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Payers Support Integrated Care Services for NC Medicaid Patients

Healthcare payers aligned business and clinical objectives in order to support integrated care delivery systems for Medicaid patients in North Carolina.

Healthcare payers aligned business goals to provided intergrated care for NC Medicaid patients

Source: Thinkstock

By Thomas Beaton

- Payers and provider organizations that support integrated care systems can help lower healthcare costs by addressing the healthcare concerns of vulnerable patient populations, including Medicaid beneficiaries.

Several commercial payers have recently announced agreements to work with Community Care of North Carolina (CCNC), a leader in data-driven population health, towards developing integrated care delivery systems for Medicaid beneficiaries.

In January, Aetna and CCNC announced a partnership to provide integrated care delivery to North Carolina’s Medicaid population.

The partnership combines Aetna’s expertise in Medicaid managed services with CCNC’s medical home and care management services. Aetna will participate in a request for proposal, released by North Carolina’s Department of Health and Human Services, to help transform the state’s Medicaid and Health Choice programs to a managed care system.

Under the agreement, Aetna’s Medicaid members will have full access to providers within CCNC’s Community Care Physician Network (CCPN) and Community Pharmacy Enhanced Services Network (CPESN). CCNC, CCPN, and CPESN will perform care management and care coordination services for Aetna and their beneficiaries.

The delivery model allows Aetna and CCNC to support medication adherence and care management for patients with complex conditions and allow the organizations to address a patient’s social determinants of health.

Laurie Brubaker, president and CEO of Aetna Medicaid, sees the partnership as a way to align the healthcare goals of Aetna and CCNC into an actionable integrated care system.

“We look forward to working with CCPN, CCNC and CPESN to develop an integrated health care delivery system that builds on existing care management programs, provides a holistic approach to health and expands the provider/payer collaborative to improve health for the Medicaid and North Carolina Health Choice populations.”

L. Allen Dobson Jr., MD, president and CEO of CCNC, added that the partnership will use the strengths of both organizations to improve health outcomes for North Carolina Medicaid enrollees.

“Both Aetna and CCNC understand that local, community-embedded health professionals and a national carrier working together can help North Carolinians live healthier lives,” Dobson said. “CCNC is ready to partner with Aetna, a health plan committed to improving quality and access to care and to build on CCNC’s strong provider infrastructure.”

In December of 2017, WellCare and CCNC engaged in a similar agreement.

Both organizations plan to coordinate and develop population health management programs, predictive analytics solutions, and care management models for Medicaid beneficiaries with complex medical conditions.

CCNC and CCPN intend to provide infrastructure, provider relationships and support processes as part of the agreement. In return, WellCare will bring managed care operational best practices, innovative payment models, and comprehensive clinical supports for population health programming.

Gregg MacDonald, senior vice president, division president at WellCare said that each organization brings strengths to the table that ensure vulnerable patient populations receive quality care through efficient healthcare spending.

"Our combined expertise offers Medicaid managed care services and clinical excellence, and importantly, an unwavering dedication to delivering the best possible healthcare to the state's most vulnerable populations,” MacDonald said.

The agreement between WellCare and CCNC includes a community outreach program tailored to address social support services for Medicaid enrollees in North Carolina.

"We know that people cannot prioritize their health when their basic social needs are not being met," said Pamme Taylor, WellCare's vice president for advocacy and community-based programs.

 "By helping people address these needs, we hope to help people lead better, healthier lives, provide greater support for North Carolina's social safety net, and reduce the overall cost of healthcare.”


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