ISE student teams help Community Care of North Carolina (CCNC) improve service to Medicaid beneficiaries while cutting costs
At its annual meeting this spring, CCNC, Inc. announced a research partnership with ISE. As part of the announcement, ISE’s Paul Cohen, Ph.D.and Maria Mayorga, Ph.D. discussed ISE’s plan to use advanced analytics and modeling to control Medicaid costs while raising the quality of care delivered. “Our students and faculty partner with organizations to solve real world problems,” Dr. Cohen explained. “Our health systems engineers optimize decision making with state-of-the-art modeling, resulting in measurable improvements to service and value.”
CCNC’s ongoing effort to control North Carolina’s Medicaid costs has been extremely successful. Numerous studies over the years, including those commissioned by NCDHHS and other independent efforts, have estimated that Community Care’s unique medical home model helped North Carolina Medicaid avoid hundreds of millions in costs annually. That success has caught the eye of health care policymakers across the country that plan to use this model in other states.
Health Systems Engineering Program
For almost 10 years, ISE has partnered with the healthcare community through its HSE Program. Led by former ISE department head Dr. Stephen Roberts, the program uses innovative tools for clinical operations and supports high quality, accessible healthcare.
“HSE brings invaluable expertise in healthcare delivery over the entire patient care cycle,” said L. Allen Dobson, Jr., MD, CEO of CCNC. “We already work with them in bringing LEAN principles to our clinical operations. With ISE, we will explore opportunities to reduce costs and get more value for the state’s Medicaid dollar.”
ISE Student Projects
This spring, two student teams from the ISE program worked with CCNC to streamline its operations, lower costs and improve outcomes. In addition to Dr. Roberts, Dr. Maria Mayorga, Dr. Julie Ivy and graduate student advisor Karen Hicklin advised the two teams.
ISE students Kiron Allen and Sofia Robles focused on Transitional Care (TC) in the Sandhills Network, one of 14 non-profit entities that make up the Community Care’s statewide network. The TC program provides continuity and coordination of care as patients transition to home after a hospitalization. It is primarily provided to Medicaid beneficiaries with multiple or complex chronic conditions and seeks to prevent repeat, unnecessary hospitalizations. If more Medicaid patients are reached by the TC program, the greater the savings which accrue to the NC Medicaid program.
Allen and Robles used database reconciliation and statistical analysis to analyze current care management costs and processes. The main goal was to estimate the amount of time and costs for the patients to complete the TC process. With the results, CCNC developed a Return on Investment Calculator that the other networks across the state can use in their own settings.
The student team of Amelia Hardee and Chad Glenn focused its research on streamlining CCNC decision support for Personal Care Services (PCS). Medicaid spends more than $600 million a year on home-based services in North Carolina, and PCS provides help in the beneficiary’s home with Activities of Daily Living. Beneficiaries must have a physical or developmental disability, cognitive impairment, or chronic health condition that hinders their independence and their ability to do tasks that they would ordinarily do for themselves if they were not disabled.
Hardee and Glenn analyzed all aspects of decision making, processes and information flow within the PCS system. This included communication between doctors and the Community Care and educating doctors and hospitals about the need for decision support services. NCCCN will use this data to develop an optimal process that is scalable statewide. It will enable Community Care to give healthcare providers critical information to relay patient needs.
The ISE and Community Care partnership is an example of how the department continues to work with private enterprise, furthering its mission to solve real-world problems and have a positive impact on the quality of life in our communities as well as on the bottom line.
Community Care is a community-based, public-private partnership that takes a population management approach to improving health care and containing costs for North Carolina’s most vulnerable populations. They create “medical homes” in all 100 counties for Medicaid beneficiaries, individuals that are eligible for both Medicare and Medicaid, privately-insured employees and uninsured people. To learn how Community Care saves North Carolina millions of dollars every year, visit www.CCNCcares.com.