Advanced Medical Home

The North Carolina Department of Health and Human Services (DHHS) developed the Advanced Medical Home (AMH) model as the primary vehicle for care management. The AMH program provides an infrastructure for primary care medical home with integrated local care management, which supports DHH’s transformation vision by maintaining the strengths of North Carolina’s legacy care management structure and promoting delivery of care management in the community. By supporting the delivery of appropriate and timely health care that meets each Member’s needs, high-quality primary care with the capacity to manage population health is foundational to the success of North Carolina’s Medicaid Transformation. 

The AMH program requires prepaid health plans (PHPs) to delegate certain care management functions to AMHs who meet the criteria. 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 (CIN), 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.

AMH Provider Manual

The AMH Provider Manual is a key resource for AMH practices, non-AMH Primary Care Providers (PCPs), Clinically Integrated Networks (CINs), and other partners working with AMHs and Primary Care Providers (PCPs). The AMH Provider Manual Updates document provides a summary of updates in the latest AMH Provider Manual, which the Department released on May 16, 2024.

AMH Technical Advisory Group

DHHS has convened a Technical Advisory Group (TAG) to support the AMH program. The role of the AMH TAG is 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.

Quality Measure Performance and Targets for the Advanced Medical Home (AMH) Measure Set

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 and incentivize Advanced Medical Home (AMH) performance. 

The NC Medicaid Quality Measure Performance and Targets for the AMH Measure Set provides baseline data for measures in the AMH Measure Set and targets for health plans. This document is updated annually with the most recent performance measure data. The purpose of this document is informational. It provides baseline data and associated targets for three populations: (1) Overall NC Medicaid, (2) Standard Plan Aggregate, and (3) Individual Plan Performance.

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 rates provided. AMHs should negotiate target performance rates with Health Plans directly.

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