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CCNC 101 What is CCNC? An overview of structure and operations

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Community Care of North Carolina. 2012 Overview. Medicaid challenges. Lowering reimbursement reduces access and increases ER usage/costs Reducing eligibility or benefits limited by federal “maintenance of effort”; raises burden of uninsured on community and providers - PowerPoint PPT Presentation

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CCNC 101

What is CCNC?An overview of structure and operations

CCNC is:

People Knowledge Technology

CCNC is:

Evolution of a CCNC

1983: DMA & ORH partner to reduce ER use in Wilson county

1983: Pilot expanded to 12 counties in 1989

1990: Twelve-county program named Carolina Access, launched by Governor Jim Martin

1991: HCFA (now CMS) approves statewide expansion & $3 PMPM

1999: ORH begins contracting with local Networks; DMA joins later

2006: Central nonprofit organization (“N3CN”) created to apply for Medicare Duals demonstration

2008: N3CN directed to manage ABD population

2010: N3CN assumes responsibility for clinical/technical assistance

2013: DMA contracts with N3CN; N3CN contracts with 14 Networks and 1,800 practices to centralize accountability

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Company Structure

CCNC, Inc.

NCCCN, Inc.

CCNC Services,

Inc.

NC HIE, Inc.

Company Structure

CCNC, Inc.

NCCCN, Inc.

CCNC Services,

Inc.

NC HIE

Parent corporation for “family of companies

Match expertise and resources with emerging opportunities

Diverse, experienced Board of Directors

Seek innovative ways to carry out the core mission

Company Structure

CCNC, Inc.

NCCCN, Inc.

CCNC Services,

Inc.

NC HIE

Decade+ of practical data analytics and “what works” in Medicaid

Statewide population health management for 1.3 million people

Provider – led, community-based

Replicates “best practices” and brings them to scale

Company Structure

CCNC, Inc.

NCCCN, Inc.

CCNC Services,

Inc.

NC HIE

Provides products and services to stakeholder partners

Exports NC’s proven approach to other states

Generates private investment in technical infrastructure

Deep expertise generates additional resources to support mission

Company Structure

CCNC, Inc.

NCCCN, Inc.

CCNC Services,

Inc.

NC HIE, Inc.

Centralized, neutral hub for data from multiple sources.

Lets providers exchange and analyze health data electronically

Improves the quality, safety and efficiency of healthcare statewide.

Primary Care Capacity10

IndependentsFQHCOther (RHC, LHD, other)Large Health System OwnedOther Hospital OwnedProvider-led ACO’s

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LargeHealth System

Owned344,655

Other(RHC, LHD, other)

96,226

Provider-ledACO’s73,887

Independents644,602

FQHC100,800

OtherHospital Owned

120,869

Unenrolled355,413

Who provides medical homes for NC

Medicaid recipients?

*Numbers represent estimated number of members enrolled in each type of practice (total member months divided by 10).

Bubbles show inpatient admissions of patients enrolled in practices controlled by the large healthcare systems.

Cross-System Traffic

NC HIE, Inc.

27 participating NC hospitals

600 clinic sites Onramp for “safety net”

clinics like FQHC Secure, affordable access

to comprehensive patient health data

Awards and Recognition

US Senator Richard Burr Presents Healthcare Leadership Council’s national Wellness Frontiers

Award, 2013

Press release from Harvard University’s Ash Institute announcing 2007

Innovations Award

Key Initiatives

Project Lazarus – Statewide chronic pain and drug overdose prevention program

Pregnancy Medical HomePregnancy

Medical Home –

reducing pre-term births,

improving prenatal

care

Children’s Health Accountable Care Collaborative – 3-year CMS Innovations

grant to improve care for children with complex conditions.

Peer-reviewed research

Cuts Hospital Readmissions

20% reduction in readmissions for patients in the transitional care program.

12-month readmission rates consistently lower for participants within each level of clinical severity.

For every six interventions, one hospital readmissionavoided – strong ROI

Significant savings for 169,667 non-elderly, disabled Medicaid recipients

$184 million savings in about 5 years Higher per-person savings for patients with multiple chronic conditions.

