when she was sending a text to her daughter while  driving 70 mph, according to a TV news account of the meeting.

She survived but now suffers from chronic pain. "That split  second of looking down and looking up, and swerving, caused a world of  damage," she says. AAA Carolinas Foundation for Traffic Safety is  backing the proposed legislation and put out a news release about the  town hall earlier this week.  

"We applaud the state of Georgia for its new law that has already  brought distracted driving crash numbers down in its short existence,"  Tiffany Wright, foundation president, said in the release. "We look  forward to North Carolina following suit and are proud to champion this  legislation in every way that we can." Studies have shown that texting  and driving diminishes driving capacity in a similar way to driving  drunk. Sixteen states, Washington, D.C., Puerto Rico, Guam and the U.S.  Virgin Islands make it illegal for drivers to use hand-held cell phones  while driving.

(Myron B. Pitts, THE FAYETTEVILLE OBSERVER, 10/05/18)