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North Carolina CHIP Fact Sheet

Webinar: Increasing Rates of Virologic Suppression: Promising Practices from HIV Health Improvement Affinity Group States

Wednesday, Dec. 6, 2017 | 2:30 to 4 pm EST

Increasing rates of virologic suppression among people living with HIV is critically important to improving their quality of life and decreasing the risk of further HIV transmission. For the last 12 months, the HIV Health Improvement Affinity Group has worked with state health departments and Medicaid agencies from 19 states to develop and implement performance improvement projects aimed at improving rates of sustained virologic suppression among Medicaid beneficiaries living with HIV. This webinar featured leaders from the Office of HIV/AIDS and Infectious Disease Policy in the US Department of Health & Human Services, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. It also featured Affinity Group states, Alaska and North Carolina, that shared lessons learned and best practices from their performance improvement projects.
The Affinity Group is a joint initiative among the following Department of Health and Human Services agencies: Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, and Health Resources and Services Administration, in collaboration with the Office of HIV/AIDS and Infectious Disease Policy, and in partnership with the National Academy for State Health Policy.

Care Coordination under the Medicaid Benefit for Children and Adolescents

August 25, 2014/in Policy Webinars Chronic and Complex Populations, Health Coverage and Access, Maternal, Child, and Adolescent Health /by NASHP

Tuesday, September 9, 2014
3:00 – 4:00 pm ET
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Care coordination provides a bridge across multiple systems that serve children and families, helping to ensure that a child receives additional screening, diagnosis and/or treatment as recommended by a health care practitioner. Care coordination strategies can help link providers and care settings by facilitating the arrangement of: appointments, referral forms, transportation, reminders and follow-up, and feedback reporting. This NASHP webinar provides a federal perspective from the Centers for Medicare & Medicaid Services on opportunities and promising strategies for states to coordinate care for children and adolescents enrolled in Medicaid.
The webinar is followed by a conversation with presenters from North Carolina and Oregon about strategies those states are using to bridge multiple systems for Medicaid–enrolled children. These states discuss building on patient-centered medical home infrastructure to coordinate care for children, facilitating data sharing across providers and measuring outcomes, and emerging issues that will impact new care coordination models. This webinar is the fifth and final in a series on the Medicaid benefit for children and adolescents (also known as EPSDT). In conjunction with this webinar series, NASHP launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.

Speakers

Rosemary Feild, Insurance Specialist, Division of Quality, Evaluation & Health Outcomes, CMCS, CMS
Dana Hargunani, Child Health Director, Oregon Health Authority
Chris Collins, Director, Office of Rural Health and Community Care, North Carolina Department of Health and Human Services

Shared Resources to Sustain Primary Care Transformation

June 20, 2014/in Policy Reports Cost, Payment, and Delivery Reform /by NASHP and Mike Stanek

Primary care practices transitioning to enhanced models of primary care require ongoing support to sustain their transformation efforts. Small and medium-sized practices in particular can benefit from shared resources facilitating care coordination and case management, use of data and technology, and ongoing practice improvement. This State Health Policy Briefing outlines key elements of a shared infrastructure to sustain primary care transformation, identifies policy levers available to federal and state policymakers to support these elements, and highlights relevant initiatives at both levels of government. It also summarizes key areas for policy improvement identified during a meeting of federal and state officials convened by NASHP.

Michael Stanek

June 2014

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Engaging Adolescents Through the Medicaid Benefit for Children and Adolescents

May 21, 2014/in Policy Webinars Health Coverage and Access /by NASHP

Wednesday, May 21, 2014
2:00 – 3:00 pm ET

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State Medicaid programs are pioneering innovative strategies for reaching adolescents, both to increase the rate of adolescent well-care visits and to strengthen the provider-adolescent relationship. While adolescents are a challenging population to reach—well-care visit rates decline as children age into adolescence—they are a particularly critical group to target under the Medicaid benefit because adolescence is a time of dramatic physical, cognitive, social, and emotional change.
This NASHP webinar offers a federal perspective from the Centers for Medicare & Medicaid Services on opportunities and promising strategies for states to leverage the Medicaid benefit for children and adolescents to better engage and meet the needs of adolescents. This is followed by a conversation with presenters from two states about initiatives they have launched to better serve adolescents using the Medicaid benefit for children. Participants learn about these states’ strategies for getting Medicaid-enrolled adolescents the services they need, and key lessons learned in implementing them.
This webinar is the second in a series on the Medicaid benefit for children and adolescents: future webinars will delve more deeply into additional topics on health services for children. In conjunction with this webinar series, NASHP recently launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.

