Community Care of North Carolina (CCNC) “a systemic care management intervention program” depends on the patient-centered medical home (PCMH) model to serve Medicaid recipients and their providers. A recently published study looked at the cost impact of their system of care “for nonelderly Medicaid recipients with disabilities” from 2007-2011. “In 2011, aged, and disabled Medicaid recipients represented 26% of Medicaid enrollees and accounted for 65% of expenditures nationally.” Additionally, from 2012-2021, Medicaid expenditures are expected to “remain substantially higher than for aged, or nondisabled adult and child beneficiaries.”
Fillmore and colleagues found that enrollment in the CCNC program produced “significant cost avoidance” in the first years of the study, which increased thereafter. Moreover, the cost impact for the program was “greater in persons with multiple chronic disease conditions.” CCNC’s cost-saving outcomes suggest that “carefully designed large-scale care management programs can have a significant impact and can increase program efficiency independent of financial risk sharing.” The study did present some limits in terms of unmeasured variables such as “differences in health system practices and socioeconomic factors that influence care utilization.” It also could not include “a direct measure of dose or test specific activities to parse the impact of particular CCNC program activities.” Additionally, the study did not take into account “Medicaid reimbursement differentials among providers and, to the extent enrollees systematically frequented higher or lower cost providers for the same service.” Including these variables would provide further insight, as noted in the article.
Nevertheless, through the use of “targeted care management interventions, aligned with person-centered medical homes, and with a focus on systems to enable change, the CCNC program demonstrates an important part of the solution for creating lasting health care improvement”.
Fillmore H, DuBard CA, Ritter GA et al. Health care savings with the patient-centered medical home: Community Care of North Carolina’s experience. Popul Health Manag 2013.