Patient Care Networks of Alabama (PCNA)
Under Medicaid’s PCNA, four community networks have been established to
support primary medical providers in medical homes. The Alabama
Medicaid Agency partnered with the Alabama Chapter of the American
Academy of Pediatrics to develop the PCNA through the formation of an
18-month workgroup.
The core staff for a PCNA includes a clinical director, clinical
pharmacist, a chronic care needs nurse, and a care manager. Three out
of the four PCNA directors are pediatricians. With pediatric patients
making up the majority of Medicaid clients in the regions currently
served by the PCNAs, pediatricians within a PCNA have access to
additional support to improve the quality of care delivered to their
patients. Several examples of the impact include social worker
management and follow-up for referrals outside of the practice,
contracts with local transportation services to provide rides for
scheduled office visits, and, access to data from the PCNA to target
areas for practice improvement (e.g., EPSDT screening rates).
Regional Care Organizations (RCOs)
RCOs are organizations of health care providers that contract with
the state Medicaid agency to provide a comprehensive package of Medicaid
benefits to beneficiaries within a defined region of the state. They
will coordinate care for the majority of the Medicaid population and
manage Medicaid benefits.
Alabama is in the early stages of RCO implementation. A
representative from the Alabama Chapter of the American Academy of
Pediatrics served on the Governor’s Medicaid Commission, which assisted
in the development and implementation of the RCOs. Currently, two
pediatrician representatives serve on the RCO Quality Assurance
Committee.
Beneficiaries will be required to enroll in a RCO or PCNA based on
geographic location. By April 2015, RCO provider networks will be in
place and by October 2016, RCOs will accept capitation payments from
Medicaid. Community-led RCOs would manage and coordinate care for the
majority of the non-dually eligible Medicaid population.