Population Health Study Confirms Value of CCNC Model

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Review Shows System of Coordinating Care for Disabled Population Reduces Costly ER and Inpatient Needs

An important addition to the growing body of evidence supporting the value of CCNC’s community-based, medical home approach. CCNC bends the cost curve by improving the care delivered.-- L. Allen Dobson, Jr., MDPresident and CEO, CCNC

A study published today in Population Health Management, a peer-reviewed journal, details the success of Community Care of North Carolina (CCNC) in better managing care provided to disabled Medicaid patients.

The study examined the economic impact of CCNC’s approach to managing the care of non-elderly Medicaid recipients with disabilities, during the five-year period (January 2007 through September 2011) since CCNC created specialized chronic care programs to serve this population. As noted in the article, disabled Medicaid recipients are characterized by complex care needs, thus account for a higher share of Medicaid costs, hospital admissions, and ER visits. CCNC utilizes a community-based model to link patients to a primary care medical home and provide additional care coordination, disease management, and pharmacy management supports for high-risk patients. The full text of the article is available on the Population Health Management site.

The study found that inpatient admission and ED visit rates declined for patients enrolled in CCNC, while increasing among the unenrolled, even though CCNC was managing a sicker population over time. Enrollment in CCNC was associated with statistically significant cost savings, ranging from almost $190.91 per member per month (PMPM) in the first year to $63.74 PMPM in the last study year, with higher savings observed among patients with multiple chronic conditions. The authors estimate a total cost savings of $184 million over the 4.75 years studied, net of CCNC program costs.

The study was conducted by Herb Fillmore, Vice President, Strategic Innovations, Treo Solutions; C. Annette DuBard, MD, MPH, Senior Vice President, Informatics & Evaluation, Community Care of North Carolina; Grant A. Ritter, PhD, Senior Scientist, Schneider Institute for Health Policy, Heller School, Brandeis University; and Carlos Jackson, PhD, Assistant Director, Program Evaluation, Community Care of North Carolina.

The study applied rigorous, state-of-the-art research methods to control for factors unrelated to CCNC’s efforts, substantiating previous reports of savings achieved by CCNC for the NC Medicaid program overall.

“This study is an important addition to the growing body of evidence supporting the value of CCNC’s community-based, medical home approach to population management,” said L. Allen Dobson, Jr., MD, CCNC President and CEO. “While it addresses specific concerns about the validity of previous actuarial studies, the findings are the same: CCNC bends the cost curve by improving the care delivered to Medicaid beneficiaries.”

Said C. Annette DuBard, MD, MPH: “The study extends earlier actuarial research on CCNC by refining the sample, using pre-post comparison methods, controlling for a number of additional factors and applying hierarchal regression models to adjust for potential correlation among outcomes.”

Dr. DuBard explained that two models were used to estimate the program’s impact on cost: the first employed a mixed model comparing member experiences in enrolled versus unenrolled months, accounting for regional differences; the second was a pre-post intervention/comparison group, difference-in-differences mixed model, which directly matched cohorts of enrolled and unenrolled members on pharmacy use, race, age, year, health status, and behavioral health history.

Article details:
Health Care Savings with the Patient-Centered Medical Home: Community Care of North Carolina’s Experience
Herb Fillmore, MSW, C. Annette DuBard, MD, MPH, Grant A. Ritter, PhD, and Carlos Jackson, PhD

Full text of article available at: http://tinyurl.com/o7dvael
Full-length URL: http://online.liebertpub.com/doi/abs/10.1089/pop.2013.0055

About CCNC
CCNC is a community-based, private sector non-profit that takes a population management approach to improving health care and containing costs for North Carolina’s most chronically ill individuals and other vulnerable populations. Through its 14 local network partners, CCNC creates “medical homes” for 1.3 million individuals, including Medicaid beneficiaries, individuals eligible for both Medicare and Medicaid, privately-insured employees and uninsured people in all 100 North Carolina counties.

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