What is CCNC? - Community Care of North Carolina

Report
CCNC 101
What is CCNC?
An overview of structure and operations
CCNC is:
 People
 Knowledge
 Technology
CCNC is:
Evolution of a CCNC
1983:
DMA & ORH partner to reduce ER use in Wilson county
1983:
Pilot expanded to 12 counties in 1989
1990:
Twelve-county program named Carolina Access, launched by
Governor Jim Martin
1991:
HCFA (now CMS) approves statewide expansion & $3 PMPM
1999:
ORH begins contracting with local Networks; DMA joins later
2006:
Central nonprofit organization (“N3CN”) created to apply for
Medicare Duals demonstration
2008:
N3CN directed to manage ABD population
2010:
N3CN assumes responsibility for clinical/technical assistance
2013:
DMA contracts with N3CN; N3CN contracts with 14 Networks
and 1,800 practices to centralize accountability
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Company Structure
NCCCN, Inc.
CCNC, Inc.
CCNC
Services, Inc.
NC HIE, Inc.
Company Structure
 Parent corporation for “family
of
companies Inc.
NCCCN,
 Match expertise and resources
with emerging opportunities
CCNC, Inc.
 Diverse, experienced Board of
CCNC
Directors
Services,
 Seek
innovativeInc.
ways to carry
out the core mission
NC HIE
Company Structure
 Decade+ of practical
data analytics and
“what works” in
Medicaid
 Statewide population
health management
for 1.3 million
people
CCNC,
Inc.
 Provider – led,
community-based
 Replicates “best
practices” and brings
them to scale
NCCCN, Inc.
CCNC
Services, Inc.
NC HIE
Company Structure
 Provides products and
services to stakeholder
partners
NCCCN, Inc.
 Exports NC’s proven
approach to other states
 Generates private
CCNC,
Inc.
investment
in technical
infrastructure
 Deep expertise
generates additional
resources to support
mission
CCNC
Services, Inc.
NC HIE
Company Structure
 Centralized, neutral hub
for data from multiple
sources.
 Lets providers exchange
and analyze health data
electronically
Inc.
 CCNC,
Improves the
quality,
safety and efficiency of
healthcare statewide.
NCCCN, Inc.
CCNC
Services, Inc.
NC HIE, Inc.
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Primary Care Capacity
Health System Owned
Unenrolled
355,413
Provider-led
ACO’s
73,887
Other
(RHC, LHD, other)
96,226
FQHC
100,800
Who provides medical
homes for NC Medicaid
recipients?
Independents
644,602
Other
Hospital Owned
120,869
Large
Health System
Owned
344,655
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*Numbers represent estimated number of members enrolled in each type of practice (total member months divided by 10).
Cross-System Traffic
Bubbles show inpatient admissions of patients enrolled in practices controlled by
the large healthcare systems.
NC HIE, Inc.
 27 participating NC hospitals
 600 clinic sites
 Onramp for “safety net”
clinics like FQHC
 Secure, affordable access to
comprehensive patient health
data
Awards and Recognition
Press release from Harvard University’s Ash
Institute announcing 2007 Innovations Award
US Senator Richard Burr Presents Healthcare Leadership
Council’s national Wellness Frontiers Award, 2013
Key Initiatives
Pregnancy Medical Home
Pregnancy
Medical
Home –
reducing
pre-term
births,
improving
prenatal
care
Project Lazarus – Statewide chronic pain
and drug overdose prevention program
Children’s Health Accountable Care
Collaborative – 3-year CMS Innovations
grant to improve care for children
with complex conditions.
Peer-reviewed research
Cuts Hospital Readmissions
 20% reduction in readmissions for patients in
the transitional care program.
 12-month readmission rates
consistently lower for
participants within each
level of clinical severity.
 For every six interventions,
one hospital readmission
avoided – strong ROI
Peer-reviewed research
Cuts Program Costs
 Significant savings for 169,667 non-elderly, disabled
Medicaid recipients
 $184 million savings
in about 5 years
 Higher per-person
savings for patients with
multiple chronic
conditions.
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National Model for What Works
 Community-based, physician-led

medical homes coordinate care
across health systems
Managed through 14 local, nonprofit networks, ~1,800 practices
& 6,000+ providers
 Population Health Approach:
Case management and medical
home capacity building
 Goal: Ensure patients receive
optimal care, avoid
unnecessary utilization and
reduce costs
 Health informatics target at-risk
beneficiaries and high-impact care
settings
 Use of data to drive performance
and standardization across
networks
 Medicaid savings achieved in

partnership with doctors, hospitals
and other providers
100 percent of savings remain in
state
The CCNC Footprint Statewide
 6,000 primary care providers
 1,800 Practices
 90% of PCPs in NC
 1.4 million Medicaid Patients
 300,000 Aged, Blind, Disabled
 150,000 Dually Eligible
All 100 NC Counties
14 Networks
Each network averages:




