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Professor Mark Hall

Professor Mark Hall advocates blending ACOs, private providers in Winston-Salem Journal

North Carolina legislators should aim for a hybrid strategy — blending affordable care organizations with private providers — in their next attempt at Medicaid reform, a Wake Forest University law professor recommends.

A brief by Mark Hall and Edwin Shoaf is the first from the law school’s recently launched Health Law & Policy program. Hall is a professor of law and public health; Shoaf is a research associate.

The state’s $14 billion Medicaid program covers about 1.9 million North Carolinians and has had a financing gap of almost $2 billion since the start of the 2009-10 fiscal year.

Hall shares the opinion of most legislators, as well as that of Gov. Pat McCrory, that the state Medicaid program “stands at a crossroads” in terms of reform. The current system is based primarily on a fee-for-service format.

Medicaid reform arguably is the biggest sticking point between state Republican leaders and McCrory. The governor declared from day one of his term that the program is broken, though some health care advocates dispute that assessment.

Senate leaders tout privatization, including hiring out-of-state, for-profit insurers operating as managed care organizations (MCOs), as the best approach to fix it.

Meanwhile, House leaders, health Secretary Dr. Aldona Wos and McCrory prefer the ACO model with existing in-state providers and health care systems leading the way. Those groups typically are controlled by health care systems, hospitals and physicians.
Among the ACOs operating in the Triad are Cornerstone Health Care of High Point, Community Care of N.C. and Triad Healthcare Network of Greensboro.

Medicaid reform bills introduced in each of the legislature’s chambers this year have failed to gain a groundswell of support.
A bill introduced by Rep. Donny Lambeth, R-Forsyth, embraces the hybrid strategy, but has limited details. Lambeth plans to expand on his reform strategy after the House state budget proposal is submitted.

Although Hall supports combining the best of the for-profit and ACO approaches, he cautioned that by doing so, “do we create a better functioning Medicaid system, or a Frankenstein’s monster?”

“By themselves, neither MCOs nor ACOs have yet achieved a strong track record of making health care organizations and providers accountable for both costs and quality,” Hall said.

“If both sides are motivated to reach a solution, compromise is very feasible. One side objects to ACOs that have no capped budgets. The other side objects to MCOs that lack control by hospitals and physicians.

“Provider-led organizations that receive capped payments seems like a viable compromise that addresses each side’s concerns, in broad principle,” Hall said.

Best of both worlds
A major, bipartisan criticism of the N.C. Department of Health and Human Services’ handling of Medicaid the past 2½ years has been the lack of dependable data and forecasting, though much of its work had been outsourced to an out-of-state vendor.
“But, a combination of both approaches could achieve the General Assembly’s key goals, as long as administrative expenses and profiteering are minimized,” Hall said.

Hall said the main advantage of MCOs is their budget control, since they operate on a fixed-fee model for each person, also known as capitation. The groups contract to provide all needed care and absorb budget shortfalls.
The state’s nine behavioral health MCOs, including CenterPoint Human Services and Partners Behavioral Health Management in the Triad, operate with that model.

The ACO model puts more focus on quality standards and providing patient-centered care. They typically don’t have the same level of budget certainty since providers are paid primarily on a fee-for-service basis.

“While Medicare ACOs have done better in other states, the current North Carolina participants are having trouble hitting their savings stride,” Hall said. He said just three of the eight large-scale ACOs operating in North Carolina are saving money, “but those savings were fairly substantial.”

For example, studies have shown that Community Care has achieved savings of nearly $1 billion over a four-year period.
Hall said that several states, including Ohio and Oregon, have gone the hybrid route through coordinated care organizations, which are mostly nonprofits owned either by providers or by MCOs. Those groups focus on quality and are paid for most of their services on a capitated basis.

A legislative committee heard a presentation from Ohio Medicaid officials in October.

“Drawing from experience both in North Carolina and elsewhere, a workable approach to Medicaid reform should combine the best of both MCOs and ACOs by using a fixed-fee payment system that ties payments to quality performance and accountability, and that includes nonprofit and provider-based organizations,” Hall said.

Health Benefits Authority
One version of Medicaid reform — disclosed in House Bill 525 and Senate Bill 696 — would take the drastic approach of establishing an independent authority within DHHS, known as the Health Benefits Authority.

It would be governed by a paid, seven-member board of directors. The authority would feature experts in administration, insurance, actuarial science, economics, and law and policy. The bills do not disclose the cost of establishing the authority, although at least $800,000 could be spent on the combined salaries of the board members.

Rep. Debra Conrad, R-Forsyth, said she supports House Bill 525 in part because Medicaid may have become too big for DHHS to handle as efficiently as possible.

“This authority would allow Medicaid its own focus,” Conrad said. “My hope is for this bill to reinvigorate the conversation about Medicaid reform and get some movement going if we want to truly get past the Medicaid turfs this session.”
By comparison, House Bill 372, sponsored by Lambeth, supports having N.C. providers and health care systems involved in ACOs carry a larger risk-reward expenditure role. Lambeth said he was not contacted by Hall for his brief.

“Even with that, it is actually on target with our notion of a hybrid model that is unique to North Carolina and the citizens Medicaid serves,” Lambeth said. “We hope to create a model of care based on quality and access, yet is fiscally responsible for the providers of care and the state.”

