Community Care of North Carolina

North Carolina Division of Medical Assistance

Purpose:

To improve the quality of care provided to the Medicaid population through the use of medical homes by contracting with community health networks organized and operated by community physicians, hospitals, health departments, and departments of social services

Target Population:

North Carolina Medicaid population: Ongoing demonstration programs revolve around specific disease states - asthma, diabetes, heart failure and mental health; there is an intensive program with the aged, blind and disabled population

Program Goals:

• Reduce the increasing rate of Medicaid costs (secondary to quality, though) - saving
  money for the state
• Place responsibility for performance (and improvement) in the hands of those who actually
  deliver the care
• Institute independent local networks that can manage all Medicaid patients and services and
  can address larger community health issues
• Ensure that all funds are kept local and go toward providing care
  

Years in Operation:

2002 – present

Results:

A study performed by Mercer Government Human Services Consulting found that, when compared to historical fee-for-service program benchmarks, the state saved $195 to $215 million in 2003 and between $230 and $260 million in 2004

Funding:

North Carolina Division of Medical Assistance

Key Partners:

Initially, the program received grants from the Kate B. Reynolds Foundation, the DukeEndowment, and pharmaceutical companies. Two state agencies, the Division of Medical assistance (Medicaid) and the Office of Research, Demonstrations and Rural Health Development, jointly administer and supervise the local networks

What Works and Why:

The program has always balanced cost and quality, operating under the premise that improving the quality of care will reduce the cost of care delivery in the long run. Allowing local networks to have authority and management for taking care of their respective populations made a tremendous difference. The networks were successful because each network has an established group of community experts to help solve local health problems. Each network employed nurses and/or social workers to coordinate care and identify high-risk patients. These physicians and community leaders have tremendous buy-in, and their support has been critical.

Structure and Operations:

Community Care of North Carolina (CCNC) consists of 15 local networks across the state and involves more than 3,000 physicians who practice in collaboration with local social service agencies. All local CCNC networks are nonprofit organizations which, at a minimum, include area primary care providers (PCPs), a hospital, the county Department of Social Services (Medicaid) office, and the county health department. Each provider receives a $2.50 per member per month (PMPM) Medicaid enhanced care management fee. Each network utilizes information gathered both locally and through the state's Medicaid claims system to assess the needs and severity of local Medicaid enrollees. From this information, targeted care and disease management initiatives are developed for those enrollees at greatest risk, who are then followed with comprehensive care management initiatives designed to improve health outcomes.

Barriers to Success:

Practice patterns of physicians are not easily changed. For specialists, the proportion of their patient population represented by Medicaid may not be sufficiently large to warrant participation. Rolling enrollment of Medicaid population makes sustained intervention challenging.

Future savings may be difficult to achieve or to sustain given rapidly increasing medical costs.

More Information:

http://www.communitycarenc.com

Download:

Download this program information in PDF format.