North Carolina – Medical Homes
Community Care of North Carolina (CCNC)
Most North Carolina Medicaid recipients receive medical home services under the Community Care of North Carolina (CCNC) program. In 1998, CCNC launched as an eight-county, 100,000-enrollee pilot extension of the existing Carolina Access primary care case management (PCCM) program – which served the Aid to Families with Dependent Children (AFDC) population. Today, CCNC’s 14 regional non-profit networks of providers, practices, local health departments and community resources serve over 1 million Medicaid recipients across the state, including Aged, Blind and Disabled (ABD) recipients. For a full history of the CCNC program and its predecessors (which date to 1983), please click here.
Under the CCNC program, both primary care providers and the networks receive a per member per month (PMPM) fee to provide patient care, population management strategies (such as disease and care management, population stratification, preventive services and coordination across delivery settings), as well as support in implementing practice improvements. Evaluation of the CCNC program data has shown both cost savings and quality improvement, and has resulted in the state expanding the program to dual-eligible clients (individuals who qualify for both Medicaid and Medicare).
Other states routinely look to CCNC for guidance when developing and implementing similar programs. Through a Commonwealth Fund grant to the North Carolina Foundation for Advanced Health Programs, CCNC collated lessons learned and sample documents into a tool-kit of best practices for interested parties.
In August 2011, CCNC announced a private-public partnership known as “First in Health,” which will allow employees of GlaxoSmithKline, Kerr Drug, and SAS Institute, Inc. (as well as individuals covered under Blue Cross Blue Shield of North Carolina and the State Health Plan) to utilize the CCNC networks.
In 2010, North Carolina passed Session Law 2010-31, appropriations legislation that, among other things, mandated by July 1, 2012 the Department of Health and Human Services, the Division of Medical Assistance and the North Carolina Community Care Networks (NCCCN) create a comprehensive plan under Community Care of North Carolina (CCNC) that incorporates performance metrics with accountable budget and shared savings payment models. To learn more about accountable care activity in North Carolina, including this pilot, visit the North Carolina page of NASHP’s State Accountable Care Activity Map.
Federal Support:
- On May 24, 2012, the Centers for Medicare & Medicaid Services (CMS) approved a Section 2703 health home state plan amendment for Medicaid enrollees with chronic conditions that builds upon the state’s CCNC program. To be eligible, patients must have two qualifying chronic conditions, or one qualifying chronic condition and risk for a second. North Carolina had previously received a planning grant from CMS to develop a state plan amendment to implement Section 2703. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
- North Carolina is also one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) Demonstration program. Four payers – Medicare, Medicaid, the State Health Plan, and Blue Cross Blue Shield of North Carolina – participate in the demonstration in seven rural North Carolina counties.
- In addition to a 5-year 646 Waiver Medicare Quality Demonstration that allows CCNC to manage the care of over 200,000 dual eligible and Medicaid-only clients in 26 counties, North Carolina has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals” across the state.
- Furthermore, the Southern Piedmont Community Care Network has received a Beacon Community grant.
- In September 2011, North Carolina received an Infrastructure for Maintaining Primary Care Transformation (IMPaCT) award from the Agency for Healthcare Research and Quality (AHRQ). This project aims to enhance North Carolina’s nationally renowned primary care support and quality improvement system. Additionally, North Carolina partnered with four states to spread lessons from their work on supporting primary care practice improvement.
Last Updated: April 2014
| Forming Partnerships |
Community Care of North Carolina (CCNC): Community Care of North Carolina is a partnership that includes providers supported by the Medicaid agency (Division of Medical Assistance), Office of Rural Health and Community Care, local health departments, and Departments of Social Services and Hospitals. Each network is run locally by an Executive Director, who oversees a team of case managers, as well as a Medical Director, who works with local physicians who provide input.
In 2006, the North Carolina Governor convened a public-private collaboration of government, payers, and provider representatives to develop and implement a common set of best medical quality standards and measures for asthma, diabetes, congestive heart failure, hypertension and post myocardial infarction care. The Governor’s Quality Initiative, now known as the independent non-profit North Carolina Healthcare Quality Alliance (NCHQA), launched in 2008. The NCHQA Board of Directors also includes consumer and business representation. The NCHQA has played a key role in aligning quality initiatives to support and transform primary care.
