Community Care of North Carolina’s Transition to Accountable Care

From Medicaid to Employer Pilots

To test organizational preparedness for accountable care incentives, some organizations are piloting new payment models with a scoped population of beneficiaries. The target population must be sized for providers to build familiarity with new processes or care pathways without overwhelming stakeholders. Pilots must also incorporate enough beneficiaries to ensure meaningful impact on outcomes and cost. Some early innovators have found that the Medicaid population presents a unique opportunity to pilot new payment initiatives.

The Medicaid system is currently in crisis, facing unprecedented enrollment resulting from the weak economy and major rate cuts as states attempt to cover budget shortfalls. With a historic number of Medicaid patients on the books, hospitals and health systems increasingly must manage patients at lower reimbursement rates.

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