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North Carolina Case Study Summary

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1. What are the strengths of the current Medicaid care management system in North Carolina? The state of North Carolina, arguable has had positive reviews concerning Medicaid. With one of the biggest issues concerning the United States being the costs associated with care, and the consistent increase in these costs, North Carolina has been one of the top states to reduce costs. In particular, their Medicaid program has been well known as the textbook describes North Carolina as a leader in improving Medicaid quality and costs. Furthermore, their plan seems to do a great job of implementing current health care issues. For example, the plan insures that the CCE’s are providing fair and equal access, using the same financial vendor to reimburse medical providers, integrating mental health, and ensures access to primary and preventative services. Furthermore, physicians have been working towards an evidence-based medicine, as well as developing case management procedures for high-risk patients. Overall, it seems as though they are doing fairly well as they are not only working …show more content…

As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet. Such criteria include fair an equal access through primary and preventative care, 24/7 medical advice, maintain hospital admitting privileges, and a refer or authorize service. Along with this, they are also suggesting the use of evidence-based medicine and the use of case management

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