Speakers

Elizabeth Hill, Centers for Medicare & Medicaid Services
Marian Earls, Lead Pediatric Consultant for Community Care of North Carolina and lead on state CHIPRA quality demonstration
Sarah Nickels, Co-Director, School-Based Health Center Improvement Project, Colorado Department of Public Health and Environment

Financing Prevention: How States are Balancing Delivery System & Public Health Roles

April 14, 2014/in Policy Reports Accountable Health, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement, Quality and Measurement, Safety Net Providers and Rural Health, Social Determinants of Health, Value-Based Purchasing /by Carla Plaza, Abigail Arons, Jill Rosenthal and Felicia Heider

This report, developed by the National Academy for State Health Policy and produced by ChangeLab Solutions, highlights leading states’ approaches to support community-based prevention initiatives by bridging the health care delivery and public health systems. It examines various mechanisms – both previously existing and created through health reform – that states can leverage to implement sustainable community-based prevention programs. They include Medicaid waivers, federal grants, accountable care and medical home models, pooled funding, and new federal requirements for nonprofit hospitals. The report includes opportunities and lessons from featured states (California, Maryland, Massachusetts, Minnesota, North Carolina, Oregon, Texas, and Vermont).

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IMPaCTing Meaningful Improvements in Primary Care Practice

April 9, 2014/in Policy Webinars Cost, Payment, and Delivery Reform, Population Health /by NASHP

Primary care extension programs improve the quality of primary care services by educating providers on new and innovative practices in areas such as preventive medicine, health promotion, and chronic disease management. Section 5405 of the Affordable Care Act authorizes the establishment of a national primary care extension program. To pursue this goal, the Agency for Healthcare Research and Quality (AHRQ) established the Infrastructure for Maintaining Primary Care Transformation (IMPaCT) initiative as a pilot to build on states with strong existing extension programs to serve as a potential model for a national extension program.
This webinar will feature a high-level overview from each of the four lead IMPaCT states (New Mexico, North Carolina, Oklahoma and Pennsylvania) that highlights key components of their extension models. Following the overviews, a facilitated discussion with state officials from these states will illuminate the role of, and implications for, state agencies in this work. Following the discussion, participants will have the opportunity to ask questions of the speakers.
Speakers:

Bob Mcnellis, Senior Advisor for Primary Care, Agency for Healthcare Research and Quality (AHRQ)
Darren DeWalt, MD, MPH, Associate Professor of Medicine, Division of General Internal Medicine, University of North Carolina – Chapel Hill
Robert Gabbay, MD, PHD, Chief Medical Officer and Senior Vice President, Joslin Diabetes Center
Art Kaufman, MD, Vice Chancellor for Community Health; Distinguished Professor, Family & Community Medicine, University of New Mexico Health Sciences Center
Jim Mold, MD, MPH, Director, Research Division, Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center
Chris Collins, MSW, Director, Office of Rural Health and Community Care, North Carolina Department of Health and Human Services
Marcela Myers, MD, Director of Pennsylvania Center for Practice Transformation and Innovation, Pennsylvania Department of Health
Garth Splinter, Medicaid Director, Oklahoma Health Care Authority

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Realizing Rural Care Coordination: Considerations and Action Steps for State Policy-Makers

April 7, 2014/in Policy Reports Chronic and Complex Populations /by Mike Stanek, NASHP and Tess Shiras

States seeking to promote better coordination of patient care, either within Medicaid or through participation in multi-payer initiatives, will run into long-standing challenges to delivering care and promoting health in rural areas. Rural areas often experience disparities in access to care, health status, and available infrastructure relative to their urban counterparts. This brief draws from health initiatives undertaken in Alabama, Colorado, Montana, New Mexico, North Carolina, and Vermont to identify common policy considerations and action steps for coordinating care in rural areas. The brief was supported by the Robert Wood Johnson Foundation’s State Health and Value Strategies.

