Overview
The North Carolina Physician Advisory Group (NCPAG) is a charitable, nonprofit organization that was created for the purpose of advising the North Carolina Department of Health and Human Services (NCDHHS) on ways to improve the health of the state’s Medicaid beneficiaries. The primary function of the NCPAG Board of Directors is to provide medical and clinical policy advice to the North Carolina Medicaid program.
The NCPAG is composed of a Board of Directors and Standing Committees. Additional consultant appointments are made in key areas to serve as additional resources for NCPAG committees, subcommittees, task forces and ad hoc groups. All members of the NCPAG are required to sign a Confidentiality Policy Statement and a Conflict of Interest Disclosure Statement.
Board of Directors
The NCPAG Board members are physicians and dentists board certified in their medical specialty, licensed to practice in the state of North Carolina, and providers of care to Medicaid patients.
The NCPAG Board of Directors includes representatives of professional organizations that represent family practice, pediatrics, internal medicine, obstetrics/gynecology, psychiatry, and dentistry as well as other physician/dentist members. In appointing board members, NCPAG considers experience with underserved populations and managed care systems, as well as diversity of geographic, cultural and demographic representation. Diversity of type of practice (eg. independent or system owned, academic, federally qualified clinic) is also considered.
Mission
The mission of the NC Physician Advisory Group (NCPAG) is to work collaboratively with NC providers in advising the North Carolina Department of Health and Human Services (NCDHHS) on ways to improve the health of the state’s Medicaid beneficiaries.
Values
The NCPAG holds several core principles to guide our work. In every decision we make, the health and well-being of NC Medicaid beneficiaries are our number one priority. Provider participation in the Medicaid program increases access to care for this population, and therefore we also seek opportunities to improve providers’ experience and efficiency in service delivery. We maintain a strong commitment to high-value care and strive to base our decisions on best available evidence.
The NCPAG is committed to achieving a vision of equity in healthcare experience, delivery, and outcomes. This vision begins with the organization’s goals to achieve a Board structure reflecting the diversity of NC’s Medicaid population and to constantly examine its own biases. Diversity includes the range of personal experiences, values, and worldviews arising from differences of culture and circumstance. These differences include, but are not limited to, race, ethnicity, gender, gender identity, sexual orientation, and geography. Together with building a diverse community, the NCPAG Board is committed to nurturing a culture which welcomes, supports, and engages diverse ideas. Diverse physician and dental leadership with a supportive culture will strengthen the NCPAG’s work to improve the health of the state’s Medicaid population and achieve health equity.
Legislative Charge
“During the development of new medical coverage policy or amendment to existing medical coverage policy, the Department shall consult with and seek the advice of the Physician Advisory Group and other organizations the Secretary deems appropriate.”
Policy Reviews
The NCPAG reviews, makes recommendations and provides advice to DHHS on clinical coverage policies. NC Medicaid initiates the review process by introducing the policy to the NCPAG. Once the policy is presented by Medicaid, the NCPAG Board of Directors determines the best process for effective policy review. Reviews can be performed by board members, committee, task force, ad hoc teams, groups of professionals, or a single professional. Upon completing the policy review, the board votes and submits its recommendations to Medicaid.
NCPAG’s medical coverage policy review encompasses the following activities:
- Provide formal policy review and recommendations on new medical coverage policies
- Provide formal policy review and recommendations on revisions to existing medical policy
- Maintain standing committees as requested to assist with ongoing policy issues
- Assure that committees are adequately representative of all relevant provider groups
- Assist the NCDHHS with challenging issues and planning by providing clinical/community perspective
- Provide panel of experts to serve as a resource to the NCDHHS for challenging clinical questions
- Seek opportunities for quality improvement
History
1997 Articles of Incorporation of NC Physician Advisory Group filed with Secretary of State of North Carolina.
Purpose: The purposes of this Corporation are to improve the health of the state’s vulnerable populations by expanding access to quality, cost-effective health care services.
Established Role: The Corporation shall seek to facilitate the development and operation of community-based, provider-driven managed care systems and to work with the NC Division of Medical Assistance and other public agencies to implement medical management policies and procedures to ensure that Medicaid and other low income patients receive appropriate, quality care. The Corporation may conduct such other activities and programs in furtherance of the foregoing purpose as may be carried out by a corporation organized under the North Carolina Nonprofit Corporation Act.
1998 Cooperative Agreement signed between NC Department of Health and Human Services, Division of Medical Assistance & North Carolina Medical Society.
Purpose: The Medical Society has formed a Physician Advisory Group (hereinafter referred to as “Advisory Group”) to focus on assisting the State Agency in furthering the goals and objectives of the Carolina ACCESS program.
Established Roles: In consideration of the mutual promises of each party, the State Agency and Medical Society agree as follows:
The Medical Society agrees to direct the Advisory Group to assist State Agency as follows, when feasible as determined by the Advisory Group:
a. Assist State Agency in physician recruitment and education by using its network of physicians to: recruit and educate other physicians about the Carolina ACCESS program and encourage their participation; sponsor and participate in educational efforts to recruit more Primary Care Physicians
(PCPs) for the program; incorporate information about Carolina ACCESS in their educational endeavors.
b. Assist State Agency in developing and implementing care management programs by advising on the development of disease management programs and other care management protocols and policies that concentrate on the use of appropriate, cost effective care and assisting in training physicians on the use of care management protocols.
c. Assist State Agency in effective utilization of data by: advising on the data needs of primary care physicians who are effectively managing patient care; advising on the content, format, frequency, and target audience for physician reporting; educating and training physicians in the effective use of data; advising on how the data generated by State Agency should be used to enhance quality improvement efforts.
d. Assist State Agency in quality improvement by providing advice and guidance on quality improvement activities and by helping to educate and train participating physicians in this area.
The State Agency agrees:
a. To assist in any way possible in formulating the policies and procedures necessary to facilitate the development of this Advisory Group by the Medical Society.
b. To provide information necessary to allow Advisory Group to achieve the objectives mentioned above.
c. To inform the Advisory Group regarding the development of any new policies and/or procedures within the Carolina ACCESS program.
d. To keep Advisory Group informed of any proposed changes in this program.
2020 PAG completes a bylaws change to remove the formal oversight role of the NC Medical Society board over PAG board composition. This change was made to avoid the potential perception of conflict of interest due to NCMS’ association with one Medicaid prepaid health plan. The PAG board is now self-perpetuating, a common arrangement for 501(c)3 boards, in which current members are responsible for recruiting and electing new members.