Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States. A. Program Overview

01/01/2014

Community Care of North Carolina (CCNC) is a statewide population management and care coordination infrastructure founded on a primary care medical home model. As an enhanced PCCM program, CCNC aims to improve the cost-effectiveness and quality of care for Medicaid recipients with chronic illness through leadership by local clinicians and a strong emphasis on care coordination, disease and care management, medication management, and quality-improvement (Kaiser Commission on Medicaid and the Uninsured 2009). CCNC's central office works with 14 regional networks, care managers, and CCNC-affiliated primary care practices (primary care medical homes) to coordinate services for Medicaid recipients and to connect them with a broad range of state and community-funded social services. Though nearly all full-benefit Medicaid recipients are eligible to enroll, CCNC focuses the majority of its care management and coordination on individuals with chronic illness.

Individuals with behavioral health needs, particularly those with comorbid physical conditions, are the focus of CCNC's behavioral health program. The program aims to facilitate integration of primary care and behavioral health care by supporting primary care providers (PCPs) in becoming the medical home for enrollees with mild to moderate behavioral health issues typically served in the primary care system as well as those with SMI typically served in the specialty behavioral health system. Historically, coordinating care for individuals with SMI has been challenging in North Carolina because the state's systems governing physical health care and mental health care are distinct. Local Management Entities (LMEs) have traditionally managed the delivery of specialty mental health services for Medicaid beneficiaries while CCNC has managed physical health services. As a result, achieving mental and physical health care integration for individuals with SMI requires close collaboration and communication between the LMEs and CCNC. The LMEs and the local CCNC networks have been working to achieve this aim; however, the state's current conversion of all LMEs to Managed BHOs has complicated these efforts.

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