03/20/17 — New DHHS secretary visits city

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New DHHS secretary visits city

By Steve Herring
Published in News on March 20, 2017 9:57 AM

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Cherry Hospital CEO Luckey Welsh meets with North Carolina Department of Health Secretary Mandy Cohen at the entrance of Cherry Hospital before touring the facility Friday.

The opioid addiction crisis and a shift in how the state pays for Medicaid services are issues facing Mandy Cohen, North Carolina's new secretary of the Department of Health and Human Services.

Mrs. Cohen, who has only been in office six weeks, was in Goldsboro Friday to visit Cherry Hospital, O'Berry Center and Work Source East.

An internal medicine physician with experience leading complex health organizations, Ms. Cohen said she is doing a "lot of listening and learning."

"I didn't come here knowing all of the answers and exactly what we are going to do," she said. "I think it is really important to get a sense of what is going on in North Carolina.

"Mostly what I have been sharing with folks over the past six weeks that I have been here is how we are going to approach the work because I think that shapes what we are going to do as well. I really focus on the values that we bring to the work."

Mrs. Cohen said she is very focused on working as a team since it will take a team effort to address the opioid crisis.

"We got here for a lot of reasons, complex reasons, and so it is going to take a complex solution," she said. "It is not just going to be in public health. It is not just going to be in Medicaid and in mental health or social services, but really across our entire department."

The crisis touches every area of the department, and they all have a role, including her, she said.

Mrs. Cohen said that as a physician she has written prescriptions for opioid medications.

She said she has penned a letter to every prescriber -- physicians, dentists, nurse practitioners -- in the state asking for their help.

It is a start if people are using the proper guidelines for writing prescriptions, so that people don't go down that addiction path to begin with, she said.

Prescribers must talk about opioid abuse and ask about the issue with their patients, Mrs. Cohen said.

The discussion will need to include treatment and prevention, she said.

Mrs. Cohen has applied for a federal grant to assist with treatment and is working with the General Assembly for additional treatment dollars.

Gov. Roy Cooper's budget includes funding for the opioid crisis, she said.

"When I talk about working as a team, I really mean about how we communicate differently, be transparent about where we are, and trust each other," she said. "There has been a lack of trust, within the department, with the department and the General Assembly, with us and the medical community.

"We need to build back that trust. I think working on a hard problem like the opioid crisis can help us show that we can all solve a hard problem together. There will be another hard problem, and another hard problem to solve."

One of those is Medicaid.

Her office will oversee the state's move to a new way of paying for Medicaid services.

Mrs. Cohen said she views the change as an opportunity to get the best possible out of the program.

Currently the state is the payer so that if a hospital takes care of a Medicaid patient, the state pays.

Under the new system, which still has to be approved on the federal level, the state would use managed care, which generally means private insurance companies, she said.

Some are commercial, like United or Aetna, she said.

Others are not-for-profits like Blue Cross while others are provider led or hospital led like UNC or Duke.

"So there will be new payers in the mix," she said. "We will have a process where they will bid to be a payer. Then we, the state, for the people they enroll will give them a capitated payment for the services.

"So we say great you have 80 people. Here is your money for 80 people. You work on working with the hospitals directly to get better outcomes (prices)."

In other words, the state provides a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services.

Almost all of the larger states in the country have gone to the system with varying degrees of success, she said.

"So what I am trying to do is learn the best lessons that I can from those other states that have done that, and see how we can drive the most improvement in our system while making that change," she said.

Mrs. Cohen has experience in the area.

She was most recently the chief operating officer and chief of staff at the Centers for Medicare and Medicaid Services, a federal agency within the U.S. Department of Health and Human Services.

She has been responsible for implementing policies for Medicare, Medicaid, the Children's Health Insurance Program and the Federal Marketplace.

Before serving that, Mrs. Cohen was the principal deputy director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services where she oversaw the Health Insurance Marketplace and private insurance market regulation.

Prior to her role in Center for Consumer Information and Insurance Oversight, Mrs. Cohen was the director of Stakeholder Engagement for the Centers for Medicare and Medicaid Service Innovation Center, where she worked with the Innovation Center's many stakeholders to identify and test new payment and care delivery models.

Mrs. Cohen graduated from Cornell University, received her medical degree from Yale School of Medicine. She has a master's in public health from the Harvard School of Public Health, and trained in internal medicine at Massachusetts General Hospital.

She is married to Sam Cohen, a health care regulatory lawyer, and has two daughters.