Achieving Improvement and Sustainability

How can NC AHEC Practice Support help you?

While our primary focus is on quality care for Medicaid beneficiaries and Advanced Medical Homes, patients and clinical quality measures covered by any payer will benefit from our quality improvement work.  This includes the Medicare Quality Payment Program, and value-based models required by payors and CINs/ACOs.   Our services are focused on helping practices redesign their clinical and administrative workflows, optimize their teams and systems of care so that practices are able to thrive with value-based care.communities. 

If would like to connect with an NC AHEC practice support coach to assess your practice’s current state and improvement opportunities, please send your request to practicesupport@ncahec.net, and a coach will be in touch with you.

What is NC Medicaid’s Quality Strategy?

NC Medicaid’s Quality Strategy delineates an innovative, whole person, well-coordinated system of care that addresses both medical and non-medical drivers of health and promotes health equity. The Strategy:
• Focuses on rigorous outcome measurement compared to relevant targets and benchmarks,
• Promotes equity through reduction or elimination of health disparities, and
• Appropriately rewards health plans and, in turn, providers for advancing quality goals and health outcomes.

Did you know NC Medicaid and the Medicaid Health Plans support value-based purchasing arrangements? NC Medicaid requires the Medicaid health plans to offer Performance Incentive Payment opportunities to AMH Tier 3 practices and encourages the plans to offer incentive payments to practices in AMH Tiers 1 and 2. While performance thresholds and payment rates are set by Health Plans, all performance incentive payments must be based exclusively on the AMH measure set and not on measures outside of the set.

The Quality Strategy also supports Federal Regulation (42 CFR 438.330{d}) which requires Medicaid health plans to conduct performance improvement projects (PIPs) that: 
• Are designed to achieve significant improvement, sustained over time, in health outcomes and enrollee satisfaction.
• Include measurement of performance using objective quality indicators.
• Include implementation of interventions to achieve improvement in access to and quality of care.
• Include evaluation of the effectiveness of the interventions; and
• Include planning and initiation of activities for increasing or sustaining improvement

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The three NC Medicaid PIPs are:
• Childhood Immunization Status (Combination 10) for ages 0-2 years,
• Diabetes Management (A1C testing and results), and
• Timeliness of Prenatal and Postpartum care.

Statewide data from CY 2019 showed NC Medicaid was performing near or below the national Medicaid median on these PIP measures. NC Medicaid uses the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) measures to assess performance against benchmarks. Additionally, NC Medicaid noticed a need to improve data reliability and data capture for these areas.

See Quality Measurement Technical Specifications, North Carolina’s Medicaid Quality Measurement Technical Specifications Manual for Standard Plans and Behavioral Health Intellectual/Developmental Disability Tailored Plans for more details.

For the first two years of managed care implementation, NC Medicaid seeks a relative improvement of 5% over the prior year’s NC Medicaid statewide performance for each measure. Go to Quality and Population Health: AMH Measures, Statewide QI Projects to view baseline data and goals.

In support of NC Medicaid’s Quality Strategy and in collaboration with the health plans, NC AHEC (including its nine regional AHECs) applies its QI resources and strategies to support AMH practices and providers across the state as they work on the PIPs and other quality improvement initiatives. In addition, physicians and physician assistants may be able obtain MOC-IV credit if they work on a quality improvement project with an NC AHEC Practice Support coach.

In addition, NC AHEC helps small practices in North Carolina successfully participate in the Medicare Quality Payment Program (QPP), Merit-Based Incentive Program (MIPS), Value Pathways (MVP) and Making Care Primary Program (MCP).  This support is available at no cost to the practice.  More information can be found at www.qpp.cms.gov or reach out to your practice support coach at practicesupport@ncahec.net.

A Coordinated Approach to Behavioral Health

What is NC AHEC’s role with Tailored Care Management (TCM)?

NC AHEC in partnership with NC DHHS and NC Medicaid provides a comprehensive suite of courses that equips TCM provider organizations and tailored plans with the knowledge to effectively provide care management services to North Carolina’s Tailored Plan beneficiaries.

Through Tailored Care Management (TCM), launched December 1, 2022, Behavioral Health (BH) – I/DD Tailored Plan beneficiaries have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that holistically addresses their needs. This includes physical health, behavioral health, intellectual and developmental disabilities (I/DD), traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS), as well as unmet health-related resource needs. Tailored plans have assigned geographic areas. A list of tailored plans, contact information, and covered counties is available at NC DHHS.

The success of Tailored Care Management will depend upon BH/IDD Tailored Plans, AMH+ practices, CMAs, pharmacies, physical health, behavioral health, and I/DD providers working together to provide a coordinated approach to beneficiary care.

For additional information and resources about Tailored Care Management, visit the DHHS Division of Health Benefits Tailored Care Management webpage.

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Tailored Care Management, Learning Collaborative & DHB Office Hour Sessions

Tailored Care Management Learning Collaboratives and DHB Office Hours are designed for TCM certified organizations at no cost. The sessions provide content experts and peer-to-peer learning opportunities to AMH+ and CMA organizations as they implement TCM. Sessions will continue every first and third Wednesday of the month from 12:30–1:30 PM. Please register for the TCM Learning Collaboratives on the TCM Web Portal’s “Events Calendar” section. Contact your AHEC Coach supporting TCM for additional information.
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Tailored Care Management, Continuing Professional Development

NC AHEC provides Tailored Care Management courses to certified TCM agencies and live events to the community. Courses and events are offered to certified TCM agencies with continuing education credit at no cost. There is a registration/credit fee for community members desiring to learn more about Tailored Care Management topics. Webinar platforms are provided for all events.

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For questions about NC AHEC Tailored Care Management (TCM) Continuing Professional Development, contact Scott Melton at Scott.Melton@mahec.net.