Wednesday, April 8, 2015

More on the Debate on Whether the Community Care of North Carolina (CCNC) Approach to the Patient Centered Medical Home (PCMH) Saves Money

...and you can take that
to the bank?
It seems no discussion on the Patient Centered Medical Home is complete without a reference to Medicaid's Community Care of North Carolina. The state's consultants' reports on CCNC have been accepted as gospel by the academic community (for example) and have contributed to a widespread consensus that the PCMH saves money. As in billions.

Or does it? For a readable discussion of why CCNC may or may not have saved money, check out this four pager by Joseph Burns appearing in March 2015 issue of Managed Care Magazine. Skeptics point out numerous inconsistencies, including North Carolina's lingering high costs and little change in inpatient utilization. MCM asked analytics impresario Ariel Linden to take a look at CCNC and, after using a time series analysis, he was unable to find evidence of savings.

Nothing new, says the Disease Management Care Blog, which has long been unable to make much sense of the consultants' reports either. What is new are the responses of CCNC's Paul Mahoney, founding physician Charles Wilson and advocate Adam Searing. It seems North Carolina's fee schedule is complicated, physician buy-in is high, something must be working because the Medicaid program has avoided making fee schedule cuts and, last but not least, the State's legislature never intended the consultants' evaluations to meet the exacting standards of the DMCB readership.

The DMCB doubts the controversy will go away.  What we can learn from the CCNC imbroglio is how important it is to think about the analysis early in the planning process. In the meantime, PCMH advocates will probably have to look elsewhere if they want to refer to studies that are understandable, transparent and convincing.

Coda: By the way, whatever it's imperfections, the CCNC is a good example of a "shared resources" approach to nurse care management. As the DMCB understands it, in CCNC, the primary care sites do not hire their own nurses.  Rather, the costs of the nurses are regionally supported and the nurses are, in effect, loaned out to the clinics. 

The DMCB argues that there is little difference between this and hiring a disease management/population health service provider. To paraphrase Comrade Deng again, the color of the cat may be different, but it still catches mice.

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