State Auditor Report: Community Care of North Carolina

BACKGROUND

CCNC is a managed primary care program that served approximately 1.3 million of approximately 1.5 million Medicaid beneficiaries in the state as of December 31, 2012.

Under CCNC, eligible beneficiaries join “medical homes,” which coordinate patients’ healthcare services. Primary care services are managed through the medical home, and access to specialty care is coordinated through the primary care physician. Each patient has access to a case manager to ensure individualized care. CCNC also provides health education to its plan members and assists them in maximizing their own health care through self-management.

The study population is limited to non-elderly, non-dual Medicaid beneficiaries. Dual eligible beneficiaries are individuals who receive full Medicaid benefits but also receive assistance from Medicare. The majority of dual eligibles meet the Medicare eligibility requirement based on age (65 and older). For these members, Medicaid is the payer of last resort, paying for long-term care or other costs that Medicare does not cover. Dual eligible beneficiaries were eliminated from the study population because significant portions of Medicare claim payments and records were not available.

KEY FINDINGS

• The researcher’s analysis, based on data from July 1, 2003, through December 31, 2012, suggests that the CCNC program saved money among non-elderly, non-dual Medicaid beneficiaries.
  • Savings of approximately $78 per quarter per beneficiary, approximately $312 a year in 2009 inflation-adjusted dollars (approximately a 9% savings)
  • Decreased spending in almost all spending categories, with the largest reduction in inpatient services
• The researcher’s analysis suggests improved health outcomes for CCNC members.
  • Approximately a 20% increase in physician services (increased physician services is expected to prevent more expensive health care in the future)
  • Approximately a 25% reduction in inpatient admissions o Approximately a 10.7% decline in prescription drug use
  • Reduction in readmissions, inpatient admissions for diabetes, and emergency department visits for asthma (only the asthma results are statistically significant) o No statistically significant effect on overall emergency department use