North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model

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Presentation transcript:

North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model Overview, March 27, 2012

Integrated Delivery Model Goals Improve responsiveness to beneficiary goals, Improve care quality, and Achieve shared savings

Strategic Framework Development Process Why: to integrate Medicare and Medicaid services and supports Who: 180 + volunteers, beneficiaries and more than 50 organizations What: Define what works well, what needs improvement

Acknowledges Individual differences in quality of life goals Wisdom of preventive services/quality care Need for flexibility to meet individual beneficiary goals to accommodate variation in the availability of natural supports and community resources

Building on Strengths Existing statewide medical home and population management strategy Community Care of North Carolina (CCNC) has 14 regional Networks In top 10 percent nationally on quality of diabetes, asthma, and heart disease care

Beneficiary Centered Medical Homes Work with beneficiaries as they define and refine their goals Physician led medical home teams to assist in the achievement of goals

Phase 1 Development Medical homes for nursing home and adult care home residents Independent assessment & functional need-based process for resource allocation Beneficiary and other stakeholders Work Groups to: Continue to refine the model Guide implementation & evaluation Design & implement community education

Community Education & Dialog Topics Medical home and model quality monitoring Beneficiary goal setting and team dynamics Importance of advance directives to specify personal preferences for instances when unable to express preferences yourself about physical health care and/or mental health care

Phase 2 – With Shared Savings Realign financial and regulatory incentives to: Build capacity & expand service and support options Establish new working relationships and information sharing, and Encourage broader use of actionable data