Overview Community 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 Provides North 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 Legend AccessCare Practice SitesCommunity Care Plan of Eastern Carolina AccessCare Network CountiesCommunity Health Partners Community Care of Western North CarolinaNorthern Piedmont Community Care Community Care of the Lower Cape FearNorthwest Community Care Carolina Collaborative Community CarePartnership for Health Management Community Care of Wake and Johnston CountiesCommunity Care of the Sandhills Community Care Partners of Greater MecklenburgCommunity Care of Southern Piedmont Carolina 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 medicines Make sure patient gets needed supports and services Connects patient back to primary care provider and any needed specialists  Refer and coordinate care with multiple providers, community resources and agencies

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