How does CCLCF support rural health departments in navigating the state’s Medicaid transformation plan?

Beginning on July 1, 2021, North Carolina Medicaid transitioned from a fee-for-service model to a “Medicaid Managed Care” model, with the goal “to improve the health of North Carolinians through an innovative, whole-person centered, well-coordinated system of care and measurement of quality, which addresses both medical and non-medical drivers of health”. In this new model, Medicaid will increasingly tie payment for services to improvement in health plan performance, health care quality and outcomes.  Under managed care, most beneficiaries will now be choosing one of five North Carolina Medicaid Managed Care Plans and North Carolina Medicaid providers may also enroll with one or more of the health plan networks.

In anticipation of the significant changes, Kate B. Reynolds Charitable Trust and the Blue Cross Blue Shield of North Carolina Foundation provided grant funding to The College of Health and Human Services at the University of North Carolina Wilmington’s Center for Healthy Communities to support rural health departments in navigating the state’s Medicaid transformation plan.  The purpose of the project was to help rural counties prepare for a successful transition to the new model of care.

How are Health Departments affected by Medicaid Transformation?

Health Departments across the state are unique, in that most locations provide medical services in addition to patient services like care management for high-risk pregnant women and at-risk children. In the previous 10 years, health departments received support from Community Care of North Carolina in providing high-quality care management services and technical support.  Now those health departments have a new partner with the prepaid health plans.

As Medicaid Transformation commenced in July 2021, Community Care of the Lower Cape Fear and UNCW Center for Healthy Communities began meeting with health department teams, reassessing strengths and barriers to success in the new healthcare environment. As with any new program, health department staff, including clinic, billing and care management teams, are dealing with significant change.  The most impactful changes have been in how payment for services is received and how programs are being measured for success.  Previously, health departments had one North Carolina Medicaid Plan,  and now there are five prepaid health plans providing insurance coverage to NC Medicaid recipients.  Each health department is now in the process of learning about the new plans, developing relationships with new contacts at the health plans and how to navigate questions and concerns.

What is CCLCF doing to support these rural Health Departments?

During this project, monthly team meetings have included health department leadership, care management teams, financial and clinical staff from Bladen and Columbus counties.  There has been a combination of both in-person and virtual meetings.  Goals for each meeting are to identity and address concerns being experienced by the health departments and provide tools and resources for identified needs.  Some key topics have included an overview of Medicaid Managed Care, a review of LEAN process, and a refresher on Motivational Interviewing.  Assessing, interpreting, and integrating data for actionable use has been a top priority.

At the conclusion of the project, each health department will receive a resource guide that pulls together important program communication, quality improvement tools, standards of work and prepaid health plan resources.  One goal of this project is to replicate the success of the local teams in other areas of the state. If you are a North Carolina Health Department and interested in learning more, please contact doris.robinson@carelcf.org.

About Community Care of the Lower Cape Fear (CCLCF)

CCLCF is a 501(c) (3) that improves health outcomes for eligible Medicare, Medicaid, uninsured and privately insured enrollees in southeastern NC including New Hanover, Pender, Brunswick, Columbus, Onslow, and Bladen counties. Our interdisciplinary Care Teams include RN care managers, social workers, pharmacists and provider support, work with Prepaid Health Plans, ACOs, practices and providers to improve patient outcomes, experience, and satisfaction. CCLCF partners with primary care providers, 7 regional hospitals, local health departments, social service agencies, Behavioral Health, Managed Care Organization\’s (MCO\’s) and other community-based organizations. We are a National Committee for Quality Assurance (NCQA) accredited care management organization.

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