1 / 11

North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model

This overview provides information about North Carolina's Integrated Delivery Model, which aims to improve beneficiary goals, care quality, and achieve shared savings. The strategic framework development process involved volunteers, beneficiaries, and various agencies to define what works well and what needs improvement. The model builds on existing strengths, such as statewide medical homes and beneficiary-centered care. Phase 1 focuses on nursing home and adult care home residents, with medical homes and resource allocation based on independent assessments. Phase 2 aims to realign incentives, build capacity, establish new relationships, and encourage data sharing. The proposal has been submitted to CMS.

psally
Download Presentation

North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. North Carolina’s Dual Eligible BeneficiaryIntegrated Delivery Model Overview April 16, 2012

  2. Integrated Delivery Model Goals • Improve responsiveness to beneficiary goals, • Improve care quality, and • Achieve shared savings 

  3. Strategic Framework Development Process Why: Design a model to integrate Medicare and Medicaid services and supports to dual eligible beneficiaries Who: 180 + volunteers including beneficiaries and more than 50 agencies & organizations What: Define what works well, what needs improvement

  4. Acknowledges • Individual differences in quality of life goals, • Wisdom of preventive services/quality care, • Need for flexibility • to meet individual beneficiary goals • to accommodate variation in the availability of natural supports and community resources

  5. Building on Strengths • Existing statewide medical home and population management strategy • Community Care of North Carolina (CCNC) has 14 regional Networks • In top 10 percent nationally on quality of diabetes, asthma, and heart disease care

  6. Beneficiary Centered Medical Homes • Work with beneficiaries as they define and refine their goals • Physician led medical home teams to assist in the achievement of goals

  7. Phase 1 Development • Medical homes for dual eligible nursing home and adult care home residents • Independent assessment & functional need-based process for resource allocation • Beneficiary and other stakeholders Work Groups to: • Continue to refine the model, • Guide implementation & evaluation and • Design & implement community education

  8. Community Education & Dialog Topics • Medical home and model quality monitoring • Beneficiary goal setting and team dynamics • Importance of advance directives to specify personal preferences for instances when unable to express preferences yourself about • physical health care and/or • mental health care

  9. Phase 2 – With Shared Savings • Realign financial and regulatory incentives to: • Build capacity & expand service and support options • Establish new working relationships and information sharing, and • Encourage broader use of actionable data

  10. Proposal Review Process NC Proposal Submitted to CMS

  11. Implementation Time Line

More Related