Wednesday, December 15, 2010

Efforts to Improve Healthcare

North Carolina received $11.8 million to launch an innovative public-private partnership to help the state healthcare system work more efficiently. The goal is to provide improved health outcomes, lower costs, and provide for more communication between insurers and payers.

“This is a major step forward in the improvement of quality medical care delivered to patients in rural communities across the state,” said DHHS Secretary Lanier Cansler. “The strength of this initiative is that it can be easily replicated in rural areas across the nation, since many states share our state’s characteristics and are struggling to find a model that works for them.”

The North Carolina Department of Health and Human Services with funding from CMS, is partnering with Community Care of North Carolina (CCNC), Blue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees in a three year Multi-payer Advanced Primary Care Practice Demonstration.

This initiative extends the benefits of Community Care networks, which currently serve nearly one million North Carolina Medicaid recipients to go to rural residents whose health coverage is through Medicare, BCBSNC, or the State Health Plan, can enroll in Community Care Networks.

Community Care’s networks of medical practices provide a “Medical Home” that manages and coordinates an individual’s healthcare emphasizing patient education, management of chronic conditions, and uses information technology to track treatments and outcomes.

In the seven counties where the demonstration project will take place, Community Care medical homes currently serve 112,774 state Medicaid recipients. Over the three year life of the project, CCNC benefits will extend to 128,186 Medicare and 121,011 privately insured BCBSNC or State Health Plan recipients.

North Carolina is also working with AHRQ to help develop a model EHR format for children and package it in a way that the data can be incorporated into other EHR systems. Existing EHR systems generally do not optimally support the healthcare given to children. North Carolina will use its Community Care infrastructure and work closely with the AHRQ contractor WESTAT to develop the Pediatric EHR format.

By December 31, 2010, North Carolina must submit an updated work plan on how to recruit and identify CCNC practices and then identify the vendors now used by primary care practices. At that point, conversations with the vendors will take place regarding interest in implementing the Pediatric EHR Format.

The timeline is for the format to be developed by June 2011 and at that time, AHRQ will begin to assess existing vendor products. Conformance testing should be done by November 2011 with the prototype to be ready by March 2012

In another state project, in August 2010, the private non-profit arm of CCNC called the “North Carolina Community Care Networks, Inc”, released the “Community Care Provider Portal”. This secure web portal helps providers access a Medicaid patient’s health record for medical information, care team contacts, pharmacy claims history and clinical care alerts.

Other entities involved in the coordination of care for Medicaid recipients such as mental health local management entities, public health departments, and state mental health facilities may also access the Community Care Provider Portal. Importantly, the use of Medicaid claims data can provide key information typically unavailable within the provider chart of the EHR.

The Community Care Provider Portal also contains key resources for assisting providers in managing low literacy or for treating Medicaid patients with low English skills. Through a seamless link into a licensed service maintained by an outside partner, providers can retrieve medical information for patients in multiple languages in video or print formats.