Study confirms N.C. Medicaid’s ‘medical home’ emphasis

Press Release: Brad Deen
Published: October 13, 2008

RALEIGH — A major study of North Carolina Medicaid recipients finds that patients who have a longer history with the same doctor are more likely to be screened for curable cancers.

The study, published this week in Archives of Internal Medicine, reinforces the N.C. Department of Health and Human Services’ recent establishment of managed care networks for state Medicaid recipients. The ACCESS/Community Care of North Carolina (CCNC) networks currently operate in all 100 counties and since 2004 have enrolled half the state’s 1.7 million Medicaid recipients into a “medical home.”

CCNC, like private managed care systems, seeks to maximize quality of care and financial efficiency. Regular visits to a primary care provider result in early diagnosis and better treatment for chronic conditions. Money is saved by preventing easily treated conditions from worsening, and through avoidance of expensive emergency rooms.

A recent actuarial study estimated CCNC cost savings of $154 million in fiscal year 2007 alone. Previous research has indicated the effectiveness of CCNC for Medicaid patients with asthma, diabetes and other chronic ailments. The new study finds evidence that N.C. Medicaid patients with long-term medical continuity also benefit in the area of cancer screening and prevention.

“Our study suggests that patients with a long-term relationship with a primary care provider are more likely to receive recommended preventive services,” said lead author Dr. C. Annette DuBard of N.C. Medicaid’s Quality Evaluation and Health Outcomes unit.

The study evaluated the medical records of nearly 2,000 state Medicaid recipients age 50 and older. About half had received screening tests for colorectal, breast and cervical cancers, which if detected early can be treated with a high rate of success. Further sifting of the data found that patients who had been seeing the same practitioner for more than five years were twice as likely to be screened as those who had been with a practitioner less than two years.

“The longer the length of the physician-patient relationship, the more opportunity a physician has to build rapport with the patient and to appropriately address cancer screening options,” said DuBard, who is also a practicing physician and research associate at the University of North Carolina’s Cecil G. Sheps Center for Health Services Research.

Study co-author Dr. William Lawrence, former state Medicaid director, said that the study’s data came from 2004 and before, when CCNC networks were just forming. “We can anticipate that the same study today would likely show better results,” Lawrence said.

Other co-authors were Angie Yow, also of the state Medicaid agency’s Quality Evaluation and Health Outcomes unit; Dorothee Schmid of the State Center for Health Statistics; and Anne B. Rogers of the State Health Plan.