Provider partnership impact
The strength and scale of our provider partnerships have been a defining element of success. We’ve focused on reducing administrative burden, strengthening provider operations, and advancing value-based care models that enable high-quality, coordinated care across the state.
Clinical Practice Consultants use clinical and operational data to identify, outreach and engage providers in performance improvement activities. Over the past five years, this team has completed approximately 30,000 provider engagement activities, including provider education, performance feedback, workflow assessments, gap closure evaluation, and guidance on navigating the Medicaid managed care system.
Modernizing the provider experience
Through technology and data sharing initiatives, we continue to simplify processes to ensure providers maximize patient care time:
- Application Programming Interfaces (APIs) link EMRs to UHC, enabling real-time data transfer, streamlined workflows, and reduced manual processes.
- Reduced prior authorizations by > 20% since 2024, with additional 30% reduction by end of 2026.
- Gold Card Program recognizes providers with a track record of high-quality, evidence-based care.
- Training and ongoing technical support for Electronic Visit Verification (EVV) for home health and Personal Care Services providers, in alignment with CMS and NC DHHS requirements.
Advancing value-based care
We have expanded value-based care by aligning incentives with quality, outcomes, and health equity by:
- Educating and supporting providers in transitioning to VBC models.
- Contracting across a diverse network including health systems, independent practices, and rural providers.
- Paying out millions of dollars in incentives, directly supporting provider sustainability and reinvestment.
- Sharing best-in-class cost, quality and clinical performance data and reports as part of our ACO agreements, including with some of the largest provider organizations serving Medicaid beneficiaries.