Early North Carolina Medicaid medical home projects were made possible by support from the North Carolina Foundation for Advanced Health Programs, Inc. and the Kate B. Reynolds Health Care Trust.
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| Defining & Recognizing a Medical Home |
Definition:
Community Care of North Carolina (CCNC): CCNC describes a medical home as a place to receive preventative and sick care; where patients have continuous relationships with their providers and staff know patients’ medical histories; where patients have enhanced access; and have access to care coordination services. Please see the CCNC member handbook for more information.
Recognition:
Community Care of North Carolina (CCNC): While Community Care of North Carolina (CCNC) actively supports providers seeking NCQA PCMH Recognition, this recognition is not required for CCNC participation. However, the Division of Medical Assistance does require CCNC/Carolina Access providers to:
Additionally, providers must complete a provider agreement that stipulates additional requirements for the practice. A similar provider agreement exists for pregnancy medical homes.
ACA Section 2703 Health Homes: North Carolina’s health homes program is delivered through the Community Care of North Carolina program; health home providers must meet CCNC’s basic participation requirements, described above.
Medicare Advanced Primary Care Practice (MAPCP)Demonstration: Practices participating in the MAPCP Demonstration program must achieve NCQA Recognition. Furthermore, participating practices in the seven demonstration counties were required to achieve Blue Cross Blue Shield North Carolina (BCBSNC) Blue Quality Physician Program recognition by September 2013.
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| Aligning Reimbursement & Purchasing |
Community Care of North Carolina (CCNC): Currently, Community Care of North Carolina (CCNC) providers and networks both receive per-member per-month (PMPM) payments for each patient under their care in addition to fee-for-service reimbursement.
CCNC providers receive:
CCNC Networks receive:
Networks return $3.17 and $0.54 monthly for each ABD and non-ABD enrollee to support the central office.
Prior to statewide expansion and ABD participation, CCNC networks and providers both received $2.50 PMPM for each enrollee.
Carolina Access providers not participating in the Community Care of North Carolina program receive $1.00 PMPM.
ACA Section 2703 Health Homes: North Carolina’s health homes program pays practices and networks using the same methodology as the Community Care of North Carolina program, described above.
Medicare Advanced Primary Care Practice (MAPCP)Demonstration: Payments to participating practices vary by payer:
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| Supporting Practices |
Community Care of North Carolina (CCNC), ACA Section 2703 Health Homes, and Medicare Advanced Primary Care Practice (MAPCP) Demonstration: Local community networks provide support to physicians participating in all three programs. Networks consist of:
In addition to providing education programs and informational services, Area Health Education Centers (AHECs) are also helping practices achieve electronic health record (EHR) meaningful use as Regional Extension Centers.
The CCNC Patient-centered Medical Home (PCMH) team hosted eight webinars to help practices achieve 2008 NCQA PCMH Recognitionand has completed a 2008 NCQA PCMH Recognition Workbook. A 2011 NCQA PCMH Recognition webinar series and workbook is in development.
North Carolina also received an Infrastructure for Maintaining Primary Care Transformation (IMPaCT) award from the Agency for Healthcare Research and Quality (AHRQ) in September 2011. North Carolina’s IMPaCT project featured a Regional Leadership Collaborative and a Care Transitions Learning Collaborative to accelerate local-level process improvements and quality improvement in clinical performance measures. The Regional Leadership Collaborative focused on developing leadership and quality improvement skills among regional teams. The Care Transitions Learning Collaborative concentrated on integrating care transitions into primary care practices’ roles as part of the PCMH.
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| Measuring Results |
Community Care of North Carolina (CCNC): Treo Solutions, Inc. has reported that Community Care of North Carolina has saved over $1.5 billion between 2007 and 2009. Mercer, Inc. prepared studies that found annual savings ranging from $154-194 million between 2006 and 2009.
CCNC has also reported that enrollee’s diabetes, asthma, and heart disease HEDIS measures rank in the top 10% nationally (compared to commercial managed care plans).
Practice assessments are completed by local Community Care Program Office using:
Furthermore, an informatics center can provide feedback reports at the individual, practice, network and state levels. However, certain data (including substance abuse and HIV data) cannot be included in individual reports.
The Brookings Institution will be evaluating the public-private “First in Health” program’s impact on both quality and cost of care.
ACA Section 2703 Health Homes: North Carolina will use claims data, a provider survey, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey to evaluate progress toward the state’s three goals for this state plan amendment:
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