Primary Care Case Management
Several states that operate primary care case management programs also use enhanced payments or special payments to support care for adults and children with special needs.
North Carolina Medicaid operates an enhanced primary care case management program out of its Division of Medical Assistance and Office of Rural Health and Community Care. Pediatricians and family practice physicians can join a regional Community Care of North Carolina (CCNC) network and receive a payment of $2.50 per month (PMPM). The PMPM is increased to $5.00 per child when the Medicaid aid category is blind or disabled. Practices must participate in medical management meetings, and work on transition care, medication reconciliation, and other quality-of-care activities. North Carolina also pays the network a PMPM to hire a clinical director, care managers, a quality improvement specialist, pharmacists and most recently a psychiatrist. The networks conduct risk assessments, quality and utilization management activities, and provide care coordination.
The state of Indiana, through its Care Select program for individuals with disabilities and children in the foster care system, pays providers $15 PMPM for care coordination.
Pennsylvania Medicaid has implemented “pay for performance” within its PCCM program to pay physicians each time they identify a child for disease management, complete a care plan, or update a treatment plan. Any pediatrician who sees a child with complex care needs can receive additional payment for maintaining and updating a care plan, twice a year.
