North Carolina’s Partnership with Physicians

1. North Carolina’s Partnership with Physicians Improving the Quality of Children’s Healthcare Marian F. Earls, MD NASHP Annual Conference August 8, 2005

2. Medicaid Infrastructure:Community Care of NC (CCNC) • Physician – driven: Clinical Directors and Physicians Advisory Group (PAG) set policy and develop quality initiatives. • Now 15 networks encompassing 92/100 counties in North Carolina. • Medical Management Committee (MMC) at network level is decision-making body.

3. Medicaid Infrastructure:Community Care of NC (CCNC) • Quality Projects include: asthma, developmental screening & surveillance (ABCD), diabetes, ED utilization, Mental Health-Primary Care Integration, Physician Advantage List (PAL-pharmacy). • Policy change July 2004, requiring use of formal standardized screening tool at well-visits according to ABCD project schedule.

4. ABCD Project Relationships • Health Check (EPSDT) Coordinators – co-faculty in physician practice trainings; helped pilot ABCD brochures to families. • DMA Managed Care Consultants - co-faculty in physician practice trainings; assisted practices in implementation. • Early Intervention – shared logos; co-faculty/networking at trainings; sought physician input for referral procedures. • Participation in training video and workbook production and dissemination.

5. ABCD: Invitations to Help Develop State Initiatives • Healthy Development Learning Collaborative (NC &VT–CCHI & VCHIP) • Medical Home (Public Health, Early Childhood Comprehensive Systems Grant) • Medical Home Learning Collaborative (CCHI) • Mental Health-Primary Care Integration (CCNC) • Linking PCP’s to Childcare and Early Education (Division of Child Development, Resource & Referral Centers, Smart Start)

6. NC Pediatric Society • Long-standing relationships with Medicaid and Public Health through Open Forums. • Promoted and provided venue to widely communicate about the ABCD project. • Mental Health/School Health Committee: multi-agency membership, change in Medicaid policy in February 2001 to allow private mental health providers to directly enroll as Medicaid providers, enabling co-location models in primary care practices.

7. Challenges for Providers • Over-riding long held assumptions about working with a bureaucracy. • Being available (meetings/calls) to nurture the relationship. • Willingness to integrate quality initiatives into the office flow.

8. Benefits for Providers • Opportunity to shape policy. • Established relationship when new issues for providers arise. • Facilitation of care coordination for the office in the community. • Improved office efficiency and family satisfaction. • Removal of bureaucratic barriers (local and state).

9. PEARLS • Begin with the needs and interests of providers. • Involve AAP and AFP Chapters early. • Identify physician champions. • Ensure physician buy-in by physician to physician communication.

10. PEARLS • Align goals with community/state partners. • Provide actual networking opportunities. • Begin with a pilot, then replicate. • Collect data/show evidence/share experience, then replicate. (Note: ABCD State Advisory Group initiated after pilot established and producing data.) • Start locally, and then move state-wide.