Multi-Payer Advanced Primary Care Practice - North Carolina

Program Location: 
Raleigh, NC
Payer Type: 
Community Care of North Carolina (CCNC)
GlaxoSmithKline (GSK)
the State Health Plan of North Carolina (SHP)
BlueCross BlueShield North Carolina

The demonstration will be implemented in seven rural counties: Ashe, Avery, Bladen, Columbus, Granville, Transylvania, and Watauga. All participating payers will contribute resources to practices and Community Care networks to support practice transformation to “medical homes,” and to improve quality of care, care coordination, access, patient education, community based support, and other care support services. 

Beginning in January, 2012 providers participating in the multi-payer project had access to a single patient-centered medical home system containing data on the majority of their patients.  This is supposed to speed adoption of evidence-based care and use of tools like the CCNC Provider Portal, a “dashboard” of patient records and care histories.

**This demonstration ended in December 2015.

Payment Model: 

In addition to payments to practices, each participating payer will pay the Community Care networks a per member per month fee to work with primary care practices to provide care coordination, medication management, and other community based support services.

The number of attributed patients is used to ensure practices are receiving a minimum of $1.50 per attributed member per month from BCBSNC for E&M codes billed.

CCNC is a “sponsor” for Patient-Centered Medical Home recognition applications to NCQA; a 20% discount. Staff of Community Care networks are assigned to help practices achieve Patient-Centered Medical Home recognition. Additional payments to support the transformation and to provide needed care coordination services to patients. Payment will vary by payer. Medicare: In addition to fee for service payments based on claims submitted, all practices will receive a minimum of $2.50 PBPM when they start with the Demonstration, with payments increasing for Level 2 or Level 3 NCQA recognition to $3.00 and $3.50 respectively. Practices will receive the regular remittance advice along with those for all of their regular Medicare claims. Medicaid: In addition to fee for service payments based on claims submitted, $2.50 PMPM for each Medicaid enrollee in CCNC (i.e, non-aged/blind/disabled beneficiary); $5.00PMPM for each aged/blind/disabled enrollee in CCNC. Practices enrolled in CCNC are already receiving these payments. Blue Cross and Blue Shield of North Carolina and State Health Plan (administered by BCBSNC): Enhanced fee for service amount for Evaluation & Management codes billed to BCBSNC. Enhanced payments begin after a practice submits its application to NCQA for Patient-Centered Medical Home recognition and continues after a practice receives BQPP recognition. The enhanced fee schedule applies to all BCBSNC and SHP patients. BCBSNC will pay the enhanced fee schedule for E&M codes billed. 

Increased Preventive Services: 

The Brookings Institution, a nonprofit public policy organization based in Washington, DC, will evaluate the program’s impact on cost and quality.

Last updated March 2019
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