North Carolina's medical home model saves $154 million
North Carolina's medical home model saves $154 million
Medicaid clients with a longer history with the same doctor are more likely to be screened for curable cancers, according to a study of North Carolina Medicaid recipients published in the Archives of Internal Medicine. Researchers evaluated the medical records of nearly 2,000 state Medicaid recipients ages 50 and older. About half had received screening tests for colorectal, breast, and cervical cancers. The researchers also discovered that patients who had been seeing the same practitioner for more than five years were twice as likely to be screened as those who had been with a practitioner less than two years.
The study's findings gave additional evidence of the benefits of the Community Care of North Carolina (CCNC) initiative, which has enrolled more than 970,000 Medicaid recipients into a "medical home."
A recent actuarial study estimated CCNC saved $154 million in fiscal year 2007. Other research has indicated the effectiveness of CCNC for Medicaid patients with asthma, diabetes, and other chronic ailments.
"We weren't necessarily surprised by the finding that patients with long-term, established relationships with a primary care provider were more likely to have received recommended preventive services," says C. Annette DuBard, MD, MPH, the study's lead author and associate medical director of Quality Evaluation and Health Outcomes at the North Carolina Department of Health and Human Services' Division of Medical Assistance.
Many prior studies have shown that people with access to primary care are more likely to receive recommended care. However, the study's findings also suggest that access to care, in and of itself, isn't necessarily enough.
"Even though all of the patients in our study had full health care coverage for cancer screening under Medicaid and had visited a primary care doctor, a large percentage was not screened appropriately," reports Dr. DuBard. "Patients with longer-standing, continual relationships with their primary care provider were far more likely to be screened. This provides further evidence for the medical home model."
North Carolina has invested in primary care for its Medicaid recipients through enhanced management fees and support of locally driven quality improvement efforts and care coordination. "Many states, especially those operating in a primarily fee-for-service environment, have looked to North Carolina as a model for assuring that Medicaid recipients have access to a stronger primary care infrastructure," says Dr. DuBard.
Dr. DuBard adds that "as more and more evidence emerges that this approach can not only improve quality but help reduce overall health care costs, we can expect to see increasing emphasis on the medical home model nationwide."
Program's four components
CCNC adopted four essential program components, all designed to strengthen the ability of the primary care provider to manage patient care and improve patient outcomes. These four components are:
-Formation of community networks. "The primary care providers were encouraged to work together with other community providers in community networks to cooperatively plan for meeting the health care needs of recipients, particularly those with chronic conditions," says Denise Levis Hewson, RN, BSN, MSPH, CCNC's director of clinical programs and quality improvement.
-Population management tools. These provide the physicians and other network partners with the tools needed to improve care. Providers are given evidence-based programs and protocols for disease management, pharmacy management, care management, and practice-based improvements.
-Case management and clinical support. These provide the support and coordination needed by physicians to care for complex chronic care patients who see many providers across an array of delivery settings.
-Data and feedback. Opportunities for improvement are pointed out in the areas of quality, utilization, cost, and care processes by collecting, analyzing, and regularly reporting performance metrics back to physicians and networks.
"These provide physicians with relevant information on how their patients are faring," says Ms. Hewson. "The community-based approach is very important. Having local physicians leading the efforts in their community has helped us achieve success."
As a result of its ability to improve the quality of care while containing costs and saving state dollars, CCNC is being looked upon as a vehicle for new initiatives in the state. Currently, the initiative covers all 100 counties through 14 regional networks. These manage the care of more than 970,000 Medicaid enrollees with about 1,250 medical homes and more than 3,200 primary care providers.
This provides the state with a launching pad for new initiatives, such as a contract with the Centers for Medicare & Medicaid Services to improve management of dual- eligibles and share in the savings. "One reason that states are hesitant to manage this population is that most of the savings occur on the Medicare side," explains Ms. Hewson. "We are also potentially developing a high-risk OB initiative."
Contact Dr. DuBard at adubard@ schsr.unc.edu and Ms. Hewson at (919) 715-1088 or [email protected].
Medicaid clients with a longer history with the same doctor are more likely to be screened for curable cancers, according to a study of North Carolina Medicaid recipients published in the Archives of Internal Medicine.Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.