April 2014

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North Carolina – Medical Homes

April 1, 2014/in Policy North Carolina /by Medical Homes

Community Care of North Carolina (CCNC)
Most North Carolina Medicaid recipients receive medical home services under the Community Care of North Carolina (CCNC) program. In 1998, CCNC launched as an eight-county, 100,000-enrollee pilot extension of the existing Carolina Access primary care case management (PCCM) program – which served the Aid to Families with Dependent Children (AFDC) population. Today, CCNC’s 14 regional non-profit networks of providers, practices, local health departments and community resources serve over 1 million Medicaid recipients across the state, including Aged, Blind and Disabled (ABD) recipients. For a full history of the CCNC program and its predecessors (which date to 1983), please click here.
Under the CCNC program, both primary care providers and the networks receive a per member per month (PMPM) fee to provide patient care, population management strategies (such as disease and care management, population stratification, preventive services and coordination across delivery settings), as well as support in implementing practice improvements. Evaluation of the CCNC program data has shown both cost savings and quality improvement, and has resulted in the state expanding the program to dual-eligible clients (individuals who qualify for both Medicaid and Medicare).
Other states routinely look to CCNC for guidance when developing and implementing similar programs. Through a Commonwealth Fund grant to the North Carolina Foundation for Advanced Health Programs, CCNC collated lessons learned and sample documents into a tool-kit of best practices for interested parties.
In August 2011, CCNC announced a private-public partnership known as “First in Health,” which will allow employees of GlaxoSmithKline, Kerr Drug, and SAS Institute, Inc. (as well as individuals covered under Blue Cross Blue Shield of North Carolina and the State Health Plan) to utilize the CCNC networks.
In 2010, North Carolina passed Session Law 2010-31, appropriations legislation that, among other things, mandated by July 1, 2012 the Department of Health and Human Services, the Division of Medical Assistance and the North Carolina Community Care Networks (NCCCN) create a comprehensive plan under Community Care of North Carolina (CCNC) that incorporates performance metrics with accountable budget and shared savings payment models. To learn more about accountable care activity in North Carolina, including this pilot, visit the North Carolina page of NASHP’s State Accountable Care Activity Map.
Federal Support:

On May 24, 2012, the Centers for Medicare & Medicaid Services (CMS) approved a Section 2703 health home state plan amendment for Medicaid enrollees with chronic conditions that builds upon the state’s CCNC program. To be eligible, patients must have two qualifying chronic conditions, or one qualifying chronic condition and risk for a second. North Carolina had previously received a planning grant from CMS to develop a state plan amendment to implement Section 2703. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
North Carolina is also one of the eight states selected to participate in the Medicare Advanced Primary Care Practice (MAPCP) Demonstration program. Four payers – Medicare, Medicaid, the State Health Plan, and Blue Cross Blue Shield of North Carolina – participate in the demonstration in seven rural North Carolina counties.
In addition to a 5-year 646 Waiver Medicare Quality Demonstration that allows CCNC to manage the care of over 200,000 dual eligible and Medicaid-only clients in 26 counties, North Carolina has also received a duals demonstration grant from the Centers for Medicare & Medicaid Services (CMS) to “coordinate care across primary, acute, behavioral health and long-term supports and services for dual eligible individuals” across the state.
Furthermore, the Southern Piedmont Community Care Network has received a Beacon Community grant.
In September 2011, North Carolina received an Infrastructure for Maintaining Primary Care Transformation (IMPaCT) award from the Agency for Healthcare Research and Quality (AHRQ). This project aims to enhance North Carolina’s nationally renowned primary care support and quality improvement system. Additionally, North Carolina partnered with four states to spread lessons from their work on supporting primary care practice improvement.