Senate Bill 703, sponsored by President Pro Tem Phil Berger, R-Rockingham, would require DHHS to convert Medicaid by Jan. 1, 2017, to one organized as a “capitated, risk-based, managed care” program. DHHS would be required to enter into “risk contracts with at least three statewide Medicaid physical health MCOs that assume full risk for all Medicaid benefits.”

Sen. Joyce Krawiec, R-Forsyth, said her Medicaid reform concern relates to a $2 billion deficit.

“If this is allowed to continue, there could be serious consequences for North Carolinians with regards to maintaining schools, roads and other state services,” Krawiec said. “That is why we must get this runaway spending back under control.
“We need to provide quality care while being fair to North Carolina taxpayers, whether that means an MCO model, an ACO model, or some combination of the two.”

View the original article here.

Professor Kami Chavis Simmons is the director of the law school's new Criminal Justice Program.

Professor Kami Chavis Simmons speaks to HuffPostLive about police officers indicted in death of Freddie Gray

Professor Kami Chavis Simmons was featured on a panel speaking to Huffington Post Live in the segment, “Police Officers Indicted In Death Of Freddie Gray” on Friday, May 22. Continue reading »

Professor John Knox

Professor John Knox co-writes story on environmental democracy being an essential right for the 21st century for Thomson Reuters

 Wake Forest’s Henry C. Lauerman Professor of International Law John Knox, the United Nation’s special rapporteur on human rights and the environment, co-wrote the following article with Manish Bapna, executive vice president and managing director at the World Resources Institute, which appeared here on May 21, 2015.
Dean Suzanne Reynolds ('77)

Interim Dean Suzanne Reynolds (’77) discusses legal education and changing legal marketplace with deans of Campbell and Elon law schools

Interim Dean Suzanne Reynolds (’77) participated in North Carolina Bar Association  (NCBA) Continuing Legal Education program,”Strange Days Indeed:  Understanding and Navigating the Changing Legal Marketplace,” on May 14.  Also on the panel entitled, “School Daze: Legal Education and the Changing Legal Marketplace,” were the deans of Campbell University and Elon University law schools.

Continue reading »

Professor Ron Wright is one of the nation’s best known criminal justice scholars.  He is the co-author of two casebooks in criminal procedure and sentencing; his empirical research concentrates on the work of criminal prosecutors.

Professor Ron Wright takes on the injustice of piling on criminal fees in The Huffington Post

Professor Ron Wright co-authored the following piece with Florida State Law Professor Wayne Logan in The Huffington Post:

Criminal courts sometime function as fee-generating machines. Take, for example, a homeless woman in Ferguson, Missouri, who owed the city $152 in parking tickets. When she paid only a portion of the amount due, she was arrested twice and spent six days in jail. The court imposed more fines and late fees totaling hundreds of dollars. To date, she has paid $550 in fines and fees to the City of Ferguson, yet still owes the city over $500. This is just one example of mercenary criminal justice at work in state courts all over the country. Continue reading »

Professor John Korzen

Professor John Korzen (’91) receives North Carolina Bar Service Award

Professor John Korzen (’91) was presented with the Howard L. Gum Service Award by the North Carolina State Bar Board of Legal Specialization at the annual specialists luncheon on Friday, May 8, in Charlotte. Continue reading »

Professor Mark Hall

Professor Mark Hall talks about Medicaid reform on WUNC’s ‘The State of Things’

Medicaid reform is at the forefront of North Carolina’s legislative agenda this session, but legislators are still debating how to design the reform.  Continue reading »

Professor Kami Chavis Simmons

Professor Kami Chavis Simmons interviewed by NPR about President Obama’s ban on sale of military-style equipment

Monday, President Barack Obama announced his administration will ban the sale of certain military-style equipment to local police departments. Professor Kami Chavis Simmons was the guest on Wisconsin Public Radio discussing this news with host, Rob Ferrett, on Monday, May 18, 2015. Continue reading »


Missed Hooding Ceremony or Stephen Colbert? Watch again on Livestream

For friends and family unable to attend the 2015 graduation exercises at Wake Forest University, the recorded webcast of the Wake Forest Law Hooding Ceremony 2015 and the Commencement webcast are both available to watch via the following Livestream players and links. Graduates, if your attending family members did not receive a print copy of the Hooding Ceremony program, please email with Hooding Program in the subject line by Friday, May 22 to request up to four programs that can be mailed to you.

Watch Commencement and comedian and author Stephen Colbert’s speech to the graduates at the Livestream website.



If you missed Stephen Colbert’s speech to the graduates watch it here:

Hooding 2015

Wake Forest Law confers hoods on 181 graduates, including a record 32 international Master of Laws in American Law degrees

The Wake Forest University School of Law conferred hoods on 181 graduates, including 32 international Master of Laws in American Law degree (LLM) candidates and a Scientiae Juridicae Doctors (S.J.D.) candidate, Juris Doctor (JD) candidates and Master of Studies in Law (MSL) candidates. That is compared to 30 international graduates in 2014 and 24 in 2013. It is the largest class of international graduates in the law school’s 121-year history. Continue reading »