Peer-reviewed research

Cuts Program Costs

National Model for What Works

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Community-based, physician-led medical homes coordinate care across health systems

Managed through 14 local, non-profit networks, ~1,800 practices & 6,000+ providers

Population Health Approach: Case management and medical home capacity building

Goal: Ensure patients receive optimal care, avoid unnecessary utilization and reduce costs

Health informatics target at-risk beneficiaries and high-impact care settings

Use of data to drive performance and standardization across networks

Medicaid savings achieved in partnership with doctors, hospitals and other providers

100 percent of savings remain in state

The CCNC Footprint Statewide

6,000 primary care providers

1,800 Practices 90% of PCPs in NC

1.4 million Medicaid Patients 300,000 Aged, Blind,

Disabled 150,000 Dually Eligible

All 100 NC Counties 14 Networks

Each network averages: 1.4 Medical Directors 42.8 Local Case Managers 1.8 Pharmacists 1.0 Psychiatrist

Local Network: Community Care of Wake/Johnston

155 primary care sites Wake Faculty Practices

103,000 Medicaid 5th largest network in

population

2 Medical Directors 39 Local Case Managers 3 PharmDs 2 Psychiatrists 1 Obstetrician

Embedded:

11 FTEs dedicated to WakeMed

9 Registered Nurses/SW 2 Patient Coordinators

Wake & Johnston Numbers

NCCCN, Inc.Avoids

Wasteful Spending

Resource allocation

ER admissions

Patient targeting

Pharmaceutical adherence

Improves Care

Medical home

Community resources

Performance data

Best practices

Physician-Led

6,000 primary care

providers

1,800 practices

90% participation

Data network

National Model

Innovation in American

Government Award

Wellness Frontiers

Award

Medicaid spending

trends

HEDIS top 10%

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Primary Care Foundation

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Primary Care Foundation

Data to inform decisions & focus efforts

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Primary Care Foundation

Data to inform decisions & focus efforts

Population mgmt: Stratify population, choose targets

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Primary Care Foundation

Data to inform decisions & focus efforts

Population mgmt: Stratify population, choose targets

Multi-disciplinary team:RX, Behavioral, Care Manager

CCNC Medical Home26

Primary Care Foundation

Data to inform decisions & focus efforts

Population mgmt: Stratify population, choose targets

Multi-disciplinary team:RX, Behavioral, Care Manager

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Advanced Medical HomesA Key to Healthcare Reform

Networks

14 networks cover all 100 NC counties

Networks develop local solutions to community health issues

Multi-disciplinary team works at “top of licenses”

Now including community pharmacists under CMMI grant

Physicians

Care Managers

Pharmacists

Clinicians

Behavioral Specialists

Networks

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Shared Vision, Aligned Goals

Provider-led Analytics-driven Best practices Shared protocols Controlling costs Improving outcomes Vulnerable populations

The CCNC Model

Palliative Care

Transitional Care

ED Management

Behavioral Health

Pharmacy Management

Population Management

Medical Home

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Where are the Opportunities?A Small Portion of Beneficiaries Are Responsible for a Disproportionate Share of Costs

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Where are the Opportunities?

Patient Segmentation to Manage Risk

Population Health Management33

Medicaid and Medicare

Aged, Blind and Disabled

Frail Elderly

Chronic Complex Comorbidities

Diabetes, Asthma, Congestive Heart Failure

Emergency Department “Frequent Flyers”

Recent Hospital Discharges

Substance Abusers

Focus Resources on Where it Matters Most

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K

Patient Risk Cohort #1

Patient Risk Cohort #2

Patient Risk Cohort #3

Targeting the “Impactable”

CCNC Services

Business verticals Population Health Management

Network and infrastructure development

PCMH support

Analytics

Decision Support

PHARMACeHOME

CCNC Services

Consulting Development Implement and Deployment Software Licensing

Analytics Decision support Informatics and Dashboards

Business Process Outsourcing Interventions Call Centers Network Support

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Our Products

Care TriageTM (pharmacy data analytics)

Predictive Modelling

Custom Interventions

Custom Dashboards

PHARMACeHOME

Network Development and Support

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Questions?

For more information, please see our website at www.communitycarenc.org

You can also contact CCNC Communications at [email protected]

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