Last Updated: April 2014

Forming Partnerships	Community Care of North Carolina (CCNC): Community Care of North Carolina is a partnership that includes providers supported by the Medicaid agency (Division of Medical Assistance), Office of Rural Health and Community Care, local health departments, and Departments of Social Services and Hospitals. Each network is run locally by an Executive Director, who oversees a team of case managers, as well as a Medical Director, who works with local physicians who provide input. In 2006, the North Carolina Governor convened a public-private collaboration of government, payers, and provider representatives to develop and implement a common set of best medical quality standards and measures for asthma, diabetes, congestive heart failure, hypertension and post myocardial infarction care. The Governor’s Quality Initiative, now known as the independent non-profit North Carolina Healthcare Quality Alliance (NCHQA), launched in 2008. The NCHQA Board of Directors also includes consumer and business representation. The NCHQA has played a key role in aligning quality initiatives to support and transform primary care. Early North Carolina Medicaid medical home projects were made possible by support from the North Carolina Foundation for Advanced Health Programs, Inc. and the Kate B. Reynolds Health Care Trust.
Defining & Recognizing a Medical Home	Definition: Community Care of North Carolina (CCNC): CCNC describes a medical home as a place to receive preventative and sick care; where patients have continuous relationships with their providers and staff know patients’ medical histories; where patients have enhanced access; and have access to care coordination services. Please see the CCNC member handbook for more information. Recognition: Community Care of North Carolina (CCNC): While Community Care of North Carolina (CCNC) actively supports providers seeking NCQA PCMH Recognition, this recognition is not required for CCNC participation. However, the Division of Medical Assistance does require CCNC/Carolina Access providers to: Perform primary care that include certain preventative services; The ability to create and maintain a patient/doctor relationship for the purpose of providing continuity of care; Establish hours of operation for treating patients at least 30 hours per week; Provide access to medical advice/services 24/7; Maintain hospital admitting privileges or have a formal agreement with another doctor based on ages of the members accepted; Refer or authorize services to other providers when the service cannot be provided by the PCP; and Use reports provided by the DMA managed care section as guides in maintaining the level of care that meets the goals of CCNC and patient needs. Additionally, providers must complete a provider agreement that stipulates additional requirements for the practice. A similar provider agreement exists for pregnancy medical homes. ACA Section 2703 Health Homes: North Carolina’s health homes program is delivered through the Community Care of North Carolina program; health home providers must meet CCNC’s basic participation requirements, described above. Medicare Advanced Primary Care Practice (MAPCP)Demonstration: Practices participating in the MAPCP Demonstration program must achieve NCQA Recognition. Furthermore, participating practices in the seven demonstration counties were required to achieve Blue Cross Blue Shield North Carolina (BCBSNC) Blue Quality Physician Program recognition by September 2013.
Aligning Reimbursement & Purchasing	Community Care of North Carolina (CCNC): Currently, Community Care of North Carolina (CCNC) providers and networks both receive per-member per-month (PMPM) payments for each patient under their care in addition to fee-for-service reimbursement. CCNC providers receive: Aged, Blind and Disabled (ABD) population: $5.00 PMPM Non-ABD population: $2.50 PMPM CCNC Networks receive: ABD population: $13.72 PMPM Non-ABD population: $3.72 PMPM Networks return $3.17 and $0.54 monthly for each ABD and non-ABD enrollee to support the central office. Prior to statewide expansion and ABD participation, CCNC networks and providers both received $2.50 PMPM for each enrollee. Carolina Access providers not participating in the Community Care of North Carolina program receive $1.00 PMPM. ACA Section 2703 Health Homes: North Carolina’s health homes program pays practices and networks using the same methodology as the Community Care of North Carolina program, described above. Medicare Advanced Primary Care Practice (MAPCP)Demonstration: Payments to participating practices vary by payer: Medicare: $2.50-$3.50 in addition to fee-for-service. Payments vary based on level of NCQA PCMH recognition: practices with Level 1 recognition receive $2.50; Level 2 practices receive $3.00; and Level 3 practices receive $3.50. North Carolina Medicaid: Medicaid payments are consistent with the CCNC payment methodology, described above. Blue Cross Blue Shield of North Carolina (BCBSNC) and State Health Plan (administered by BCBSNC): Practices receive enhanced fee-for-service payments for Evaluation & Management codes. Enhanced payments begin when a practice submits its application for NCQA PCMH recognition. Participating CCNC networks in counties also receive per-member per-month payments from each participating payer. See CCNC’s MAPCP Frequently Asked Questions page for more information on how payments are made.
