International: North Carolina, United States
Geography type: Urban
Population covered: the programme covered 3,000 physicians who provide care for over 880,000 Medicaid patients across the state (at the time of the case study)
Professional group/type of organisation involved e.g. acute, CAMHS, voluntary sector, primary care
A central network office plus 14 regional offices. Each network has a medical director, network manager and case management team (including nurses, pharmacists, social workers and other staff depending on need).
Details of initiative
Medicaid is a US health programme for low-income adults and their children, and people with certain disabilities, funded jointly by the Federal and State governments CCNC is funded through the state Medicaid programme. It aims to improve the quality, cost, accessibility and utilisation of services.
CCNC promotes integration through coordinated and standardised clinical practice including:
- Locally adapted clinical guidelines
- Case management services
- Financial incentives
- Data review
- Analysis and feedback on clinical practice
The central programme office provides medical leadership, operational support including IT and data analytics and developmental support to the regional networks. The network offices received US$3 per Medicaid-enrolled patient per month at the time of the case study to support physicians in the CCNC programme. The network offices work with clinicians to disseminate guidance and support, monitor changes in clinical practice, and enable more integrated care to be delivered to patients.
Type of integration (vertical, horizontal, population)
CCNC had no performance role or monitoring over local providers.
Challenges, successes, lessons learned and advice
There were three stimuli to develop more integrated care.
- Unhelpful duplication of services received by Medicaid beneficiaries
- Perceived fragmentation of care
- Pressure to reduce the state Medicaid budget
All these factors led to innovations in service delivery.
Challenges to successful integration included:
- Slow uptake by some physicians – limited consequences for non-compliance
- Relatively limited resources of regional networks
- CCNC has no performance management role or line management authority over local providers, so its influence on clinical practice is indirect
Cost benefit information
Information taken from a report by the Nuffield Trust, (2011)