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• The Medicaid budget must be cut somehow. The three options recommended to date have been reimbursement cuts to physicians, commercial managed care, or ACOs. NCMS (and WCMS) support physician-led ACO development as the (obvious) best option of the three.
• The challenge is that NC ACOs are building the plane as they fly it. Legislators would like an immediate solution. MCOs are aggressively offering themselves up as the panacea. NC ACOs need to recommend initial actions that can be taken to begin moving the dial toward budget control in order to satisfy legislators.
• There are a number of concerns with DHHS' current ACO proposal that NCMS is trying to work through.
• Mental health is not integrated into the ACO model. LME's are still a carve out.
• The "shared risk" is largely on the provider side.
• Uncertainty about CCNC's future
• It is up to physicians and medical societies to vigorously advocate to DHHS and legislators that the ACO model is the best model for lasting success.  It is not sufficient to protest MCOs; the medical community MUST come up with a viable solution and then take the lead on developing the proposal. (WCMS and regional physician leaders are currently meeting with WNC Senators and Representatives to discuss Medicaid reform and push the ACO model. The discussion will continue in Raleigh when the short session begins on May 14. WCMS and physicians are traveling to Raleigh on May 28 to do so. Please consider joining us.) 

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