community care of north carolina
DESCRIPTION
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 PresentationTRANSCRIPT
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
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
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
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
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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
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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