As a part of a national, five-year Medicare Health Care Quality (MHCQ) Demonstration Program mandated by Congress, the Centers for Medicare & Medicaid Services (CMS) will implement a program in North Carolina to encourage the delivery of improved quality care.  CMS announced earlier this year that the “North Carolina Community Care Networks” (NC-CCN) project, implemented under MHCQ, will build on a primary care case management program that was developed by the North Carolina Medicaid program that currently serves the state’s Medicaid-only, low-income, and uninsured populations.  The goal of the demonstration will be to expand the same coordination of care to the dually eligible and Medicare-only population.

Under the demonstration, NC-CCN will implement a four-pronged strategy to improve care delivery:

  • Assign beneficiaries to participating primary care physician practices.  These practices will be responsible for coordinating care and improving performance on a defined set of quality measures.
  • Provide community-based care coordination services to participating practices and beneficiaries.
  • Expand the current case management information system to include the dually eligible and Medicare-only population.
  • Develop and implement a performance measurement, reporting and incentive program to recognize and encourage improvements.

CMS says that NC-CCN will link claims data from various sources to produce quality reports, alerts and reminders for patients and providers.  The demonstration project will be implemented in 26 of the 100 counties in North Carolina with 8 of NC-CCN’s 14 physician networks participating in the demonstration.    A press release by CMS regarding the demonstration project can be obtained here.

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