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After holding a variety of jobs within the Department of Health and Human Services, Dr. Robin Cummings will take on leading the state Medicaid program.
By Rose Hoban
When state Medicaid chief Carol Steckel resigned her office last October after only eight months on the job, state health officials said they would look nationwide for a replacement to guide the agency through a promised reform process.
But, in the end, Department of Health and Human Services Sec. Aldona Wos decided to tap one of her most trusted advisors, Robin Cummings, to run North Carolina’s Medicaid program.
Cummings, a retired cardiothoracic surgeon, assumed the reigns of the nearly $14 billion program April 28, replacing longtime employee Sandy Terrell, who had been acting head at Medicaid since Steckel’s departure.
“My vision for a sustainable Medicaid program is one that puts patients first, effectively uses North Carolina’s outstanding health care delivery system and achieves budget predictability,” Wos said. “We have been on a path to achieving this vision, and Dr. Cummings has the right combination of strong leadership and extensive involvement in our health care system to make it a reality.”
In an exclusive interview with North Carolina Health News on Tuesday afternoon, Cummings said he thinks his experience as a provider will be instrumental in guiding the Medicaid program through a proposed reform process.
“There have been other physicians who have run Medicaid,” he said, referring to Allan Dobson, William Lawrence and Craigan Gray, all of whom have headed the program within the past decade.
Cummings said a Medicaid director’s responsibilities include finance, policy and an understanding of the provider perspective. But, he said, “No one person is going to have all of that.”
“So if you come into this position, you’re going to bring strengths and maybe one or two … of those areas, and the others you have to build a team around you to create that,” he said.
Cummings joined DHHS in early 2013 as head of the Office of Rural Health, was then appointed State Health Director and was quickly elevated to be deputy secretary for health services.
Before joining DHHS, Cummings served as the head of the Community Care Network of the Sandhills, a Medicaid provider network stretching over a seven-county area, including more than 250 health care providers and covering more than 75,000 patients.
He said his experience running the network will be key in helping sell the new Medicaid reform plan proposed in February.
Last year, Wos and Steckel initially proposed a plan that would have converted North Carolina’s Medicaid program into a system run by for-profit managed care companies, but that plan was met with intense opposition from providers, local doctors and hospitals.
The current plan proposes that Medicaid physicians organize themselves into “accountable care organizations,” in which the provider groups can earn bonuses if they reduce costs and could face financial penalties if they fail to hit predetermined patient-outcome and savings goals.
“I have yet to have a provider come to me and say that this is a bad plan, it’s not going to work, I’m not going to participate,” Cummings said. “They say, ‘We like the plan; tell me the details.’”
“I was talking to a provider the other day, and he said, ‘I love this model, Robin, because it brings it down to my exam room, when I’m sitting there with the patient. I am now responsible for that patient’s care and I’m looking at the patient and am thinking about quality and I’m also thinking about cost. And the patient, likewise. I’m engaging that patient to get involved in his or her care as well.'”
But the plan has had a much cooler reception in the General Assembly, in particular from the Senate.
Sen. Louis Pate (R-Mount Olive), who sat on the Medicaid Reform Advisory Group, added a letter of dissent that was included in the final presentation of the plan. Pate’s objection is that the plan does not provide the financial “predictability” desired by lawmakers.
“I don’t think the plan gives predictability for budgetary decisions that we asked for,” Pate said during a panel discussion at the N.C. Medical Society in April. “I don’t know that it really addresses the whole person care that we’ve asked for – that includes mental health services – and it does not take the administrative load off the providers.”
But Cummings said he believes those objections can be overcome at the legislature by educating lawmakers about the benefits of the plan.
“We respond to questions, and we make ourselves open to explaining why we think this is the way to go,” he said. “Hopefully, in the end, after good debate, we will come to a plan that will look a lot like what we have presented as our goal, and we can move on.”
Cummings said he believes that DHHS will get the legislature to agree to move ahead on the plan during the upcoming short session.
But Pate has said he’s not so sure the Senate is ready to sign off on the plan.
“I’d rather get it right if it takes three to four years than do something rapidly and get it wrong,” he said in April.
Turning an ocean liner
Medicaid has had multiple problems over the past few years, with budget overruns that have exasperated lawmakers, the hobbled rollout of the NCTracks management and billing system last summer that left thousands of providers short of cash and, most recently, questions about no-bid contracts.
Recently, Medicaid officials told lawmakers they anticipate a budget overrun of about $140 million.
“I think if you sat back and looked at the whole picture, have you ever seen 15 months like the last 15 months, in terms of what’s going on?” Cummings asked. “NCTracks, NC FAST [the new electronic benefits-tracking system], reform and the Affordable Care Act on top of it.
“Keep in mind that until a few weeks ago, we were also gearing up for ICD 10,” he said, referring to the rollout of a new national medical coding system that Congress pushed back by a year several weeks ago.
Cummings was positive about the future of DMA, noting that he now receives almost “zero” emails and phone calls with complaints from providers about NCTracks payments.
He also said he believes the data created by the system will be robust enough to better predict the budget, drive efficiency and help accountable care organizations make decisions about managing patient care.
He also defended the reform plan’s strategy of keeping the state-funded mental health managed care organizations in place, noting that the details still need to be worked out on how ACOs will dovetail with the mental health MCOs.
“So I imagine there is going to be a lot of give and take between the two entities,” Cummings said. “My ACO is going to do better if I’ve got a close relationship with my regional MCO. Some of that will evolve over time – there are conversations and relationships.
“But it’s our job at the state level to enhance that conversation.”
But Cummings acknowledged that the changes in the Division of Medical Assistance and some of the rhetoric from the past year created morale issues in the division that have led to staffing shortages. He was quick to praise DMA employees as “talented, dedicated, good people, who are committed to what they do.”
“There are people who could leave tomorrow and go to a private job and do well and make more money and work less hours, but they stay there because they are committed to their position,” he said.
He also said he would be more careful about using the no-bid contracts that have recently angered critics and lawmakers.
“Our preference is to go through the [request for proposal] process,” Cummings said. “I think we need to use [no-bid contracts] very carefully and judiciously.”
Cummings/ NCHN Interview April29, 2014 (PDF)
Cummings/ NCHN Interview April29, 2014 (Text)