Community Care of North Carolina: Saving State Money and Improving Patient Care

Willson, Charles F.

doi:10.18043/ncm.66.3.229

Cited by 5 publications

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“…Dr. Charles Willson, President-Elect of the North Carolina Medical Society, describes the development of a similar CCNC model in Pitt County. 84 CCNC programs are now being implemented in every county in North Carolina.…”

Section: New Delivery Models For Community-based Carementioning

confidence: 99%

New Developments in Primary Care Practice

Newton

DuBard²,

Wroth³

2005

North Carolina Medical Journal

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he great paradox of modern American medicine is the coexistence of stunning achievement in biomedical knowledge and technology, alongside our failure to meet the basic healthcare needs of a substantial proportion of the population. As the bridge between technical advances in medicine and the real lives of patients, primary care physicians find themselves stretched thin by patient demand for greater responsiveness to urgent care needs, lack of time to deliver preventive services, and the increasing complexity of chronic disease management. Communities in North Carolina and throughout the country are facing a relentless escalation of healthcare costs, with an alarming rise in the proportion of the population without health insurance. Simultaneously, the physicians serving these communities face increasing costs and decreasing reimbursement, with mounting pressure to see more patients in less time, or to limit the types of patients they care for, in order for their practices to survive. 1 The Aim of this Issue of the JournalIn response to these challenges, primary care is rapidly evolving, as healthcare providers explore new ways of responding to patient needs while also making their practices more efficient and effective. These innovations are the foci of this issue of the North Carolina Medical Journal.Revisiting the history of general practice in North Carolina offers insight into contemporary primary care delivery, and allows us to examine whether the structure of primary care that has evolved in our communities is adequately equipped to address the needs of the population being served. Our own review of this history suggests that primary care practice requires substantial systematic change to remain viable and to provide adequate access to quality healthcare. Against the background of this historical overview, we will present ways in which practices across the state are rising to the challenge of improving access and quality while decreasing costs, and discuss implications for future strategic initiatives, policies, and research.It is well-established that community-based primary care practices play a key structural role in the care of the population. Kerr White, T. Franklin Williams, and Bernard Greenberg first established this with their classic 1961 paper on "The Ecology of Medical Care," derived from their work here in North Carolina, which demonstrated that the vast majority of patient care takes place in community-based outpatient practices, substantially distinct from care received in hospitals and academic

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Section: New Delivery Models For Community-based Carementioning

confidence: 99%

New Developments in Primary Care Practice

Newton

DuBard²,

Wroth³

2005

North Carolina Medical Journal

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Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

Kohler

Lich

et al. 2015

Cancer

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Background The patient centered medical home (PCMH) is increasingly being implemented in an effort to improve and coordinate primary care, but its effect on health care utilization among breast cancer patients remains unclear. The objective of this study was to examine health care utilization and expenditures as a function of PCMH enrollment among breast cancer patients in North Carolina's Medicaid program. Methods North Carolina Medicaid claims linked to North Carolina Central Cancer Registry records (2003-2007) were used to examine monthly patterns of health care use and expenditures. Fixed effects regression models analyzed associations between PCMH enrollment and utilization of outpatient, inpatient, and emergency department (ED) services and Medicaid expenditures during the 15-months after breast cancer diagnosis, controlling for selection bias on time-invariant characteristics. Results Among 758 breast cancer patients, 381 (50%) were enrolled in a PCMH at some time in the 15 months post-diagnosis. After controlling for individual fixed effects, PCMH enrollment was significantly associated with greater outpatient service use, but there was no difference in the probability of inpatient hospitalizations or ED visits. Enrollment in a PCMH was associated with increased average expenditures of $429 per month during the first 15 months. Conclusions Greater outpatient care utilization and increased average expenditures among breast cancer patients enrolled in a PCMH may suggest that these women have improved access to primary and specialty care. Expanding PCMHs may change patterns of service utilization for Medicaid breast cancer patients, but may not be associated with lower costs.

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Utilization and Adherence in Medical Homes

et al. 2018

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Background: The complex nature of managing care for people with severe mental illness (SMI), including major depression, bipolar disorder and, schizophrenia, is a challenge for primary care practices, especially in rural areas. The team-based emphasis of medical homes may act as an important facilitator to help reduce observed rural-urban differences in care. Objective: The objective of this study was to examine whether enrollment in medical homes improved care in rural versus urban settings for people with SMI. Research Design: Secondary data analysis of North Carolina Medicaid claims from 2004–2007, using propensity score weights and generalized estimating equations to assess differences between urban, non-metropolitan urban and rural areas. Subjects: Medicaid-enrolled adults with diagnoses of major depressive disorder, bipolar disorder or schizophrenia. Medicare/Medicaid dual eligibles were excluded. Measures: We examined utilization measures of primary care use, specialty mental health use, inpatient hospitalizations, and emergency department use and medication adherence. Results: Rural medical home enrollees generally had higher primary care use and medication adherence than rural non-medical home enrollees. Rural medical home enrollees had fewer primary care visits than urban medical home enrollees, but both groups were similar on the other outcome measures. These findings varied somewhat by SMI diagnosis. Conclusions: Findings indicate that enrollment in medical homes among rural Medicaid beneficiaries holds the promise of reducing rural-urban differences in care. Both urban and rural medical homes may benefit from targeted resources to help close the remaining gaps and to improve the success of the medical home model in addressing the health care needs of people with SMI.

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Community Care of North Carolina: Saving State Money and Improving Patient Care

Cited by 5 publications

References 0 publications

New Developments in Primary Care Practice

New Developments in Primary Care Practice

Association between medical home enrollment and health care utilization and costs among breast cancer patients in a state Medicaid program

Utilization and Adherence in Medical Homes

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