Supporting Practices	Community Care of North Carolina (CCNC), ACA Section 2703 Health Homes, and Medicare Advanced Primary Care Practice (MAPCP) Demonstration: Local community networks provide support to physicians participating in all three programs. Networks consist of: Part to full time paid Medical Director – oversight of quality efforts, meets with practices, holds medical management meetings and serves on State Clinical Directors Committee. Clinical Coordinator – oversees the overall network operations. Local care managers (CM). Small practices share/large practices may have their own assigned CM to support practice’s high risk and high cost population and population management activities. Pharmacists to assist with medication management, poly-pharmacy and poly-prescribing. Networks provide population management support to the practices, including customized reports. They work with practices in the implementation of all Community Care of North Carolina (CCNC) initiatives including: Practice re-design (network staff and/or Improving Performance in Practice [IPIP]/Area Health Education Center staff). Develop relationships with community agencies/organizations including links to mental health, public health, hospitals, etc. Transitional support processes – participate in discharge planning, medication reconciliation. Customize practice and patient tools and educational materials. Sponsor learning sessions for network and practice staff. Facilitate group medical visits for chronic conditions. Targeted outreach to patients that will benefit from care management interventions in concert with medical home. In addition to providing education programs and informational services, Area Health Education Centers (AHECs) are also helping practices achieve electronic health record (EHR) meaningful use as Regional Extension Centers. The CCNC Patient-centered Medical Home (PCMH) team hosted eight webinars to help practices achieve 2008 NCQA PCMH Recognitionand has completed a 2008 NCQA PCMH Recognition Workbook. A 2011 NCQA PCMH Recognition webinar series and workbook is in development. North Carolina also received an Infrastructure for Maintaining Primary Care Transformation (IMPaCT) award from the Agency for Healthcare Research and Quality (AHRQ) in September 2011. North Carolina’s IMPaCT project featured a Regional Leadership Collaborative and a Care Transitions Learning Collaborative to accelerate local-level process improvements and quality improvement in clinical performance measures. The Regional Leadership Collaborative focused on developing leadership and quality improvement skills among regional teams. The Care Transitions Learning Collaborative concentrated on integrating care transitions into primary care practices’ roles as part of the PCMH.
Measuring Results	Community Care of North Carolina (CCNC): Treo Solutions, Inc. has reported that Community Care of North Carolina has saved over $1.5 billion between 2007 and 2009. Mercer, Inc. prepared studies that found annual savings ranging from $154-194 million between 2006 and 2009. CCNC has also reported that enrollee’s diabetes, asthma, and heart disease HEDIS measures rank in the top 10% nationally (compared to commercial managed care plans). Practice assessments are completed by local Community Care Program Office using: Medicaid claims data; Pharmacy claims data – web-based pharmacy home program; Case identification reports – risk stratification; Gaps in care analysis reports; Customized queries; and Baseline measures, ongoing monitoring, and trend analysis. Furthermore, an informatics center can provide feedback reports at the individual, practice, network and state levels. However, certain data (including substance abuse and HIV data) cannot be included in individual reports. The Brookings Institution will be evaluating the public-private “First in Health” program’s impact on both quality and cost of care. ACA Section 2703 Health Homes: North Carolina will use claims data, a provider survey, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient survey to evaluate progress toward the state’s three goals for this state plan amendment: Reduce avoidable emergency department utilization; Reduce avoidable hospitalizations; and Increase integration of primary care and behavioral healthcare.

North Carolina's IMPaCT Initiative: Enhancing Primary Care Practice Support

November 22, 2013/in Policy Reports Chronic and Complex Populations, Cost, Payment, and Delivery Reform /by NASHP

Through the Infrastructure for Maintaining Primary Care Transformation (IMPaCT) initiative, North Carolina launched two learning collaboratives to enhance its existing infrastructure for primary care practice support. North Carolina is one of four lead IMPaCT states that have expanded, evaluated, and shared their efforts to transform primary care practices. This issue brief summarizes key strategies, results and lessons from North Carolina¹s IMPaCT learning collaboratives, which focused on regional leadership and care transitions.

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