By Sheela Ramamurthy and Jamie Philyaw
The promise of community-based care management is not lost on today’s payers and providers. Networks designed to address the unique population health needs of a local region are realizing notable success with the implementation of such programs.
Community Care of North Carolina (CCNC) is a prime example. A not-for-profit corporation created to foster and enhance the quality, efficiency and access to health care services and provide population management interventions for high-risk patients. CCNC provides essential support to safety net clinicians and vulnerable and underserved populations. CCNC has a strong focus on low income individuals, especially those with multiple chronic conditions living in rural and underserved areas of North Carolina. CCNC has brought together physicians, nurses, pharmacists, hospitals, health departments and social service agencies to improve access to care for North Carolina’s vulnerable populations. The program’s success speaks for itself: An independent evaluation by leading actuarial firm Milliman Inc., found that CCNC saved nearly a billion dollars over a four-year period.
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Yet, like any forward-looking organization, CCNC realized that early success would not necessarily equate to long-term sustainability of its model. As best practices have emerged in recent years, the organization has continued to evolve and adopt better strategies to achieve optimal outcomes.
In 2016, CCNC identified the need for an advanced integrated medical management solution that would provide clinicians with tools to optimally manage a member’s health along the health care continuum. Their goal was to find a medical management system that integrates health and wellness, care management (including complex care and transitions of care), and disease management to provide the user a 360-degree working view of a member.
Following a rigorous discovery process, the organization chose to partner with VirtualHealth to deploy a comprehensive medical management platform. The partnership proactively addresses the health needs of its high-risk populations including the developmentally disabled, aging adults, pregnant women with high-risk complications and those with chronic health conditions.
Barriers to coordinated care
Extracting the greatest value from a care management strategy requires turning health care upside down. Traditional transaction-based models must morph into a proactive approach that tackles “whole-person”, patient-centered care.