NORTH CAROLINA’S Medicaid Managed Care Program Jeffrey Simms Assistant Director, NC Division of Medical Assistance - DHHS.

Slides:



Advertisements
Similar presentations
Making Payment Reforms Work for Patients and Families Lee Partridge Senior Health Policy Advisor National Partnership for Women and Families January 28,
Advertisements

Community Care of North Carolina The Honorable Verla Insko N.C. House of Representatives.
Update on Recent Health Reform Activities in Minnesota.
FEBRUARY 2012 Nevada DHCFP 1115 Waiver Managing the Medicaid Population.
SAFETY NET NETWORK LEADERSHIP AND ADVISORY GROUP MEETING Wednesday, June 19, 2013.
Parent Professional Partnership Assuring an Integrated System of Care for CSHCN.
Partnering for Healthy Communities Since 1973 NC SCHOOL COMMUNITY HEALTH ALLIANCE Annual Meeting December 4, 2012.
Community Care Medical Home EnrollmentFor Adult Care Homes Hosted by: In conjunction with:
Medicaid Health Homes Presented by: Jayde Bumanglag, Quinne Custino & Sean Mackintosh.
Donald Mack, M.D. Ohio State University Medical Center Gregg Warshaw, M.D. University of Cincinnati College of Medicine.
1115 WAIVER Utah Department of Health Division of Medicaid and Health Financing 1Chacon.
Community Care of North Carolina 2012 Overview. Medicaid challenges  Lowering reimbursement reduces access and increases ER usage/costs  Reducing eligibility.
CSHCS Strategic Planning Michigan Issues George Baker, MD I. CSHCN Definition II. System of Care.
Patient Safety and Clinical Pharmacy Services Collaborative (PSPC)! Karen C. Williams, MBA, PharmD Office of Pharmacy Affairs Health Resources and Services.
Department of Health Care Policy and Financing 1 Colorado Department of Health Care Policy and Financing Presentation to the DU Strategic Issues Panel.
UNC-CH SPH Minority Health Conference February 29, 2008 Healthcare Access Session Jeffrey Simms, MSPH Deputy Director NC Office of Rural Health & Community.
Children’s Hospital of Michigan Mission, Vision, and Values.
Community Care of North Carolina 2012 Overview. Medicaid challenges  Lowering reimbursement reduces access and increases ER usage/costs  Reducing eligibility.
Access to Care: An Insurance Card that Means Something Getting to the Finish Line July 14, 2009 Amy Rosenthal, New England Alliance for Children’s Health.
Quality Management Update March 18, New Performance Improvement Project (1) Title: Controlled Substance Prescription Monitoring Program Database.
NCALHD Public Health Task Force NC State Health Director’s Conference January 2014 A Blueprint of the Future for Local Public Health Departments in North.
Missouri’s Primary Care and CMHC Health Home Initiative
MARCHING TO THE BEAT OF A DIFFERENT DRUM. Two States Experience Using the CHIPRA Quality Grant and ABCD To Test and Evaluate Promising Ideas To Improve.
Community Care of North Carolina Child Health Accountable Care Collaborative (CHACC)
Presented By William F Pilkington CEO, Cabarrus Health Alliance at the Public Health Data Standards Consortium November 4, 2010 REAL WORLD Learning from.
Overview Community Care of North Carolina. Our Vision and Key Principles  Develop a better healthcare system for NC starting with public payers  Strong.
Integrated Care in Practice Laura Galbreath, MPP Director, Center for Integrated Health Solutions May 15, 2013.
Affordable Care Act Aging Network Opportunities Judy Baker Regional Director Health and Human Services October 18, 2010.
Delaware Health and Social Services NAMI Delaware Conference: January 24, 2013 Rita Landgraf, Secretary, Department of Health and Social Services ACA and.
Primary Care and Behavioral Health 2/4/2011 CIBHA.
Managed MaineCare Initiative Discussion with the Stakeholder Advisory Committee 7/15/10 9/10/
Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions Mike Hall, Director Division of Integrated Health Systems Disabled.
Assuring Health Reform Meets the Needs of Children and Youth with Special Health Care Needs.
Stephanie Hull MGA Conference Chief, Long Term Services and Supports June 7, 2012 Maryland Department of Aging.
North Carolina’s 646 Quality Demonstration National Academy for State Health Policy’s 23 rd Annual State Health Policy Conference Denise Levis Hewson,
1 NAMD: Moving Past the Hype: Real World Payment Reforms in Virginia November 8, 2011 (2:15-3:45 p.m. session) Cindi B. Jones, Director Virginia Department.
State Coverage Initiatives Symposium February 7, 2008 Nashville, Tennessee Charles F. Willson MD Medical Director Community Care Plan of Eastern Carolina.
2004 CCNC “ Improving Medicaid Quality and Controlling Costs by Building Community Systems of Care” L. Allen Dobson,Jr. MD FAAFP Assistant Secretary NC.
2012. UWATX Program Areas Navigation Center Services.
Managing Care in Wisconsin Donna McDowell, MSS, Director Bureau of Aging & Disability Resources Division of Long-Term Care Dept. of Health Services ASA.
1 South Carolina Medicaid Coordinated Care and Enrollment Counselors Programs.
Overview of the Maryland Primary Adult Care (PAC) Program Rhode Island Policy Makers Breakfast November 17, 2010 Stacey Davis Deputy Director of Planning.
HEALTH HOMES ARKANSAS DEPARTMENT OF HUMAN SERVICES LONG-TERM CARE POLICY SUMMIT SEPTEMBER 5, 2012.
Partnering with Affordable Care Organizations Vernice Davis Anthony Greater Detroit Area Health Council President and CEO October 13, 2011.
1 Community Based Care Management Demonstration Project May 22 nd, 2008 Presenters: Geoff Green, Deputy Commissioner Deborah Nichols, Director Schaller.
Pennsylvania’s CHIP Expansion to Cover All Uninsured Kids.
1 Health Care Reform: The Patient Protection and Affordable Care Act (PPACA) Impact on Medicaid John G. Folkemer Deputy Secretary Health Care Financing.
The State Innovation Model Grant: The Importance of the SIM Grant to Maine 1 Mary C Mayhew Commissioner, Maine DHHS.
Healthy Alaska Plan Alaska Medicaid Redesign Initiative North Star Council on Aging Senior Center presented by Denise.
P4P as a Support Tool for Medicaid Disease Management Programs Jim Hardy President, Sellers-Feinberg.
Medical Homes For Children in Foster Care: A Proposal for CCNC Consideration Proposal collaboratively developed by: NC Pediatric Society Foundation & Benchmarks.
Community Care of North Carolina 2011 Overview March 15 th, 2011.
Maryland Medicaid’s Partnership in Improving Behavioral Health Services Susan Tucker Executive Director, Office of Health Services May 14, 2014.
1 The Patient Protection and Affordable Care Act.
CHCS Center for Health Care Strategies, Inc. Center for Health Care Strategies, Inc. Nikki Highsmith Center for Health Care Strategies June 7, 2007 Pay.
Health Reform: Local Safety Net Implications Karen J. Minyard, Ph.D., Executive Director, Georgia Health Policy Center, Georgia State University.
Improving Population Health through Effective Public-Private Partnerships LaQuandra S. Nesbitt, MD, MPH Director, DC DOH October 27, 2015.
1 Mmmmm Making Meaningful Measures Charles Gallia, PhD State of Oregon, Health Authority, Division of Medical Assistance Programs.
Mark Leeds Director of Long Term Care and Community Support Services April 26, 2012 Maryland Medicaid Advisory Committee: Balancing Incentive Program.
Department of Health and Social Services Division of Medicaid & Medical Assistance Joint Finance Committee Hearing Fiscal Year 2012 Rosanne Mahaney Division.
Planning Phase March 1, 2010 from 3 to 5 PM One Ashburton Place, 21 st Floor Conference Room # 3 Boston, Massachusetts Integrating Medicare and Medicaid.
Reengineering next steps Bruce Bailey, Co-Chair, Reengineering Steering Committee.
Approaches to Slowing Cost Growth in Public Programs State Coverage Initiatives National Meeting August 5, 2010 Nikki Highsmith Center for Health Care.
The New Jersey Department of Children & Families Division of Children’s System of Care.
The Patient Centered Medical Home. Learning Objectives Identify the attributes of a patient centered medical home Describe some processes that facilitate.
A Collaborative Approach to Early Care and Education BRAIDED FUNDING.
Human Services Delivery Systems and Organizations
FADAA Health Care Reform
Department of Health LIP Request
L. Allen Dobson ,Jr. MD FAAFP Assistant Secretary
Presentation transcript:

