Abstract: The North Carolina Integrated Care for Kids (NC InCK) Model program objectives are to improve health and well-being by integrating services across healthcare and social sectors for included children and families. This integration will (1) improve population health, (2) reduce avoidable out-of-home placements and inpatient hospitalizations, and (3) create innovative and sustainable pediatric alternative payment models. Implementation of the NC InCK model will substantially build upon the NC Medicaid transformation to managed care activities and highlight the unique needs of children and opportunities to improve their well-being. The NC InCK model will serve to build capacity and support core child service providers and payers to improve the value of care provided to Medicaid and CHIP-insured included children.
We propose to implement the NC InCK model in the Model Service Area of Alamance, Orange, Durham, Granville, and Vance counties (>80,000 included child lives). This project is led by the NC InCK Team, a collaboration between Duke University (Lead Organization), the University of North Carolina at Chapel Hill (UNC; Partner Organization), and NC Division of Health Benefits in the NC Department of Health and Human Services (State Medicaid Agency). Duke and UNC together serve >80% of Medicaid/CHIP-insured children in the NC InCK Model Service Area. All NC InCK Team members have extensive experience in engaging multi-sector stakeholders and coordinating care for children within the target communities.
The NC InCK Partnership Council will serve as the governing body for the NC InCK integrated service delivery and payment model. This Council will include representation from families, youth and Medicaid payers as well as the following core child service areas that will be integrated in the model: physical and behavioral health, schools, housing, food, early care and education, Title V, child welfare, mobile crisis response services, juvenile justice, and Legal Aid.
The requested budget of $16 million over the Planning Period (2020-2021) and Implementation Period (2022-2026) will be used to improve the system of care for children through NC InCK Initiatives, which were developed to build upon existing programs and infrastructure. Additionally, these initiatives will address the root causes of poor health outcomes for children in the NC InCK model: inadequate capacity to identify and address compounded social drivers of health and behavioral health comorbidities, and poor integration of services that promote child health and well-being across agencies and providers. NC InCK Initiatives will emphasize a two-generation approach and include an early childhood innovation initiative; universal whole-person screening, risk stratification, and social service referrals; outpatient behavioral health capacity building; and processes for creating single plans of care. Data sharing across sectors (e.g., healthcare and schools) and leveraging existing innovative information technology tools (e.g., NCCARE360, a statewide electronic coordinated care network supporting whole-person health) will facilitate service integration and a streamlined experience for families. Service Integration Coordinators hired across sectors will work together to develop policies that ensure a single point of contact for integrated care and will participate in coalition building, trainings, and capacity building. All NC InCK initiatives will be supported by an NC InCK Executive Team from Duke, UNC, and NC Medicaid.
The NC InCK team will collaborate with NC Medicaid payers to leverage existing authorities and implement Alternative Payment Models (e.g., Accountable Care Organizations and Primary Care First models for children) that are benchmarked on child-centric performance measures. The NC InCK team anticipates improved health outcomes and cost savings through the NC InCK care delivery and payment model for children and their families in the model.