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September 2011 St@teside

North Carolina Employees Join Successful Medical Home Network

Community Care of North Carolina is one of the longest running medical home networks in the nation, and, for the first time, will accept people with job-based insurance. The network has managed North Carolina’s Medicaid population—even the most costly—with low administrative costs, and proven measurable results.The term “medical home” is given to efforts that transform how primary care is organized and delivered. According to the Agency for Healthcare Research and Quality (AHRQ) a medical home encompasses five functions and attributes:

  • Patient-centered. A relationship centering around the patient and a primary care provider;

  • Comprehensive care. Care given from a team of providers (physicians, nurse practitioners, nutritionists, pharmacists, and mental health providers);

  • Coordinated care. Coordination across the entire health system—specialty care, hospitals, home health care, and community services;

  • Superb access to care. Making care more accessible and tailored to patients’ preferences; and

  • A systems-based approach to quality and safety. Utilizing quality improvement strategies and performance measurement tools to better manage health outcomes.

Community Care of North Carolina (CCNC) has evolved over the last 25 years, and is one of the nation’s most studied medical home networks. CCNC is a public-private partnership between the state and 14 community care networks, covering all counties and serving more than 1 million enrollees—the majority Medicaid recipients. In an effort to manage a growing Medicaid budget, North Carolina’s legislature appropriated $6 million in 2005 for CCNC to extend its service model to the most costly Medicaid beneficiaries—the blind, aged, and disabled. Two years later, the chronic care initiative was implemented across the program. At the end of 2005, the community-based model expanded once again to serve patients eligible for both Medicare and Medicaid (dual eligibles), and at-risk Medicare patients. Mercer cost analyses found CCNC saved between $135 million and $194 million in health care costs between state fiscal years 2007 and 2009. More recent estimates from Treo Solutions found CCNC saved about $1.5 billion in health care costs in 2007, 2008, and 2009 combined.

Now, North Carolina employers, GlaxoSmithKline, Kerr Drug, SAS, and Blue Cross and Blue Shield of North Carolina, are voluntarily enrolling their employees in the CCNC network. CCNC and its physicians receive about $2.50 per enrollee per month to incentivize care coordination. Employers who offer CCNC also pay a fee for those who participate. Employers hope that by including CCNC in existing health insurance coverage offerings they will see better coordination of care and cost savings.

Maine, Maryland, and New York also have medical home programs or pilot projects that private insurers and employers can join. To view a list of states with medical home pilots click here.