N.C. Employers Embrace Medicaid Medical Home Network

North Carolina employers are trying to find out if there really is no place like home.

As in medical homes, that is.

For the first time, people with job-based insurance in the state will soon be offered a chance to tap into a well-known medical home network that has primarily served Medicaid enrollees since 1998.



Photo by Andy Callahan via Flickr

That network is one of the longest running and most studied medical homes, a term that encompasses efforts to better coordinate primary care, often by creating a more team-based approach that links physicians with other medical providers, such as nurse practitioners, nutritionists, pharmacists and mental health experts.

Today, drug maker GlaxoSmithKline, pharmacy chain Kerr Drug, analytics firm SAS, the state and Blue Cross and Blue Shield of North Carolina announced that their employees will be able to voluntarily enroll in the nonprofit Community Care of North Carolina network.

The network, made up of physicians, hospitals, social service agencies and county health departments,  is credited with saving the state millions of dollars since its founding in 1998.  In recent years, the program has expanded to serve some Medicare patients under a special waiver.

Other states, including Maryland, Maine and New York, have medical home programs or pilot projects that private insurers and employers can join.   Each state program is different, as are its insurance markets.

In an effort to slow Medicaid spending, many states have also embraced private managed care plans, often HMOs.  North Carolina has not gone the HMO route, preferring the public-private partnership approach, says Pam Silberman, president and CEO of the North Carolina Institute of Medicine, a state agency that studies health issues.

The Community Care network – and its participating physicians – each receive a small fee of about $2.50 per enrollee per month in order to boost coordination of care, such as hiring nurse care mangers or improving data systems to support the doctors’ practices.  Employers offering the network to workers will also pay the network a fee for those who participate.

GlaxoSmithKlines’s Jack Bailey says the firm will make it a voluntary add-on to the firm’s existing health insurance coverage for 10,000 active and retired employees in North Carolina. Those who use it will have their doctor visit copays waived when they see a primary care physician.

The drug maker hopes the move will result in better coordination of care and cost savings – and says about 95 percent of the doctors it already uses for its health program are aligned with the Community Care network around the state.

Employees who use the network, he says “will get more personalized attention … likely with professionals they already know and trust.”