In an effort to slow the rapid rise in health care costs while improving the quality of patient care, North Carolina has developed Community Care of North Carolina, a collection of 14 regional healthcare networks organized by community physicians, hospitals, health and social services departments, and other community organizations. The networks improve the quality, efficiency, and cost-effectiveness of care for North Carolina's Medicaid program, paying particular attention to the needs of low-income and uninsured residents.
This community-based health care model makes use of evidence-based, practice guidelines in the treatment of asthma, diabetes, congestive heart failure, depression, and chronic obstructive pulmonary disease. It disseminates information regarding best practices throughout the health care network and provides tools to aid implementation. Case managers, hired locally by the networks, work closely with primary care physicians and patients to implement physician-determined care and disease management interventions; emphasis is placed on identifying those who will benefit the most, including at-risk patients and those with particularly expensive medical issues. By providing a medical home for Medicaid patients, network members are able to target patients at greatest risk and intervene before significant deterioration in their health, resulting in better medical outcomes and substantial savings.
Improvements in quality, operation, and cost-effectiveness are evident. The first four years of asthma-reduction efforts resulted in a 34 percent reduction in emergency department visits and a 35 percent reduction in hospital admissions. The Sheps Center for Health Services Research at the University of North Carolina reported a $3.5 million savings for asthma management and a $2.1 million savings for diabetes management, from 2000 to 2002. An actuarial study from Mercer Human Resource Consulting Group found savings of approximately $60 million in the 2003 fiscal year and $124 million in the 2004 fiscal year.
In addition to substantial cost savings, Community Care of North Carolina and its member networks serve as a model of an integrated approach to health care which emphasizes chronic conditions, promotes physician willingness to adapt and improve, and extends the availability of quality health care to patients living in rural areas. For states that share North Carolina's characteristics—namely a large and dispersed population with minimal access to managed medical care—the Community Care model has the potential to be replicated in jurisdictions across the country.
*This program was the winner of the special Annie E. Casey Innovations Award in Children and Family System Reform.