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 rates and targets for 2022 and 2023. The updated document can be found in the link below.  
 
As a reminder, this document provides baseline data and targets for Health Plans. NC Medicaid does NOT set targets for AMHs. These baseline data and targets are shared as a reference for AMHs. An AMH practice (NPI + location) will have its own rate that may be above or below the baseline state median rate. AMHs should negotiate target performance rates with Health Plans.

Added in IMA missing measure and it's rates and targets. Corrected Child and Adolescent Well-Care Visits 2022 target.

To ensure delivery of high-quality care under the managed care delivery system, the 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 2022 and 2023 AMH Measure Targets table provides baseline data and targets for health plans. 
• NC Medicaid does NOT set targets for AMHs. 

These baseline data and targets are shared as a reference for AMHs. An AMH practice (NPI + location) will have its own rate that may be above or below the baseline state median rate. AMHs should negotiate target performance rates with health plans.

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

Resources

• 2022 and 2023 AMH Measure Targets table
• AMH Provider Manual
• AMH Tier 3 Glidepath Payment Reconsideration Process and Attestation Program Update (Dec. 17, 2021)
• Glidepath presentation (Feb. 1, 2021)
• AMH Data Specification Guidance
• AMH Training Page
• Supporting Provider Transition to Medicaid Managed Care

Fact Sheets

• Panel Management for Advanced Medical Homes in Standard Plans
• AMH Provider Fact Sheet

Policy Papers

• Clinically Integrated Networks and Other Partners Support of Advanced Medical Homes Care Management Data Needs
• Data Strategy to Support the Advanced Medical Home Program in North Carolina
• North Carolina's Care Management Strategy under Managed Care

Programmatic Guidance

• Integrating Community Health Workers into NC Medicaid (July 11, 2022)
• Glidepath Payment Reconsideration Process bulletin (May 7, 2021)
• Notice of AMH Policy Changes Requiring Modifications to AMH Provider Contract Templates memo (Nov. 16, 2020)
• Provider Contract Templates memo
• Programmatic Guidance on Care Management Component of PHP Capitation Rates
• Programmatic Guidance on Risk Stratification for Tier 3 AMH Practices
• Protocol for Changing Advanced Medical Home Tier Status

Frequently Asked Questions

• AMH Frequently Asked Questions (Dec. 11, 2019)
• Data Strategy Frequently Asked Questions

Additional Information

• Medicaid Transformation: medicaid.ncdhhs.gov/medicaid-transformation
• Email questions or comments to: medicaid.transformation@dhhs.nc.gov