1.4 Medical Directors
42.8 Local Case Managers
1.8 Pharmacists
1.0 Psychiatrist
Local Network: Community Care of Wake/Johnston
 155 primary care sites
 Wake Faculty Practices
Wake & Johnston Numbers





2 Medical Directors
39 Local Case Managers
3 PharmDs
2 Psychiatrists
1 Obstetrician
 103,000 Medicaid
 5th largest network in population
Embedded:
 11 FTEs dedicated to WakeMed
 9 Registered Nurses/SW
 2 Patient Coordinators
NCCCN, Inc.
Avoids
Wasteful
Spending
National
Model
Improves Care
Physician-Led
Resource
allocation
Medical home
6,000 primary
care providers
Innovation in
American
Government
Award
ER admissions
Community
resources
1,800 practices
Wellness
Frontiers
Award
Patient
targeting
Performance
data
90%
participation
Medicaid
spending
trends
Pharmaceutical
adherence
Best practices
Data network
HEDIS top 10%
22
Primary Care
Foundation
23
Data to inform
decisions &
focus efforts
Primary Care
Foundation
24
Population
mgmt:
Stratify
population,
choose
targets
Data to inform
decisions &
focus efforts
Primary Care
Foundation
25
Population
mgmt:
Stratify
population,
choose
targets
Data to inform
decisions &
focus efforts
Multi-disciplinary team:
RX, Behavioral, Care
Manager
Primary Care
Foundation
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CCNC Medical Home
Population
mgmt:
Stratify
population,
choose
targets
Data to inform
decisions &
focus efforts
Multi-disciplinary team:
RX, Behavioral, Care
Manager
Primary Care
Foundation
A Key to Healthcare Reform
Advanced Medical Homes
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Networks
Physicians
Care
Managers
Pharmacists
Clinicians
Behavioral
Specialists
 14 networks cover all 100 NC
counties
 Networks develop local solutions
to community health issues
 Multi-disciplinary team works at
“top of licenses”
 Now including community
pharmacists under CMMI grant
Networks
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The CCNC Model
Shared Vision, Aligned Goals

Provider-led

Analytics-driven

Best practices
Transitional Care

Shared protocols
ED Management

Controlling costs

Improving outcomes

Vulnerable populations
Palliative Care
Behavioral Health
Pharmacy Management
Population Management
Medical Home
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Where are the Opportunities?
A Small Portion of Beneficiaries Are Responsible for a
Disproportionate Share of Costs
32
Where are the Opportunities?
Patient Segmentation to Manage Risk
Focus Resources on Where it Matters Most
Population Health Management







Medicaid and Medicare
Aged, Blind and Disabled
Frail Elderly
Chronic Complex Comorbidities
Diabetes, Asthma, Congestive Heart Failure
Emergency Department “Frequent Flyers”
Recent Hospital Discharges
 Substance Abusers
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Targeting the “Impactable”
Patient Risk
Cohort #1
Patient Risk
Cohort #2
Patient Risk
Cohort #3
$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
$0 $1K $2K $3K $4K $5K $6K $7K $8K $9K $10K $11K $12K $13K $14K $15K $16K $17K $18K $19K $20K
CCNC Services
Business verticals
 Population Health Management
 Network and infrastructure development
 PCMH support
 Analytics
 Decision Support
 PHARMACeHOME
CCNC Services




Consulting
Development
Implement and Deployment
Software Licensing




Analytics
Decision support
Informatics and
Dashboards
 Business Process Outsourcing
 Interventions
 Call Centers
 Network Support
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Our Products
 Care TriageTM (pharmacy data analytics)
 Predictive Modelling
 Custom Interventions
 Custom Dashboards
 PHARMACeHOME
 Network Development and Support
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Questions?
 For more information, please see our website at
www.communitycarenc.org
 You can also contact CCNC Communications at
[email protected]
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