SOUTH

Modern Healthcare - - REGIONAL NEWS - —An­dis Robeznieks

Com­mu­nity Care of North Carolina, a not-for-profit agency that runs the state’s much her­alded Med­i­caid med­i­cal home pro­gram, is coming un­der scru­tiny af­ter a state au­di­tor report found that the pro­gram was fall­ing far short of achiev­ing the sav­ings it had pre­dicted. The state has since pub­lished a re­quest for in­for­ma­tion seek­ing rec­om­men­da­tions to im­prove its Med­i­caid pro­gram. A study has also been called for to de­ter­mine whether the med­i­cal home prac­tice model—that em­pha­sizes in­creased ac­cess and co­or­di­nated care—does in fact save money and im­prove health out­comes. State Au­di­tor Beth Wood’s report found a gen­eral short­fall of $190 mil­lion, and showed that Com­mu­nity Care fell $39 mil­lion short of the $90 mil­lion sav­ings it had pro­jected. The pro­gram has been in place since 1998, and the au­dit report noted that “North Carolina is the home of the med­i­cal home.” The pro­gram has been the sub­ject of glow­ing re­ports from con­sult­ing and ac­tu­ar­ial firms. In De­cem­ber 2011, a report from the Mil­li­man ac­tu­ar­ial firm cal­cu­lated that the pro­gram had saved the state $984 mil­lion be­tween fis­cal 2007 and 2010. But the au­dit found flaws in the Mil­li­man report, stat­ing that it is “based on as­sump­tions and ad­just­ments to data.” “For in­stance, it ad­justs the health sta­tus of rel­a­tively healthy adults and chil­dren in CCNC to be com­pa­ra­ble to non-CCNC par­tic­i­pants,” the au­dit report stated. “How­ever, this re­quires an as­sump­tion that the CCNC par­tic­i­pants are much un­health­ier be­fore com­par­ing the pro­jected costs of the the­o­ret­i­cally un­healthy pop­u­la­tion to the non-CCNC pop­u­la­tion. While such an ex­er­cise may be ac­tu­ar­i­ally sound, it does not pro­vide the same qual­ity of data that could be de­rived from med­i­cal re­search.” Among the au­dit report’s rec­om­men­da­tions is a sug­ges­tion for the state to en­gage med­i­cal re­searchers to per­form a sci­en­tif­i­cally valid study based on ac­tual data to de­ter­mine whether the CCNC model saves money and im­proves health out­comes. In its writ­ten re­sponse to the report, the North Carolina De­part­ment of Health and Hu­man Ser­vices said it agreed with the rec­om­men­da­tion, not­ing that, “as we work to con­trol costs and im­prove the qual­ity within the Med­i­caid pro­gram, it is crit­i­cally im­por­tant that the data avail­able is an­a­lyzed by a rep­utable re­search or­ga­ni­za­tion.” A rep­re­sen­ta­tive from the DHHS did not re­turn a re­quest for com­ment.

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