Community Care of North Carolina

Community Care of North Carolina
Name	Community Care of North Carolina
Formation	1998
Type	Nonprofit
Headquarters	North Carolina
Region served	North Carolina

Community Care of North Carolina is a North Carolina-based nonprofit health care network established in 1998 to coordinate primary care for Medicaid recipients through local networks of providers, public agencies, and managed care organizations. The initiative linked state policymakers, academic institutions, health systems, community health centers, and physician practices to redesign Medicaid delivery using medical homes, care management, and regional coalitions. Influenced by national health reform debates, state budget negotiations, and Medicaid waivers, the program became a model cited in discussions involving the Centers for Medicare & Medicaid Services, Robert Wood Johnson Foundation, and academic health policy research.

History

Community Care emerged during the late 1990s amid conversations involving the North Carolina General Assembly, James B. Hunt Jr., Governor Jim Hunt, and policy advisers from Duke University, University of North Carolina at Chapel Hill, and Duke University School of Medicine. Early pilots involved collaborations with the North Carolina Department of Health and Human Services, Blue Cross Blue Shield of North Carolina, and local community health centers situated in counties such as Mecklenburg County, North Carolina and Wake County, North Carolina. Funders and partners included the Robert Wood Johnson Foundation, The Duke Endowment, and federal Medicaid initiatives associated with the Centers for Medicare & Medicaid Services. The model expanded following evaluations by researchers affiliated with RAND Corporation, Kaiser Family Foundation, and faculty at University of North Carolina School of Public Health.

Organization and Governance

The organization’s governance combined boards drawn from health care executives, county commissioners, academic leaders, and clinicians with input from entities such as North Carolina Medical Society, North Carolina Academy of Family Physicians, Association of Community Health Centers, and local public hospitals like Carolinas Medical Center. Operational leadership engaged executives with experience from Aetna, Humana, and state agencies. Contractual relationships linked the nonprofit to county social services agencies, federally qualified health centers affiliated with Community Health Centers, Inc. and hospital systems including WakeMed Health and Hospitals, Vidant Health, and Novant Health.

Care Model and Services

The care model emphasized a patient-centered medical home approach implemented through primary care physicians, nurse care managers, behavioral health providers, and pharmacy partners. Service coordination involved collaboration with Department of Social Services (North Carolina), local health departments, and specialty referral networks including rheumatology, pediatrics, and obstetrics associated with UNC Health and Duke University Health System. Care management protocols drew on evidence from Agency for Healthcare Research and Quality, chronic disease frameworks for diabetes mellitus, congestive heart failure, and behavioral health integration, while leveraging electronic health records developed in partnership with vendors used by Epic Systems Corporation and health information exchanges modeled after regional initiatives.

Funding and Financial Structure

Funding streams combined state Medicaid allocations appropriated by the North Carolina General Assembly, federal Medicaid matching payments under Title XIX, grants from foundations such as the Robert Wood Johnson Foundation, and contracts with managed care entities including organizations similar to Centene Corporation and WellCare Health Plans. The fiscal model employed shared savings incentives, per-member-per-month care management payments, and performance-based bonuses tied to metrics endorsed by National Committee for Quality Assurance and federal Medicaid quality measures. Financial oversight involved audits by state auditors and reporting to entities like the North Carolina Office of the State Auditor.

Performance and Outcomes

Evaluations by researchers at Duke University, University of North Carolina, and independent analysts at RAND Corporation and Kaiser Family Foundation reported reductions in emergency department utilization, hospital readmissions, and ambulatory care-sensitive admissions for targeted populations. Reports highlighted improved vaccination rates, better diabetes control using HbA1c measures, and patient satisfaction metrics aligned with instruments from the Agency for Healthcare Research and Quality. Comparative studies referenced outcomes similar to initiatives in Massachusetts, Minnesota, and demonstrations under the Medicaid Section 1115 waiver framework.

Criticism and Controversies

Critics from think tanks such as Heritage Foundation and policy commentators at outlets like The Raleigh News & Observer and Charlotte Observer raised concerns about scalability, governance transparency, and the balance between public oversight and private contractor roles. Legal and procurement disputes involved county supervising boards and debates over contract renewals with hospital systems and managed care partners. Fiscal critics cited budgetary analyses by fiscal watchdogs and debated whether shared savings were fully realized compared with projections by North Carolina Budget and Tax Center and academic cost-effectiveness studies.

Legacy and Influence on Medicaid Reform

The model influenced Medicaid policy discussions at the Centers for Medicare & Medicaid Services, and informed reforms in states like Texas, Ohio, and Oregon that considered regional care management, patient-centered medical homes, and shared savings. Academic literature from Health Affairs, New England Journal of Medicine, and policy briefs from Kaiser Family Foundation and Robert Wood Johnson Foundation referenced the program as an example of state-level innovation, contributing to debates about value-based purchasing, population health, and integration of primary care with behavioral health and social services. Its practices appear in technical assistance manuals used by National Academy for State Health Policy and influenced later Medicaid managed care contracts and demonstrations.

Category:Health in North Carolina Category:Medicaid in the United States