First Medicaid Scorecard Provides Insight into Areas North Carolina Can Improve

Last Updated on June 7, 2018 11:37 am

Raleigh – The Centers of Medicare and Medicaid Services released its first-ever Medicaid Scorecard intended to advance a longer-term goal to improve understanding of Medicaid performance nationally. The North Carolina Department of Health and Human Services supports this effort and looks forward to working with CMS to improve the accuracy and comparability of the measures.

“North Carolina has a strong commitment to quality and sees the report card as another tool to advance our efforts to improve the Medicaid program,” said Dave Richard, Deputy Secretary for Medical Assistance.

North Carolina ranks high across multiple child and adult health measures, scoring in the top third for children’s access to primary care, well child visits and immunizations. In adult health measures, North Carolina scored in the top tier of states for managing adults on persistent medications and monitoring individuals on antipsychotic medications. Strong performance in these areas reflect the effort and work North Carolina has invested in pediatric preventive care and chronic disease management in adults.

North Carolina still has work to do to improve other key health performance indicators, including timeliness of prenatal and postpartum care, low birth weight, preventive health measures for women, and timely access and follow-up to mental health services.

The CMS Medicaid Scorecard has been released as North Carolina is designing the program, operations and reporting to transform the Medicaid and NC Health Choice programs from a predominantly fee-for-service delivery system to managed care.

“In partnership with our provider community, health plans and other partners, the department is using the transition to managed care to drive value — the best health outcomes and quality for the dollars we are spending — in the Medicaid program,” said DHHS Secretary Mandy Cohen, M.D. “Through an aggressive quality strategy, expanded care coordination activities and a focus on prevention and the underlying drivers of health, North Carolina is committed to improvement and innovation.”

As part of the managed care transformation, DHHS has developed a data-driven, outcome-based quality strategy that will reward health plans for advancing quality outcomes in key areas, including pregnancy and birth outcomes, women’s health, chronic disease management and preventive care.

Working with health plans, DHHS will collect a comprehensive set of quality data to provide a clear view of service delivery and clinical care across the state. Additionally, results will be reported across regional and geographic areas and racial and ethnic groups to decrease health disparities. DHHS will hold health plans accountable for improving quality outcomes and is committed to rewarding those plans that demonstrate meaningful improvement against quality targets.

Other elements of Medicaid transformation also are designed to improve the health and well-being of North Carolinians, such as advanced medical homes, enhanced care coordination and addressing underlying drivers of health. For example, the AMH program will include financial incentives for health care practices to focus improving quality outcomes over time by gradually aligning incentive payments to specific measures, including increasing provider accountability for cost of care and health outcomes.

Medicaid managed care is planned to begin in 2019. For more information about transformation, visit the Medicaid Transformation website at

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