Audit Shows Large Part Of NC Medicaid Is Saving Money, Improving Outcomes

Aug 20, 2015

As North Carolina lawmakers debate how to overhaul the state's Medicaid program, there's now a new report on how well a major part of the current program is working. The state auditor released a report Thursday on Community Care of North Carolina, which coordinates services for about 80 percent of the state's Medicaid recipients.

The state audit shows that Community Care of North Carolina is both saving the state money and improving patient outcomes.

In a nutshell, Community Care is a network of doctors, nurses, social workers and pharmacists who coordinate treatment for most Medicaid patients. They serve as boots on the ground - checking in on patients to make sure they get their medicines and make their doctor's appointments so they don't end up in the hospital. 

The audit analyzed nearly 10 years of data and found Community Care is fulfilling that goal, with reductions in hospital admissions and readmissions. That also resulted in big savings - $312 per Medicaid patient per year. Put another way, that's a savings of 9 percent in a program that costs billions of dollars.

Dr. Tom Wroth is acting president of Community Care.

"The report shows that CCNC generates a three-to-one return on investment for the state, with every dollar invested in the nonprofit CCNC program generating over $3 in savings," he said in a statement. "The largest spending reductions were seen for inpatient services, with a 25 percent reduction in inpatient admissions. Meaningful savings were also observed in pharmacy spending despite increased medication use, driven by a shift to less expensive medications. Similarly, spending on ambulatory services declined despite an increase in physician visits, reflecting a shift away from expensive services and sites of care."

All that said, it's unclear if Community Care will survive the push to overhaul Medicaid. The Senate's approach would get rid of Community Care, while the House wants to build on what it's doing well. The two chambers have set up a conference committee to work through that and several other differences.