An innovative approach called Community Care may have found a cure for Medicaid's losses in North Carolina.
An independent analysis shows that the state saved $2 for every dollar it spent on the community care system, which treats more than 810,000 Medicaid patients in 14 nonprofit networks around the state.
That translates to $100 million a year in savings.
Now the success of Community Care of North Carolina is drawing national attention. The principles that guide it – monitoring patients closely and emphasizing disease prevention – could become the foundation for national reforms of Medicaid, as well as Medicare.
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At a forum in Washington on Friday, representatives of the major-party presidential campaigns are booked to discuss the role the N.C. model can play in a new administration's health care reforms.
“North Carolina has led on this – it's had an instrumental role,” said Dr. Ted Epperly, president of the American Academy of Family Physicians and moderator of this week's forum.
As Medicaid and Medicare costs spike nationally – last year's tab for the federal health insurance programs topped $500 billion – representatives from Community Care of North Carolina have answered requests from 32 other states to talk about the system.
Supporters call Community Care of North Carolina a quiet success that has gained attention across the political spectrum during its decade of existence. U.S. Sen. Richard Burr joined Sen. Dick Durbin, an Illinois Democrat, in sponsoring medical-home legislation in the Congress last year.
“He thinks it's worked well in North Carolina and that it's an excellent piece of an overall health care plan,” Burr spokesman Chris Walker said Friday. “He's hoping to encourage other states to adopt something like this.”
And Lt. Gov. Beverly Perdue, a Democrat running for governor, said Wednesday the medical-home model is “the most magnificent thing happening in America.”
N.C. Medicaid administrators, notably former director Dr. Allen Dobson, developed the program in the late 1990s through an agreement between Medicaid and the state Office of Rural Health and Community Care. The current economic crisis puts a premium on its efficiency in health care, said Tom Vitaglione, senior fellow for health and safety at Action for Children North Carolina.
“A medical home, as far as we know at this point, is the most efficient way of delivering care,” Vitaglione said.
Patricia Newton, 43, of Goldsboro learned about the medical-home model through Goldsboro Pediatrics when her children, Antwon and Ebonni, were enrolled in Community Care of N.C.
“It was always so great,” Newton said. “The only thing I have is praise.”
Antwon, now 21, had problems with asthma, and Ebonni, 23, had diabetes, high blood pressure and kidney problems – the kinds of chronic disease the system is designed to manage. Both got referrals to appropriate specialists as well as thorough ongoing care, she said.
The medical-home system, also called “patient-centered care,” gives patients a case manager. The manager works with doctors, other professionals, public health agencies, public hospitals, social service agencies and community health centers to take on all the patients' health care needs. Doctors get help with time-consuming, uncompensated general care and a management fee to subsidize extra costs.
Case managers often arrange transportation, follow up with patients who visited an emergency room for non-emergency care, send reminders about flu shots and checkups, and provide referrals to social service or public health department programs.