Medicaid Reform Minute #4: What your practice can do to prepare for Managed Care
1. Check the accuracy of Primary Care Designation on patient Carolina Access II (CAII) Cards
Whether you are Tier 2 or Tier 3, you will still be receiving, at minimum, the same Per Member Per Month payment ($2.50 PMPM or $5 ABD PMPM) each month. You only receive PMPM payment for patients who are attributed to your practice on their CAII Medicaid card.
2. Invite patients in for covered preventative care so that claims information links them actively to your practice
By inviting patients to come in for an appointment for preventative care services if they have not been seen in the past 12 months, you can help ensure that a relationship is shown between your practice and the patient. This can assist in the assignment of patients to their primary care provider.
3. Start working on your registries and dashboards
Registries are a list of patients who require action from your practice and dashboards monitor quality performance over time. These help your practice stay on top of care opportunities your practice can address to reach and maintain quality benchmarks that will drive performance incentive payments in the future.
4. Learn about your practice’s options for tiered status as a Medicaid provider in the Advanced Medical Home model
Educate yourself and leadership in your practice about the Advanced Medical Home model and choose the option that fits best with your practice. Consider whether your practice can manage new duties such as risk stratification, or if partnering with a Clinically Integrated Network* would work better for you.
*Clinically Integrated Networks are explained here: https://files.nc.gov/ncdma/documents/Medicaid/Provider/AMH%20Webinar%204.pdf.
This Medicaid Reform Minute is provided courtesy of a partnership between Community Care of Western North Carolina and the Western Carolina Medical Society. For questions about this content, contact firstname.lastname@example.org.