North Carolina Primary Care Program Continues To Save Millions

North Carolina's Medicaid program continues to demonstrate how physician-led primary care networks and patient-centered medical homes can improve health care quality and save costs.

North Carolina Gov. Mike Easley recently released data showing that Community Care of North Carolina, or CCNC, saved the state a combined total of more than $231 million in Medicaid costs for fiscal years 2005 and 2006.

"Community Care is a good example of how we can be smarter in what we do," said Easley in a press release. "The long-term goal is to raise the quality of health care for the patient while at the same time making it cheaper for the state."

CCNC provides care to more than 750,000 Medicaid recipients in North Carolina, relying heavily on patient-centered medical homes, population health management, case management services and community-based networks to deliver care. Since its inception in 1999, the program has saved North Carolina nearly a half a billion dollars, becoming a driver of quality initiatives in the state in the process.

"We make sure every Medicaid recipient has a medical home," said Allen Dobson, M.D., of Concord, a family physician and former assistant secretary for health policy and medical assistance at the North Carolina Department of Health and Human Services. "We give (Medicaid recipients) a case manager who becomes their coach to make sure they understand what the doctor has ordered, so they can get to their appointments on time."

Since 1999, CCNC has grown to encompass 15 networks, 3,500 primary care physicians and 1,000 medical homes. Under the program, the state pays physicians 95 percent of Medicare plus a $3 per-member, per-month case-management fee. The state also pays networks a $3 per-member, per-month fee for care and disease management.

The patient-centered medical home serves as a regular source of treatment, enabling primary care physicians to manage and coordinate patient care on an ongoing basis, which results in fewer ER visits and hospitalizations and reduces unnecessary medical costs, said Dobson, who was awarded the AAFP's 2007 Public Health Award for making extraordinary contributions to the health of the American public. As Dobson points out, "healthier patients are less costly."

The North Carolina state legislature, in an attempt to capitalize on the success of the program, has mandated CCNC coverage for all of the state's aged, blind and disabled recipients in addition to all recipients of the State Children's Health Insurance Program.

CCNC also continues to serve as a model for other state Medicaid programs. Some states already have implemented various parts of CCNC for their Medicaid programs; others are studying the program in the hope of adopting it.

"It is exciting that family physicians, the medical home and community-based systems are starting to gather some attention nationally," said Dobson. "Most of us felt this was a missing part of health care for a long time."