In 2019, the current fee-for-service model in North Carolina moves to a Managed Care approach. Provider Led Entities (PLEs) are being formed to help manage the care of beneficiaries within this new model.
Optima Family Care of North Carolina, part of the Sentara Healthcare family, has submitted a license application to the North Carolina Department of Insurance and plans to locally operate a Provider Led Entity.
Sentara Healthcare is a nationally respected Managed Care Organization with more than 127 years’ experience operating hospitals and provider groups.
Optima Health, in collaboration with local providers, is a leader of Medicaid Managed Care efforts in Virginia.
Since 1997, Optima Health has served Virginia’s Medicaid recipients. Currently, we are providing services to 185,000 members in Virginia.
Will partner with local providers to remove barriers and expand access to medical care in North Carolina, including implementing preventive programs created specifically for rural populations.
Will create an advisory committee, made up of local providers, to ensure providers have an opportunity to share their vision for the PLE and its outcome for beneficiaries.
Will be operated locally, and with guidance from North Carolina Medicaid providers and advisory members, to determine how Medicaid dollars are spent in the state.
Launched Meds to Beds bedside medication delivery in partnership with Todd’s Pharmacy
Improved patient satisfaction in hospital departments and emergency department to meet community expectations
Hired a patient navigator to assist orthopedic and oncology patients
Decreased rate of patient readmission by providing the right care, at the right time, and in the right place
Low-dose CT lung screenings to help detect lung cancer earlier
Sentara Living health education series for those 50 and older
Tele-stroke program to provide care to stroke patients faster
Decreased wait from a mammogram to biopsy
$30 million in local charity care
By signing a non-binding Letter of Interest (LOI) with Optima Family Care of North Carolina, you are expressing interest in participating as a provider of healthcare services with Optima Family Care of North Carolina.
Contract requirements and rates will be provided at a later date when NCDHHS releases this information.
Signing does not obligate the provider to contract with Optima Family Care of North Carolina.
Call (252) 384-2828 or submit the form below and an Optima Health representative will contact you.