Community Care of Southern Piedmont (CCofSP) is a regional partnership of primary care providers, hospitals, departments of social services, and community organizations. We are one of 14 similar physician-led networks participating in the statewide Community Care of North Carolina (CCNC) initiative. Our goal is to work with local providers to better manage the Medicaid population and ensure consistent quality, medically appropriate, and cost-effective health care services.
Our objectives are to:
- Improve health outcomes and reduce care costs for Medicaid, NC Health Choice children, and select Medicare, dually-eligible Medicare/Medicaid, and privately-insured enrollees in our geographic footprint
- Promote integrated communities of care using the medical home, evidence-based medicine, and health information technology
- Support patients through the continuum of care, providing care management services to high-risk, chronically ill patients
CCNC’s statewide efforts saved nearly $1 billion in Medicaid costs from 2007 through 2010, and current evidence shows NC Medicaid saves 15% on patients after six months of enrollment in Community Care. Community Care’s innovative, community-based approach received Harvard University’s prestigious Innovations in American Government Award.
The Medical Home
Built on the Medical Home model, Community Care matches each patient with a primary care provider to manage and coordinate care across providers and settings. We support the medical home by:
- Promoting best practices
- Providing Care Management services to high-risk patients
- Supporting clinical decisions at the point-of-care via Community Care’s Provider Portal
- Analyzing performance data and providing practice-specific feedback for quality improvement
Participation Requirements of Primary Care Providers
- Perform primary care that include certain preventative services;
- The ability to create and maintain a patient/doctor relationship for the purpose of providing continuity of care;
- Establish hours of operation for treating patients at least 30 hours per week;
- Provide access to medical advice/services 24/7;
- Maintain hospital admitting privileges or have a formal agreement with another doctor based on ages of the members accepted;
- Refer or authorize services to other providers when the service cannot be provided by the Primary Care Physician (PCP);
- Use reports provided by the Division of Medical Assistance (DMA) managed care section as guides in maintaining the level of care that meets the goals of CCNC and patient needs. Reports are available via the web (physician portal) and paper copies that are mailed.
- To allow the case manager to access patient records for chart reviews
- To refer patients for case management services
- To have a representative from your practice attend medical management committee meetings held by your network
- Participate in yearly chart audits
- Provide pediatric developmental screenings and referrals / following up with Children's Developmental Services Agency (CDSA) or support services (pediatric/ family medicine practices)
In order to serve as a primary care physician in a CCNC network, the provider must first be enrolled with DMA as a Carolina ACCESS PCP. The provider will be required to sign a contract with CCofSP.