Medicare Quality Demonstration (646 Waiver)

The 646 Project

Medicare Modernization Act Section 646 Health Care Quality Demonstration – Through the North Carolina Community Care Networks, this project combines physician-directed care management with community based care coordination and health information technology (HIT) to connect providers, support care management and delivery, measure performance and implement pay-for-performance financial incentives in a medical home.

The goal of this project is to improve the quality of care and patient outcomes of the “dually eligible” (patients with both Medicare and Medicaid), as well as Medicare-only beneficiaries by using the CCNC system model to address gaps in care, quality and efficiency.  Improvements in both clinical and non-clinical processes are combined with payment reimbursement changes to introduce financial incentives to facilitate improved healthcare.

This demonstration began on January 1, 2010 with eight Networks with more than 200 practices and 900 providers participating in twenty-six counties.   Dual eligibles seen in one of the participating practices on a qualifying visit constitute the program population.  Networks contract with the practice to provide support in identifying and assisting in the care management of these duals.  Using Medicare claims data obtained from CMS to develop population risk stratifications, CCNC will identify patients who would benefit from specific disease management interventions.

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