Health Care Innovation Awards: Project Profile


Project Title: "Building a statewide child health accountable care collaborative: the North Carolina strategy for improving health, improving quality, reducing costs, and enhancing the workforce"
Geographic Reach: North Carolina
Funding Amount: $9,343,670
Estimated 3-Year Savings: $24,089,682


Community Care of North Carolina (CCNC) began a three year program in August 2012 called the Child Health Accountable Care Collaborative (CHACC) to improve the quality and cost-effectiveness of care associated with children who have complex, chronic illnesses. CCNC comprises fourteen local networks dispersed throughout the state of North Carolina. A fundamental component of this program is the use of an embedded Specialty Care Manager (SCM) whose primary role is to coordinate care between the pediatric subspecialist and the primary care physician (PCP). These SCMs are embedded in all five Academic Medical Centers (Carolinas Medical Center, Duke University, Vidant Medical Center, University of North Carolina, and Wake Forest Baptist Medical Center) as well as seven tertiary Medical Centers (Cape Fear Valley Medical Center, CMC Northeast, Mission Hospital, Moses Cone, New Hanover Regional Medical Center, Presbyterian Medical Center and Wake Med). The first SCMs began seeing patients in January 2013 after orientation and initial training. Patient Coordinators are also embedded, in collaboration with the SCMs, in medical centers with high volumes of children to assist the SCMs. A Patient Treatment Plan (PTP) was introduced to facilitate collaboration between pediatric subspecialists and PCPs. This PTP is updated by the SCMs during subspecialist visits or any hospitalization to ensure the PCP has the most current information needed to manage the child in a medical home environment. The CHACC Gastroenterology workgroup has also developed Co-Management Guidelines for Pediatric Constipation and GERD, which have been widely disseminated to the PCP group as well as residency programs throughout the state.

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