Community Care NC nabs $100,000 prize

Community Care of North Carolina, which oversees medical care for Medicaid patients in the state, has received a $100,000 cash award as recognition for the statewide organization’s effectiveness in reducing waste and cutting costs while improving health care.

Though not large by health care budget standards, it’s the first cash prize for the Raleigh-based organization that is often cited in studies and analyses as a nationwide model for managing health care costs. CCNC is the first organization to receive the inaugural Hearst Health Prize, jointly awarded by medical data company Hearst Health in New York and the Jefferson College of Population Health of Thomas Jefferson University in Philadelphia.

“It’s a national recognition with a little ‘genius’ grant,” said CCNC chief executive L. Allen Dobson. “And a validation that here in North Carolina we’re doing good work.”

The Hearst Health Prize cited CCNC’s transitional care program, in which the organization oversees care for about 2,600 Medicaid recipients a month who are discharged from hospitals and at high risk of recurring medical problems because they are elderly, disabled, mentally ill, illiterate, low-income, or some combination of those and other factors.

The program involves home visits and coordinating checkups and doctor’s appointments, as well as connecting the patient with social service agencies that can provide transportation and food deliveries.

The organizations said CCNC stood out from more than 125 submissions and said its model is valuable because it can be replicated by other organizations. CCNC was formed in 1998 as a provider-based network and an alternative to corporate managed care organizations.

“Physicians viewed the CCNC model as a positive alternative to capitated managed care that allowed them to maintain more control and protect their reimbursement rates,” the Kaiser Family Foundation said in a report. “Reflecting this viewpoint, virtually all primary care Medicaid providers agreed to participate in the CCNC networks as they formed.”

CCNC is not without its skeptics who are frustrated with cost overruns in North Carolina’s management of the federal Medicaid program for the poor. Last year, the state Senate proposed a budget that would have terminated CCNC’s contract with the state. North Carolina has undertaken a Medicaid reform that will ultimately result in CCNC losing its state contract. But the organization is expected to be able to contract with private entities that end up managing the state’s Medicaid program.

CCNC manages care for about 1.4 million people in North Carolina under a $110 million state contract in which the Medicated patients are provided with “medical homes” to assure they continue receiving health care. That program includes every hospital in the state, some 1,800 primary care provider practices, 250 community pharmacies and about 600 CCNC care managers in all 100 counties of the state.

The financial savings come from avoiding unnecessary hospitalizations, procedures, tests and medications.

In 2011 the Milliman consulting firm in California concluded that CCNC had saved the N.C. Department of Health and Human Services about $1 billion between 2007 and 2010. That same year an analysis by health care analytics consultant Treo Solutions of New York estimated that CCNC saved nearly $1.5 billion in health care costs from 2007 through 2009 for the state. The Mercer consulting firm pegged the savings generated by CCNC at more than $500 million.

A 2015 audit by the state’s Division of Medical Assistance found that CCNC cuts the state’s Medicaid budget by about 9 percent. It does so by increasing physician services by 20 percent while cutting inpatient admissions by 25 percent and cutting prescription drug use by 10.7 percent.

Formed in the late 1990s, CCNC has also provided health management services for other organizations, including Blue Cross and Blue Shield of North Carolina, GlaxoSmithKline and Medicare.

John Murawski: 919-829-8932, @johnmurawski