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.