HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, reports that North Carolina's last Medicaid HMO, Coventry-owned SouthCare, has gotten out of the Medicaid business as of August 1, meaning that the state will manage the entire Medicaid population through its own primary-care case-management (PCCM) program. According to the latest issue of North & South Carolina Health Plan Analysis, South Carolina has taken the opposite approach, opening itself up to entry by competitive plans that have had success in other states.
"This is just the final stage in a long transition for North Carolina," said Lori Anne Parker, HealthLeaders-InterStudy analyst. "SouthCare has been alone since the next-to-last plan left the market in 2002. North Carolina's PCCM is unique among state programs in keeping all services, such as disease management and enrollment, within its own networks, rather than contracting with outside vendors. They say this allows them to control costs."
Like most other states, and unlike North Carolina, South Carolina has opted for a hybrid system, with some MCO/HMO managed care, while maintaining its own PCCM system. Among plans mentioned as possible market entrants is AMERIGROUP, which recently exited the Illinois Medicaid market.
Other health plan news in North and South Carolina: * A coalition of employers and provider groups in Charleston have partnered with WellPath Select Inc. to created a community health plan model. * Blue Cross Blue Shield of North Carolina is expecting to see its short- term healthcare insurance business to grow as small employers reduce their healthcare benefits. About Health Plan Analysis
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