1. North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model
Overview April 16, 2012

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

3. Strategic Framework Development Process
Why: Design a model to integrate Medicare and Medicaid services and supports to dual eligible beneficiaries
Who: volunteers including beneficiaries and more than 50 agencies & organizations
What: Define what works well, what needs improvement

4. 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

5. 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

6. 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

7. Phase 1 Development
Medical homes for dual eligible 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 and
Design & implement community education

8. 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

9. 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 

10. Proposal Review Process
March - April
NC Public Comment and Editing Period
May 2
May - June
Federal Public Comment and Review Period
July - August
CMS/NC Memorandum of Understanding Developed
NC Proposal Submitted to CMS

11. Implementation Time Line
Fall 2012
CMS/NC Negotiate Agreements
Readiness Review
Notifications
2013 Phase 1 – 18 months
ACH/NH Residents
Develop Independent Assessment & $$ Allocation Process
Community Education/Dialog
Phase 2 est. Mid & 2015
Shared Savings Become Available
Information Sharing & Capacity Incentives
Assess & Allocation Process Implemented/ More Flexible Use of Funds