CCNC quality report shows strong program performance
The Annual Quality Report for State Fiscal Year 2019 finds that CCNC continues to effectively manage cost and utilization for enrolled Medicaid populations through high-performing primary care and effective care management. CCNC’s focus on continuous quality improvement enhances care delivery, resulting in fewer ED visits, impatient admissions, readmissions, and lower total health care costs.
“I am pleased to report strong program performance in the midst of significant changes in the State’s Medicaid delivery system,” said CCNC Chief Medical Officer, Tom Wroth. “We look forward to continuing to work together with North Carolina’s Division of Health Benefits to improve health outcomes and reduce the cost of care for Medicaid and NC Health Choice beneficiaries.”
The report displays 22 measures in four categories—primary care case management, pediatrics, maternal health, and behavioral health—of which nine are benchmarked against the 2017 NCQA HEDIS national Medicaid MCO mean. Overall program performance is measured through claims data across chronic conditions, population specific preventive care, and utilization measures.
Highlights from the report include:
- Primary Care Case Management: Actual rates for the Key Performance Indicators continue to outperform expected rates. Actual inpatient admissions are 28.5% below expected admissions and ED visits are 13.7% below expected.
- Pediatrics: Well child visit rates for children in the first 15 months of life exceed the Medicaid MCO HEDIS mean and continue to increase. There has also been significant improvement in adolescent preventive care with both well visits and immunizations rates increasing.
- Maternal Health: Almost 80% of pregnant women in the Pregnancy Medical Home program undergo a comprehensive risk screening. There has also been an increase in early entry to prenatal care and postpartum follow-up visits as a result of CCNC’s statewide initiative launched in 2018.
- Behavioral Health: The rate of Medicaid members who have been hospitalized in psychiatric facilities having adequate follow up continues to be above the HEDIS mean for all ages.
As part of CCNC’s commitment to continuous quality improvement, the annual quality review is used to stimulate and facilitate quality improvement efforts at CCNC’s networks and medical homes. For more information, contact Paul Mahoney at firstname.lastname@example.org.