In this episode, we have a conversation with Kelly Garrison, President and CEO of Emtiro Health, about the leap into managed Medicaid care in North Carolina and how to support providers that participate in value-based payment arrangements for Medicaid populations.
Let’s talk about Emtiro Health. Tell us about what you've been doing and how it's been going lately
Great! So Emtiro Health is a population health management company based in Winston-Salem, NC with a specific focus in working with the Medicaid population there's a lot of companies and groups out there that focus on Medicare, Medicare Advantage, other commercial insurers and where we have really found our niche is supporting providers and patients in their move towards value in the Medicaid space which is something that’s a little bit new and a little bit different. Emtiro was born by two not for profit companies with a 20 year experience in working with the Medicaid population. North Carolina specifically has for 25 or more years had an enhanced primary care case management program that was really overseen by the Department of Health and Human Services and a number of years ago now, about nine years ago, there was an emphasis on moving the state's Medicaid Program towards managed care and after many pauses and delays and an even a suspension along the along the way, we finally have gone by with the Medicaid managed care program last July. And we are still in the fairly early phases I think everybody across the state has learned a tremendous amount including Emtiro and we are still rolling out new components of the Medicaid managed care program in North Carolina but with the change that we saw coming with what Medicaid managed care was going to bring to providers, the impact it could have on our local communities and the patients that we had served for a really long time, there was really a group that came together that said there's a different vision that needs to be had, This is an opportunity for us to partner with and just do Healthcare differently for this population specifically. And so that's why we decided to form Emtiro Health and really make the bridge across the bridge from the old Medicaid program to now the Medicaid managed care program.
The managed Medicaid program in North Carolina went live in July 2021. How has this start up then and how are things proceeding?
So I have to say that overall I think the program implementation has gone over incredibly well. I think, one our Department of Health and Human Services did a tremendous amount of work and looking around at other states to see kind of lessons learned. North Carolina was really the last big state to transition to Medicaid managed care so there were a lot of learnings that could have happened over the last 20 to 25 years that other states have gone through this type of transition. I think we've learned a tremendous amount. I think we learned the importance of data flow and that being accurate from the get-go. I think we learned some hard lessons potentially particularly around patient attribution which was it always going to be important in any value space regardless of the payer because that's how we collect quality data and have to report out on it and ultimately payments get tied to those types of things. And so overall I think generally it went smooth. Of course, we didn’t have as many patients self-enroll as maybe we would have initially liked but we’re still, again, kind of in the early phases so we rolled out the first phase which is the standard plan we are still looking ahead now towards December 1st of 2022 who were going to be rolling out tailored plans which is a specific program that is designed for the this more severe behavioral help mentally ill patient population that is going to be served by Medicaid going...
