Care Management
Validate NC Medicaid Managed Care Readiness
Generate Immediate Incremental Funding
Successful AMH Tier 3 Development Strategy
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Executive Summary
A large, multispecialty group sought independent validation of its North Carolina Medicaid Managed Care readiness and turned to a physician-led health network for guidance. The combination of years of investment and preparation by the group, peer-based insight and deep relationships from the network and consulting expertise by a trusted third party resulted in successful AMH Tier 3 program development and readiness. The engagement generated immediate incremental funding for the group, validation of their leading approach to quality management and strong potential for better health outcomes for their high-risk Medicaid patients.
“JCMC has long been on our radar screen as one of the most advanced practices in the state. The fact that they challenged themselves to raise the bar despite a position of established leadership speaks volumes about the caliber of their entire team.”
-Peter Bird
CCHN’s Vice President of Strategy and Performance
RESULTS:
• JCMC and AMM emerged from the project with increased confidence their ability to perform at the Advanced Medical Home Tier 3 level within North Carolina Medicaid Transformation
• AMM enabled JCMC to qualify for NC DHHS AMH Tier 3 Glidepath Payments to partially offset AMM’s significant investment in JCMC’s transformation
• Emtiro Health gained renewed perspective on the importance of leadership buy-in and trust
• The project underscored JCMC’s leadership in higher-quality, lower-cost care for patients
Situation
Jacksonville Children’s and Multispecialty Clinic (JCMC), a member of AMM Healthcare’s multispecialty group, is a large, steadily growing practice in coastal North Carolina. They have been providing quality healthcare to military families from Camp Lejeune and New River Air Station, as well as residents of Onslow, Carteret, and New Hanover County for over 40 years. The practice is widely viewed as a leader in improving care and reducing costs by leveraging innovative technology systems and sophisticated quality improvement processes, all wrapped in exemplary care.
“The North Carolina Department of Health and Human Services (DHHS) developed the Advanced Medical Home (AMH) program as the primary vehicle for delivering care management as the state transitions to Medicaid managed care. The AMH program builds on the Carolina ACCESS program.”
-NCDHHS
medicaid.ncdhhs.gov/transformation/advanced-medical-home
AMM Healthcare had invested heavily in JCMC’s infrastructure to prepare for North Carolina’s Medicaid Transformation to managed care. Anecdotal and informal feedback suggested they were ready to perform at the AMH Tier 3 level, however the COVID-19 pandemic and economic upheaval challenged the strong medical home JCMC and AMM had built. The CEO and President & Medical Director strove to emerge from the pandemic with more confidence – not just as a Medical Home, but as a truly Advanced Medical Home. They chose to partner with Carolina Complete Health Network to optimize the model.
Carolina Complete Health Network (CCHN) is a new kind of Physician-Led Network. CCHN is a subsidiary of the North Carolina Medical Society and co-founders of a first-of-its-kind partnership with Centene Corporation, the North Carolina Community Health Center Association and other providers across North Carolina. CCHN’s mission is to drive better health, lower cost and greater health equity in our communities.
Solution
CCHN had been exploring unique ways to support groups such as JCMC and AMM Healthcare. Since its inception in 2016, CCHN has been surveying the healthcare landscape in North Carolina, forging broad and deep relationships with providers and partners in order to better understand unmet needs and bring innovative solutions together to improve health. CCHN had long been impressed with the leadership, mission, culture and expertise at Emtiro Health.
Emtiro Health supports providers, systems, and payers with the experience achieved through the efficient use of data and analytics to enhance the provider-patient care interface and bring about improved health outcomes at a lower cost. Emtiro is driven by its mission to provide bold, inspired solutions in population health management and address barriers to health and wellbeing.
Anticipating the need for AMH Tier 3 readiness validation, CCHN approached Emtiro about forming a partnership to support practices gearing up for the Medicaid Transformation, particularly around AMH Tier 3 readiness. Emtiro agreed enthusiastically and the partners announced CCHN’s AMH Practice Innovation Grant Program in August 2020. JCMC applied for the program and was awarded one of the grants in September 2020.
Project
“The Emtiro team was great. They brought strong technical and care management expertise and coupled that with robust project management rigor.”
-Zen Menon
AMM Healthcare’s CEO
JCMC, AMM, CCHN and Emtiro came together in October 2020 to launch a six-month project to assess JCMC’s readiness to perform at the AMH Tier 3 level coming out of the global pandemic and economic crisis. The Emtiro team leveraged its robust project management and provider services expertise to lead the interdisciplinary team through a thorough assessment of existing infrastructure and current-state processes.
The findings were compared to AMH and NCQA requirements specific to Data Analytics, Risk Stratification and Patient Identification, Care Management and Population Health Management. The Emtiro team worked in collaboration with JCMC’s clinical and AMM’s management staff to develop a customized optimization work plan designed to close identified gaps in JCMC’s readiness to meet North Carolina’s AMH mandated standards, address NCQA care management performance standards and further strengthen JCMC’s already robust quality improvement processes.
“Early in the Innovation Pilot we were able to see that JCMC is a quality-focused and progressive practice. They had multiple strong elements already in place to build from and were comfortable making data-informed decisions. Based on our knowledge of the new AMH program, experience in Medicaid care management and extensive work with practices across the state, we identified a few key areas to strengthen to help JCMC launch a bold and successful AMH Tier 3 program.”
-Joy Key
Emtiro’s Director of Provider Services
Key Contacts
Jacksonville Children’s and Multispecialty Clinic: Zen Menon, CEO; Dr. Madhur Mittal, President & Chief Medical Officer
AMM Healthcare : Zen Menon, President and CEO; Alec Menconi, IT Senior Manager
Carolina Complete Health Network: Dr. Rachel Keever, CEO, President & Chief Medical Officer; Peter Bird, Vice President of Strategy and Performance; Donetta Godwin, Director of Provider Engagement; Jesse Hardin, Senior Provider Engagement Coordinator
Emtiro Health: Kelly Garrison, President and CEO; Joy Key, Director of Provider Services; Cindy Green, Practice Optimization Manager; Brad Horling, Director of Information Technology and Analytics