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North Carolina Medicaid finds savings in care management strategy

North Carolina’s Medicaid system has found a way to save as much as $6,000 annually per patient with the help of a unique care management program.

North Carolina’s Medicaid system has found a way to save as much as $6,000 annually per patient with the help of a unique care management program.

The management program—provided by the Community Care of North Carolina, a public-private partnership of healthcare providers and payers—focuses on providing medical homes, community support and data analysis to target the needs of Medicaid beneficiaries in the state.

Payers participating in CCNC include Medicaid; the state employee health plan; Blue Cross and Blue Shield of North Carolina; and Medicare, through Multi-Payer Advanced Primary Care Practice.

CCNC’s unique “impactability based targeting” provides two to three times the return on investment, compared with other targeting strategies, according to a new CCNC report entitled, “CCNC’s Impactability Approach: How ‘Finding the Needle in a Haystack’ Continues to Yield Savings from CCNC Care Management.”

CCNC uses administrative data to create an “impactability score” for Medicaid members that focuses on Medicaid utilization patterns that go beyond medical care to include social determinants of health and other variables, researchers say.

For the study, CCNC estimated the impact on the care of patients receiving complex care management vs. a control population, to estimate the total cost of savings at an individual level. “The savings was then used to determine the predictive contribution of a multitude of demographic, clinical, and utilization characteristics,” researchers say.

In addition, community-based CCNC care managers help patients targeted with multiple chronic conditions to address barriers that could impact their health outcomes. Individualized plans are developed for each patient with their case manager. “These are the patients CCNC care managers can really help—not just the riskiest or most expensive,” the study says. “By focusing on individual care plans, quality of care is improved while avoidable hospital admissions and readmissions are reduced.”

CCNC is quick to note that analytics is never all that is needed to make an impact on a patient population. The group says a key component of its success is the state’s historical dedication to going beyond the brick-and-mortar of medical care to building strong community partnerships.

In a recent webinar, Carlos Jackson, chief data and analytics officer at CCNC, said only a third of the total spend for North Carolina’s Medicaid members enrolled in a health system practice occurs within the four walls of the health system. The highest-cost, most complex patients, are much more likely to receive care outside of the health system, he says.

Recent initiatives by the state to address social determinants of health, including NCCare360, are poised to help North Carolina achieve even greater success, CCNC says. NCCARE360 is the first statewide coordinated care network to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. NCCARE360 implementation started in January 2019. NCCARE360 will be available in every county in North Carolina with full statewide implementation by end of 2020, the state says.

Access CCNC’s report here.

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