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North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model

North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model. Overview April 16, 2012. Integrated Delivery Model Goals. Improve responsiveness to beneficiary goals, Improve care quality, and Achieve shared savings . Strategic Framework Development Process.

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North Carolina’s Dual Eligible Beneficiary Integrated Delivery Model

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  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

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