09-01-08

Beginning October 15 , 2008, During the RSV season, prior approval will not be required for the five monthly doses of Synagis. The number of doses should be adjusted if an infant received the first dose prior to a hospital discharge. For the following four diagnoses (Chronic lung disease of prematurity, Hemodynamically significant congenital heart disease, Cystic fibrosis, and Severe congenital immunodeficiency) , the date of birth must be on or after October 15,2006.  Any claims before October 13,2008 and after March 31, 2009 will not be allowed.

 

 

 

 

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PROGRAM OVERVIEW

Mission:
Our mission is to improve the health and quality of life for Carolina Access/Health Choice patients in Cumberland County by collaborating with patients and their family members, health care providers, the hospital, the Health Department and the Department of Social Services. 4C will promote medical best practices and reduce Medicaid cost by providing population management, disease management and care/case management services.

 

History:
Carolina Collaborative Community Care (4C) is the 14th primary care case management network that has joined the Community Care of North Carolina (CCNC) program in January 2005. 4C is a not for profit company that was formed based on the collaboration of three community partners: Department of Social Services (DSS), Cumberland County Public Health Department and Cape Fear Valley Health System.

The company is governed by a board of directors and a medical policy/management committee.  4C provides population management, disease management and case management services to over 36,000 Medicaid Carolina Access enrollees and North Carolina Health Choice enrollees in Cumberland County .  Seventy-three primary care practices are part of the 4C network.

 

Case Managers:

4C hires case managers to help our enrollees meet their health care goals by assessing needs, coordinating care, providing education and serving as a liaison for the enrollee/patient and provider.  Case managers are assigned to each participating network practice and they work collaboratively with the doctors, patients, health care agencies and community partners.  Our case managers:

	ASSESS the medical, environmental and social risk factors facing patients.
	COORDINATE appropriate health and social services.
	EDUCATE patients about self-care and proper use of medical equipment.
	HELP patients make and keep appointments.
	SERVE as a liaison between physicians and patients to increase patients understanding and compliance.
	REVIEW emergency department utilization and address inappropriate use.
	MANAGE chronic diseases such as asthma and diabetes through home visits.
	PROVIDE physician with feedback on patient progress.