North Carolina

North Carolina implemented its initial medical home initiative in 1991 through a traditional primary care case management (PCCM) program (Carolina Access) for Medicaid beneficiaries who qualify for coverage because they belong to low-income families. In 1998, an enhanced primary care case management program (Community Care of North Carolina) began as a pilot based on the Carolina Access program. Under this program, providers were required to form networks that include primary care, safety net, and specialty care providers in collaboration with the local health departments, departments of social services, and hospital(s). Primary care providers direct the care that program participants receive. Both primary care providers and the networks receive a per member per month (PMPM) fee to implement population management strategies (such as disease and care management, population stratification, preventive services and coordination across delivery settings), as well as support in implementing practice improvements from Community Care of North Carolina (CCNC). Program data confirms both cost savings and quality improvementóand the state is expanding the program to people who qualify for both Medicaid and Medicare (dually-eligible).
Targeted Population: Medicaid/CHIP.