Emerging Practices in Medicaid Primary Care Case Management Programs. North Carolina: ACCESS

06/01/2001

North Carolina has embraced the concept of state and local partnerships in the development and implementation of its PCCM program. State agency officials view the development of infrastructure at the local level to be one of the most important aspects of their successful PCCM initiatives. The state began Carolina ACCESS as a small PCCM demonstration in 1991, and expanded by county, achieving statewide coverage in 1999. The Medicaid agency funds a position at the regional level to work with both members and providers. Known as a managed care representative, this individual is based at the regional social services office and provides a link with the various providers and services in the community. By taking a gradual county-by-county approach and providing representation and accountability within the community, state officials believe that their agency built credibility and an acceptance of the ACCESS program, as well as preparing each region prior to implementation.

The ACCESS II and III programs began with the state issuing a letter in 1997 to the 35 provider groups in the state that had the largest number of Medicaid patients, to gauge their interest in participating in a PCCM program that focused on quality as well as access, in exchange for a greater case management fee. The response was overwhelmingly positive, so the state issued a Request for Proposals (RFP), asking respondents to propose how they would partner with the other providers in their area to manage the care of their members. ACCESS II and III are network-driven, combining physicians, hospitals, public health, social services, and other community-based services.

Currently, there are seven ACCESS II sites serving local regions, with the exception of a large provider network that spans 32 counties. The two ACCESS III sites are countywide networks composed of physicians, hospitals, health departments, departments of social services, and other community providers. The ACCESS II and III networks are paid an enhanced case management fee of $5.00 per member per month. The PCP receives the usual monthly $2.50 case management fee per patient 23, and the remaining $2.50 goes to the network's administrative entity for case management and administrative functions related to the network's enrolled population. With this network approach to PCCM, case management is an expectation of not only the individual PCP but also of the ACCESS II and III networks. In addition, the networks are expected to build a community service delivery infrastructure and promote collaboration among providers.

North Carolina has invested in the development of local infrastructures with each of the ACCESS programs. The state has promoted an enhanced model of PCCM and has helped the networks build service delivery collaboration at the local level to avoid duplication. State officials firmly believe that partnerships — both within communities and between the state and local providers — are essential to the long-term success and sustainability of North Carolina's PCCM system.

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