Is North Carolina Medicaid the Healthcare Industry’s Solyndra?

Al Lewis

Posted 2/21/12 on The Health Care Blog

North Carolina Medicaid recently reported, for the third time, using a third consulting firm, the achievement of massive savings through its patient-centered medical home (PCMH) program, now called Community Care of North Carolina (CCNC). Among other things, CCNC pays the physicians more money in order to encourage and compensate behaviors and processes, including enhanced access to care and case management, to hopefully reduce the need for emergency and inpatient services. (A brief summary of this and past consulting reports appear in the current issue of Modern Health Care.

However, the third time is not a charm. Notwithstanding these consultants’ reports — which paradoxically support my contrary conclusions by choosing to ignore the overwhelming data contradicting their own claims – the program is a total failure as far as reductions in cost and inpatient utilization are concerned.

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Medical Homes – A Boost To Primary Care

Merrill Goozner

The following appeared 11/24/11 in The Fiscal Times:

Amerigroup Inc., the health insurer for Medicaid patients in Nashville, has a serious problem. Many of its 50,000 inner city, low-income beneficiaries go for their routine care to local hospital emergency rooms, which is the most expensive place for such treatment.

So a year ago, without government help, the company instituted a so-called medical home program, paying extra money to local physicians who care for Medicaid patients. They were asked to hire outreach workers to call patients to make sure they keep appointments, take their medication or simply to check up on how they were doing. The insurer also encouraged physicians to establish same-day scheduling and keep extended hours for patients who call with immediate problems.

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Putting the Mouth Back Into the Body

Patricia Salber

First posted 9/29/11 on The Doctor Weighs In

Medicine has been great at creating body silos over the years.  The most obvious example is the disconnect between physical health and mental health.  Physical health providers often find it very difficult to get information about their patients’ mental condition from their patients’ mental health providers and mental health providers rarely connect with physical health providers to really understand the total health picture of the person they are treating.  Vision – mostly treated by optometrists is rarely integrated into general medical care and increasingly our feet are carved out to podiatrists practicing in a one-off fashion.

I could go on and on about body carve-outs, but won’t, as what I want to talk about today is oral health.  Unless you get a mouth cancer of some sort, oral health pretty much belongs to the dentists and the dentists are not really connected (or considered by most doctors to be a part of)  your medical care.

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Nurse Care Managers: The Mortar Holding the Bricks of Medical Homes

Jaan Sidorov

First posted 9/22/11 on the Disease Management Care Blog

It’s no secret that the Disease Management Care Blog is an enthusiastic believer in nurse care managers. In its humble opinion, it makes no difference what “bricks” are used to build a Patient Centered Medical Home, an Accountable Care Organization, a Population Health Management Program or an employer-based care support/wellness initiative, the nurses are the mortar.

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