OverviewCommunity Care of North Carolina

Our Vision and Key Principles

Develop a better healthcare system for NC starting with public payers

Strong primary care is foundational to a high performing healthcare system

Additional resources needed to help primary care providers manage population health

Timely data is essential to success

Must build better local healthcare systems via public-private partnerships

Physician leadership is critical

Improve the quality of the care provided and cost will come down

A risk model is not essential to success, shared accountability is

Need to implement a patient-centered model of care

2

Primary Goals of Community Care Improve the care of the enrolled population

while controlling costs Create a “medical home” for patients,

emphasizing primary care Build community networks capable of

managing beneficiary care Establish local systems that improve

management of chronic illness in both rural and urban settings

Community Care ProvidesNorth Carolina with:

Statewide medical home & care management system to address quality, utilization and cost

100 percent of all Medicaid savings remain in state

A private sector Medicaid management solution that improves access and quality of care

Medicaid savings that are achieved in partnership with – rather than in opposition to – doctors, hospitals and other providers.

Source: CCNC 2011

LegendAccessCare Practice Sites Community Care Plan of Eastern CarolinaAccessCare Network Counties Community Health PartnersCommunity Care of Western North Carolina Northern Piedmont Community CareCommunity Care of the Lower Cape Fear Northwest Community CareCarolina Collaborative Community Care Partnership for Health ManagementCommunity Care of Wake and Johnston Counties Community Care of the Sandhills Community Care Partners of Greater Mecklenburg Community Care of Southern PiedmontCarolina Community Health Partnership

Community Care: “How it works” Primary care medical home serving 1.2 million

Medicaid and Health Choice recipients in all 100 counties.

Provides 4,500 local primary care physicians (PCPs) -- 94% of all NC PCPs-- with resources to better manage Medicaid population

Links local community providers (health systems, hospitals, health departments and other community providers) to primary care physicians

Every network provides local care managers (600), pharmacists (26), psychiatrists (14) and medical directors (20) to improve local health care delivery

How it Works, cont.

The state identifies priorities and provides financial support through an enhanced per member per month (PMPM )payments to community networks

14 local networks pilot potential solutions and monitor implementation

Networks voluntarily share best practice solutions, best practices are spread to other networks

The state provides the networks (CCNC)access to data Cost savings / effectiveness are evaluated by the state

and third-party consultants (Mercer, Treo Solutions)

Community Care Networks

Are non-profit organizations Seek to incorporate all providers, including safety net

providers Have Medical Management Committee oversight Receive a PM/PM from the State for most enrollees Hire care management staff to work with enrollees and

PCPs Participating PCPs receive a PM/PM to provide a

medical home and participate in Disease Management and Quality Improvement

Each CCNC Network Has:

A Clinical Director

A physician who is well known in the community

Works with network physicians to build compliance with CCNC care improvement objectives

Provides oversight for quality improvement in practices

Serves on the State Clinical Directors Committee

Each CCNC Network Also Has: A Network Director who manages daily operations

Care Managers to help coordinate services for enrollees/practices

A PharmD to assist with Medication Management of high cost patients

A Psychiatrist & Behavioral Health Coordinator to assist with mental health integration

Palliative Care and Pregnancy Home Coordinators

Social Work support

Patient Benefits to Participating in Medical Home

Help patient really understand chronic condition and how to manage it

Help overcome barriers to managing health Help with transitions Help get right screenings and preventive services Refer & coordinate care with specialists Help patient remain healthy – promote nutrition,

exercise and stress reduction

Cont. Patient Benefits to Participating in Medical Home

Help after a hospitalization, if needed:Help understanding medicinesMake sure patient gets needed supports and

servicesConnects patient back to primary care provider

and any needed specialists Refer and coordinate care with multiple

providers, community resources and agencies

More information?

www.communitycarenc.org