Members of the press met with health-care providers and health-policy makers at the 2014 North Carolina Health Care Media Summit to discuss proposed changes to the state’s health-care system Wednesday at the North Carolina Medical Society in downtown Raleigh.

Panels of experts debated health-care problems in North Carolina at the summit, which was sponsored by the Sponsored by the NCMS, the North Carolina Press Association and the North Carolina Association of Broadcasters.

Rose Hoban, founder of North Carolina Health News, said it is critical to keep the population aware of its health-care system, which she said accounts for a massive portion of North Carolina state spending.

“Twenty-three cents out of every dollar goes to health care,” Hoban said. 

Bo Bobbitt, an attorney who served as a panelist, said the high rate of health-care spending is unsustainable for the state.

“Thirty cents out of every dollar we spend on health care is waste,” Bobbitt said. 

The potential reform of North Carolina Medicaid was the main health-care reform plan discussed at the Summit. 

After the North Carolina General Assembly passed a law last year that required changes in the Medicaid system, the Department of Health and Human Services submitted a proposal to reform the system.

This legislation was made in response to overspending by North Carolina in the health-care budget. 

Grace Terrell, a panel member and CEO of Cornerstone Health Care, said the new health care proposal seeks to move the current health care structure from a fee-per-service model to one where health care providers are paid based on their performance.

“It’s very hard work, and it requires redesigning every aspect of the way you provide care,” Terrell said. “It isn’t just about what you do with a patient but what’s happening at the population health management level.”

A unique aspect of this proposal is the movement of health care facilities toward becoming part of Accountable Care Organizations.

An ACO is an organization of doctors, healthcare providers and hospitals that provide patients with the highest quality of care and offers taxpayers more value per dollar spent, Terrell said.

While excited about ACOs, members of the panel also acknowledged its challenges. 

Bobbitt said he has concerns about transitioning health care facilities toward becoming ACOs.

“The biggest difficulty of forming an ACO is not in forming one, but forging one, and having people work together,” Bobbitt said.

However, according to Mandy Peal, senior advisor to the North Carolina Department of Health and Human Services, the value of ACOs to taxpayers is undeniable. 

“Over time our plan does put more and more risk on providers, and transfers that risk from the state to the provider community, while we maintain an emphasis on quality outcome, so we are sure our beneficiaries are given excellent care,” Peal said.

Changes in Medicaid are proposed to begin in July of 2015. If accomplished, the changes would offer more predictability in the annual North Carolina budget.

“Savings in health care could transfer to bigger education budgets,” Terrell said.

Among the many benefits, price transparency will also have room to improve between equipment suppliers and hospitals, which will help prevent inflation in prices for lifesaving health care equipment, Terrell said. 

Physicians will also be allowed to allocate funds how they see fit, which will give them the freedom to provide transportation and late-night clinics to low-income patients who might otherwise go untreated, Terrell said.

The savings will also give providers an incentive to start cutting back on wasteful spending, Bobbit said.

“If you change the way it’s paid for, we would solve the fact that 42 percent of people who use emergency departments don’t have emergencies,” Bobbitt said.

Bobbitt continued to explain how unnecessary spending like this is a major flaw in the fee-per-service model currently in use.

“Those are some of the obvious things that I’m excited about under Accountable Care. Where you’re rewarded for squeezing out that waste,” Bobbitt said.

Bobbitt said that although the new plans come with many benefits, there are still flaws in this new proposal.

“This is way out of everyone’s comfort zone,” Bobbitt said.

Louis Pate, a Republican state senator representing North Carolina’s 7th District, said he was opposed to the plan. 

“I don’t believe that a plan that completely relies on provider based ACOs is the answer either, but in my opinion we need an insurance reform.” Pate said. “One that shifts the responsibility away from the state to give us true budget predictability.” 

However, Senator Pate said he didn’t completely disagree with the proposal.

“I don’t know what the proper model is, but I think that somewhere in here is the answer,” Pate said.