Overview

Community Care of North Carolina (CCNC)—formerly known as ACCESS II and III—develops local networks of primary care providers to coordinate prevention, treatment, referral, and other services for Medicaid enrollees. The goals of CCNC are to increase access to care, promote community-based systems of care, enhance care management, and improve quality and cost effectiveness in the Medicaid program. The program builds on Carolina ACCESS I, the statewide primary care case management (PCCM) program, which connects Medicaid enrollees with a medical home that provides primary care. It is a collaboration among the state government, counties, community institutions, and physicians, and relies on care management, adoption of best practices, and accountability by local providers to reduce duplication and fragmentation of services. The program includes more than 3,000 physicians in 13 networks. Using care managers and medical management staff, the networks identify high-cost patients and services and develop plans to manage utilization and cost. There are four quality improvement program areas that each network is required to address: disease management; high-risk and high cost patients; pharmacy management; and emergency department utilization. The program continues to expand toward statewide implementation. As of May 2005, enrollment has grown to 640,000 individuals. Planners and administrators are exploring ways to build on the disease management program to include congestive heart failure. They are also in the early stages of a provider incentive/pay for performance initiative. The state provides resources and guidance, but encourages the networks to "localize" their strategies and branch out with additional efforts. Many communities use the relationships and infrastructure developed through CCNC to address other problems and populations such as the uninsured, indigent populations, or nursing home residents. A number of pilot initiatives are being pursued that focus on therapy services, low birth weight, health disparities, mental health integration, in-home care, and sickle cell anemia. Accountability is achieved through chart audits, practice profiles, care management reports on high-risk and high-cost patients, scorecards, and monitoring of progress toward benchmarks.

For More Information Web site: www.communitycarenc.com/ Contact: Jeffrey Simms, Assistant Director of the NC Office of Research, Demonstrations, and Rural Health and of the NC Division of Medical Assistance Phone: (919) 857-4016 E-mail: jeffrey.simms@ncmail.net