Community Care of North Carolina

CCNC saves the state of North Carolina
millions of dollars each year. Click the button below
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This Is Jennifer.

A 31-year-old single mom from Garner who struggles to control her asthma.

Jennifer and her daughter are Medicaid patients who see a
family physician who participates in Community Care
of North Carolina

Today, Jennifer is suffering from another
asthma attack.

She heads to the emergency room for treatment. This is her third trip in less than two months.

Ambulance Emergency Room


CCNC patient admission rates are consistently
40-50% lower than non-CCNC Medicaid patients.1

1. 3,464.50 claims for CCNC enrolled vs. 8,397.80 for non-enrolled. State Fiscal Year 2013 rates based on July 2012-March 2013 dates of service.

CCNC receives an ALERT that she is having problems and has been in the ER.

The CCNC Care Manager assigned to Dr. Adams, Jennifer's family doctor, is notified.

IV Drip Plant CCNC Care Manager

The CCNC Care Manager reviews Jennifer's prescription records and sees she hasn't been regularly refilling her new asthma medicine.

The CCNC Care Manager also finds out that Jennifer has taken an older medication that may reduce the efficacy of her new prescription.


The CCNC Care Manager calls Jennifer to suggest a home visit to talk about her asthma and to review her medications.

CCNC Care Manager

When the CCNC Care Manager arrives at Jennifer's home, she asks Jennifer to collect all her medications, including what was prescribed at the hospital.

A CCNC Pharmacist is contacted to look for problems between medications. He lets Dr. Adams know that Jennifer is having complications.


CCNC's transitional care management patients are 20% less likely to return to the hospital.2

2. In a study of patients hospitalized during 2010-2011, patients receiving CCNC transitional care were 20 percent less likely to experience a readmission during the subsequent year, compared to clinically-similar patients receiving usual care.

The CCNC Care Manager helps Jennifer schedule a follow-up appointment with Dr. Adams and shows her the correct way to use her inhaler to prevent an asthma attack from becoming an emergency.


90% of NC primary care providers participate
in CCNC.


With a heads-up from the CCNC Care Manager and the recommendations from the CCNC Pharmacist, Dr. Adams adjusts Jennifer's prescriptions at her next appointment and confirms she understands how and when to take her medications.


CCNC ranks in the top 10% of health plans for managing diabetes, asthma and heart disease.3

3. As ranked by the Healthcare Effectiveness Data and Information Set (HEDIS) which consists of 75 measures across 8 domains of care to compare the performance of health plans.

One year later, Jennifer has her asthma under control and hasn't been back to the emergency room.

By working with Medicaid patients like Jennifer, CCNC reduces ER admissions statewide.


CCNC has delivered the state of North Carolina a
4-year savings of nearly $1 Billion.4

4. Analysis of Community Care Cost Savings, Milliman, Inc., 2011.

The Impact

  • CCNC avoided costs amounting to nearly $1B between 2007-2010
  • North Carolina is the only state with consistent declining growth rates in medical spending over
    a decade
  • CCNC ranks in the top 10% of health plans for managing diabetes, asthma and heart disease
  • A unique public-private partnership is established with the state
  • Recipient of Harvard's "Innovations in American Government" award and the "Wellness Frontiers" award

Avoids Wasteful Spending

  • Emergency departments utilization, hospital admissions and readmissions are decreased
  • Pharmaceutical Compliance is improved
  • Waste and duplication are reduced
  • Resources are allocated efficiently to keep savings in North Carolina

CCNC: A North Carolina Physician-Led Partnership

  • 6,000 primary care providers representing 1,800 practices in North Carolina
  • Local health departments and departments of social services are included
  • A presence in every hospital across the state
  • Doctors have control over care and share innovations and strategies across a robust data network

Improves Health

  • Each Patient is matched with a primary care provider, or medical home, to manage and coordinate care
  • Data is used to target care management interventions for high-risk, chronically ill patients
  • Pharmacy Management is provided to meet the needs of medically-complex patients, helping to keep them from returning to the hospital unnecessarily
  • Performance data is analyzed to target practice-level opportunities for quality improvement and cost cutting
Community Care of North Carolina

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Meet Jennifer Jennifer is having an asthma attack Jennifer 1 year later