NORTH CAROLINA’S Medicaid Managed Care Program Jeffrey Simms Assistant Director, NC Division of Medical Assistance - DHHS

Medicaid Snapshots SFY 2001 N.C. Population 8,049,313 Medicaid Eligibles 1,354,593

North Carolina Medicaid Managed Care Statewide Primary Care Case Management Program: Carolina ACCESS > 700,000 enrollees HMO Option: Mecklenburg County Enrollment – 10,000 enrollees

CHALLENGE: Can the Primary Care Case Management Program become a vehicle for managing care, improving quality, and costs?

ISSUES:  PCPs feel limited in their ability to manage care  Local public health departments and area mental health programs are not looped into the medical care process  Duplication of services at the local level  Fragmented care

What Needs To Happen  Partnership  Population Management  Accountability

What is ACCESS II & III? An opportunity for community health care providers to collaborate and demonstrate their ability to manage the healthcare needs of the Medicaid population.

ACCESS II & III Is:  Built on Carolina ACCESS A collaborative effort between communities, providers and the State  A collaborative effort between communities, providers and the State

ACCESS II & III Goals u Increase access to care u Promote community based systems of care u Enhanced patient care management u Improve quality and cost effectiveness

ACCESS II & III Demonstration Projects ACCESS II - local integrated networks (10) - Statewide physician network (1) ACCESS III - countywide integrated networks (2) Collaborative networks comprised of key Medicaid providers: physicians, hospitals, health departments, departments of social services and other community organizations. 297,000 Enrollees (January 2003)

ACCESS II & III Initiatives Disease Management Asthma, Diabetes, CHF, Gastroenteritis Pharmacy Management Generic Prescribing, Polypharmacy Case Management Re-engineering

Asthma Disease Management

ABCD Pilot Project Commonwealth Funded/NASHP Administered “Assuring Better Child Development” Developing a comprehensive community model for child development in the medical practice. ASQ (Ages & Stages Questionnaire) 63% of children screened in 2 nd Qtr 02 compared to 3 % in 2 nd Qtr 99 Replicate in other ACCESS II & III practices

Major Challenges - Budget (the need to focus on initiatives with immediate returns) justification to the administration & legislature - Data needs - Recipient education & responsibility - Federal regulations (inability to mandatorily enroll dually eligibles, emergency room regulations EMTALA & Prudent Layperson)

Next Steps: - Statewide expansion of ACCESS II & III - Expansion of disease management initiatives - Expansion of cost containment initiatives - Explore provider incentives