North Carolina

Aetna and Carolinas HealthCare System are using a clinically integrated organization (CIO) model to support stronger patient-centered medical homes and other accountable care efforts.  Using CHS's broad system of integrated facilities and physicians, the collaboration is designed to give Charlotte-area employers better health care options for their employees by: 

The demonstration will be implemented in seven rural counties: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga. All participating payers will contribute resources to practices and Community Care networks to support practice transformation to “medical homes,” and to improve quality of care, care coordination, access, patient education, community based support, and other care support services. 

Blue Cross Blue Shield North Carolina introduces Blue Quality Physician Program on the heels of its successful Bridges to Excellence quality improvement program, which concluded in April 2009. Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have been invited to apply for the higher reimbursement structure. The program is designed to reward quality over quantity in the delivery of medical services.

Community Care of North Carolina (CCNC) is a public-private partnership designed to create regional networks of primary care clinicians, hospitals, pharmacy, public health, social services and other community organizations to provide care based on the patient-centered medical home (PCMH). In this regional PCMH model, patients are partnered with a primary care provider who leads the health care team to address all of the patient's needs. The goals of CCNC is to:

North Carolina will be working with pediatric and family practices within Community Care of North Carolina to build on a strong public-private partnership that has documented successes in quality improvement, efficiency and cost-effectiveness of care for more than 14 years. North Carolina, via the Division of Medical Assistance (DMA) and the Office of Rural Health and Community Care (ORHCC), was awarded 9.2 million dollars to work on three of the five categories of the CHIPRA Quality Demonstration Grant; A, C and D. The grant projects as outlined in the statute will:

The Child Health Accountable Care Collaborative (CHACC) builds on the Community Cares North Carolina (CCNC) medical home model and infrastructure of regional networks to improve care for children with complex medical conditions. This CMMI grant-funded program embeds specialty care managers from hospitals and specialty clinics to collaborate with pediatricians to coordinate care. The key components of the program are described as:

Under the program, Novant Health monitors and coordinates all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. In addition, many patients using Novant Medical Group physicians will be managed using the EPIC electronic medical record system installed in practices, as well as have access to My Chart, an electronic patient access tool that enables patients to communicate with their care team and review medical records online.  

Under the program, CaroMont Medical Group monitors and coordinates all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists.