Health and Human Services Secretary Aldona Wos demonstrating how her agency would like to "bend the cost curve" on health care costs. Image courtesy News 14 Carolina.
Health and Human Services Secretary Aldona Wos demonstrating how her agency would like to "bend the cost curve" on health care costs. Image courtesy News 14 Carolina.

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Health care in North Carolina was often the big story in 2013, from Medicaid to the Affordable Care Act to controversy surrounding North Carolina’s health and human services secretary Aldona Wos and some of her hires.

But these weren’t the only hot topics in North Carolina’s health care scene this past year. Issues ranged from a fight over abortion in the General Assembly to the emergence of newly-identified tick-borne diseases.

This is North Carolina Health News’ list of the Top 10 health stories of 2013.

(Disagree with our list? Think we missed something? Let us know in the comments section)

1. Mental health group homes look for a way to survive

Bradley Gauriluk, 37, said he lived in a group home in Raleigh as he recovered from mental illness. Now he lives independently in an apartment Knightdale. Photo credit: Rose Hoban.

Even though this was a big story and a big issue around new year’s 2013, there’s no solution for mental health group homes that house thousands of people with disabilities.

The problem started when the federal government compelled North Carolina to abide by a 20-year-old law that requires equal treatment for people with disabilities living in institutions and in their own homes. Instead of raising rates for everyone, state legislators cut rates for mental health group homes.

People in the mental health community have continued to rally around this issue all year, but a solution that will allow the homes to remain viable remains elusive.

2.Wos blames Goodwin for Medicaid refusal

It always makes news when a state official “misspeaks” about policy or a program. N. C. Health News broke the story on how Department of Health and Human Services Secretary Aldona Wos claimed Insurance Commissioner Wayne Goodwin was responsible for the state’s decision not to expand Medicaid.

DHHS spokesman Ricky Diaz said it was all taken out of context. N.C. Health News has the tape of the interaction, you can decide for yourselves.

3. Obamacare off to wobbly start in North Carolina

What will coverage on the federal individual market cost you? Get an estimate on our interactive map.

Obamacare has had a rocky rollout in North Carolina as it has also had in many states that chose to become part of the federal health care marketplaces. By mid-December, more than 9,000 North Carolinians had signed up for coverage on the online portal, but one thing slowing down enrollment in North Carolina is the high cost of the insurance policies, particularly in rural areas, as displayed by our interactive map.

Why are rates in rural areas so high? N.C. Health News took an in depth look here  and here.

4. Mental health system keeps shifting

Health and Human Services Secretary Aldona Wos demonstrating how her agency would like to “bend the cost curve” on health care costs. Image courtesy News 14 Carolina.

North Carolina’s mental health system has been in flux for more than a decade and this year was no different. N.C. Health News continued our in-depth coverage of those changes, best exemplified the troubles at the Western Highlands Network. WHN was one of the larger and more respected mental health local management entities, but soon after making the transition to a full-fledged managed care organization, the agency got into trouble.

By the end of the year, state officials had announced that the remaining 10 mental health managed care organizations will consolidate down to four agencies by the end of 2014, something N. C. Health News predicted back in March, 2013. 

5. State hospital systems merging

Hospital mergers picked up steam this past year, as changes in the way health care gets paid for started to really take effect. Some of those changes are a function of the Affordable Care Act, and some of them are a function of the fact that insurers and other payers are finding that it makes more sense to pay for “episodes” of care and outcomes, rather than simply paying doctors and hospitals for doing procedures and not tying payment to how well patients actually do.

Image courtesy Ohio Health Insurance, flickr creative commons

This change in reimbursement accelerating a trend of consolidation in hospitals around the state, particularly those in rural areas. N.C. Health News also ran a series of articles on how these changes are affecting rural hospitals and how some rural hospitals are responding more creatively than others.

Part 1: Changes in Hospital Finance Drives Flurry of Mergers
Part 2: Rural Hospital Mergers Make for Improved Bottom Lines, Mixed Feelings
Part 3: Rural Hospitals Drive Local Economies as They Evolve

6. Legislators enact stricter restrictions on abortion

During the General Assembly session, debate flared about the state’s abortion restrictions. North Carolina Health News added to the conversation with the first of a series of interactive maps. Folks found some of the statistics about abortion from around the state to be surprising.

The map was only one part of North Carolina Health News’ coverage of this issue and how it played out in the legislature. Questions from the media finally compelled the state’s Obstetrical and Gynecological Society to take a position on the issue after a long silence.

7. N.C. General Assembly contemplates rescinding motorcycle helmet laws

Photo credit Jason Edward Scott Bain, flickr creative commons

During the General Assembly session, lawmakers attempted to pass a repeal to North Carolina’s motorcycle helmet law, and NC Health News readers reacted. The stories about this bill garnered some of the highest readership and most comments of any story this year.

But in the end, efforts to repeal the helmet law… crashed.

8. Medical schools inflate general practice numbers

For years, North Carolina has had four medical schools in the state (Campbell U. just added a fifth this year) and for years, those schools have talked about how many of their graduates go into primary care. But the numbers tell a different story.

It turns out only East Carolina University’s Brody School of Medicine has had real success at getting people into primary care practice.

9. Bartonella is everywhere, so why don’t we know more about it?

Vectors of Bartonella infections include fleas, body lice, and sand flies, as well as animals. Image courtesy Centers for Disease Control and Prevention.

Bartonella is a bacteria transmitted by fleas, ticks, animals, even spiders, but few people know about it except as the causative agent for “cat scratch” disease. But new methods for diagnosing it are showing it’s more common than previously thought, and may have more profound effects than imagined.

A professor from NC State has made it his business to get the word out about Bartonella, literally.

10. McCrory administration officials alter response to a Medicaid audit

Incoming DHHS officials edited an audit of the Medicaid program delivered in January in a way that made the program appear more troubled than it is.

An investigation by NC Health News editor Rose Hoban uncovered documents in which DHHS officials sat on information that would have depicted North Carolina’s lauded Medicaid program in a better light. The most telling document is a “track changes” edition of the DHHS response to an audit showing how Medicaid officials eliminated detailed explanations of alleged high administrative costs, management problems and budget overruns in past years.

State Auditor Beth Wood describes the results of her audit of the state Medicaid program, while Governor Pat McCrory listens.

The resulting document accepts the criticism in the audit wholesale and paints the health care program that covers 1.6 million North Carolinians as “broken.” That critique was also used as justification to reject expansion of Medicaid that would have been paid for by the federal government under the Affordable Care Act. The flawed audit response was also used to justify a push to privatize the program.

Guaranteed: Medicaid will continue to be a big story in 2014, and you can get up to speed on what’s happened in the past year here.

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