Advanced Medical Home

The North Carolina Department of Health and Human Services (DHHS) developed the Advanced Medical Home (AMH) program as the primary vehicle for delivering care management as the state transitions to NC Medicaid Managed Care. The AMH program builds on the Carolina ACCESS program.

The AMH program requires prepaid health plans (PHPs) to delegate certain care management functions to AMHs at the local level. In order to provide these care management functions, AMHs may work with their affiliated health care system or make an arrangement, with an entity called a Clinically Integrated Network, a Care Management vendor or other population health entity. To ensure that beneficiaries across the state are receiving high-quality care management, DHHS developed standards for AMHs and will be responsible for initially certifying that practices meet AMH criteria.

AMH Technical Advisory Group

As part of ongoing Medicaid Transformation in North Carolina, DHHS has convened a Technical Advisory Group (TAG) to support the AMH program. The role of the AMH TAG will be to advise and inform DHHS on key aspects of the design and evolution of the AMH program. For more information on the AMH TAG, please visit the AMH TAG webpage.

Panel Management for Advanced Medical Homes in Standard Plans

In response to provider concerns about on-going member assignment and panel management issues for Advanced Medical Homes (AMHs), NC Medicaid is working with the Standard Plans to analyze errors and create easier pathways for providers to reach Standard Plans and resolve panel issues. 

  • Standard Plans updated their contact information for providers to contact with panel questions or issues. 
  • Standard Plans are working to ensure their member and provider call lines are well equipped to respond to calls related to AMH assignment. 
  • Providers can also discuss panel limits with Standard Plans so they understand any panel limits they currently have with the plan based on initial contracting and can update panel limits, as needed. See the Panel Management for Advanced Medical Homes in Standard Plans fact sheet for general information on updating panel limits.  

Additional information is provided in the Panel Management for Advanced Medical Homes in Standard Plans bulletin article.

2022 and 2023 Advanced Medical Home Measure Targets

Update: NC Medicaid has made some updates to the published AMH measure benchmarks for 2022 and 2023, which can be found at the link below. As a reminder, the purpose of this document is informational. It provides baseline data for the overall NC Medicaid population as well as aggregate Standard Plan performance and associated targets.

NC Medicaid does NOT set targets for AMHs. An AMH practice (National Provider Identifier (NPI) + location code) will have its own rate that may be above or below the baseline state median rate and/or the aggregate Standard Plan rate. AMHs should negotiate target performance rates with Health Plans directly.

To ensure delivery of high-quality care under the managed care delivery system, NC DHHS has developed the NC Medicaid Managed Care Quality Strategy and identified a set of quality metrics that it will use to assess health plans’ performance across their populations. The Department has identified a subset of these measures for health plans to use to monitor Advanced Medical Home (AMH) performance and calculate AMH performance incentive payments. The first quality performance period for AMHs began in January 2022. The tables within the Calendar Year 2022 and 2023 Measure Benchmarks for the Advanced Medical Home Measure Set document provide baseline data and targets to serve as a reference for Health Plans and AMHs. 

More information about quality strategy and metrics are available on the NC Medicaid Quality Management and Improvement webpage.

Resources

Fact Sheets

Policy Papers

Programmatic Guidance

Frequently Asked Questions

Additional Information

This page was last modified on 04/17/2023