Medical Home - Ongoing Medical Home Projects

Ongoing Medical Home Projects

One notable implementation of medical homes has been Community Care of North Carolina (CCNC), which was started under the name "Carolina Access" in the early 1990s. CCNC consists of 14 community health networks that link approximately 750,000 Medicaid patients to medical homes. It is funded by North Carolina's Medicaid office, which pays $3 per member per month to networks and $2.50 per member per month to physicians. CCNC is reported to have improved healthcare for patients with asthma and diabetes. Non-peer-reviewed analyses cited in a peer-reviewed article suggested that CCNC saved North Carolina $60 million in fiscal year 2003 and $161 million in fiscal year 2006. However, an independent analysis asserted that CCNC cost the state over $400 million in 2006 instead of producing savings.

The Rhode Island Chronic Care Sustainability Initiative (CSI-RI) is a community-wide collaborative effort convened in 2006 by the Office of the Health Insurance Commissioner to develop a sustainable model of primary care that will improve the care of chronic disease and lead to better overall health outcomes for Rhode Islanders. CSI-RI is focused on improving the delivery of chronic illness care and supporting and sustaining primary care in the state of Rhode Island through the development and implementation of the patient-centered medical home. The CSI-RI Medical Home demonstration officially launched in October 2008 with 5 primary care practices and was expanded in April 2010 to include an additional 8 sites. Thirteen primary care sites, 66 providers, 39 Family Medicine residents, 68,000 patients (46,000 covered lives), and all Rhode Island payers are participating in the demonstration. Further, its selection to participate in the Centers for Medicare and Medicaid Services' Multi-Payer Advanced Primary Care Practice demonstration, CSI-RI is one few medical home demonstrations in the nation with virtually 100% payer participation. Since the start of the demonstration, CSI-RI sites have implemented a series of delivery system reforms in their practices, aimed at becoming patient-centered medical homes, and in turn receive a supplemental per-member-per-month payment from all of Rhode Island's insurers. Each participating practice site also receives funding from participating payers for an on-site nurse care manager, who can work with all patients in the practice, regardless of insurance type or status. All 5 original pilot sites achieved NCQA level 1 PPC-PCMH recognition in 2009, and all 8 expansion sites achieved at least level 1 PPC-PCMH recognition in 2010. As of December 2010, all of the pilot sites and two of the expansion sites have been recognized by NCQA as level 3 patient-centered medical homes.