2019 Mecklenburg Community Board Meeting...2019/01/24 · NC Medicaid Transformation Under SL 2018- 48, DHHS will consider only LME/MCOs to become BH/IDD Tailored Plan managers. The

2016 Board of Directors Meeting

2019 Mecklenburg

Community Board

Meeting

January 24, 2019



COMMUNITY BOARD MEMBERS

NAME PHONE EMAIL

Mecklenburg

Stacy Lowry, Chair (704) 314-8903 [email protected]

Deborah Page (704) 900-7646 [email protected]

Sonja Goodwin (980) 253-4576 [email protected]

Beverly Corpening (704) 493-8520 [email protected]

CFAC

Vacant

mailto:[email protected]





MECKLENBURG COMMUNITY BOARD AGENDA January 24, 2019 DINNER (SERVED AT 6:00 p.m.)

SPEAKER PAGE PURPOSE 1. Call to Order- Matters of the

Public

Stacy Lowry, Chair 1 Information

2. Opening Remarks


3. Approval of October 25, 2018 Meeting Minutes

Stacy Lowry, Chair 3 Action

4. Local CFAC Update

Laura Berryhill 6 Information

5. Presentations

A. Community Relations Report

Laurie Whitson 7 Information

B. Network Management Adequacy and Accessibility Analysis

Leslie Gerard 8 Information

C. Community Operations Annual Report

Laurie Whitson

9 Information

D. Corporate Training & Development Annual Report

Revella Nesbit 10 Information

6. Community Updates


7. Closing Remarks


Adjournment

MECKLENBURG AGENDA ITEM

MEETING DATE: January 24, 2019 AGENDA ITEM: 1

SUBJECT: Call to Order – Matters of the Public

BRIEF SUMMARY: The public may address the Board.

REQUESTED ACTION: None

ATTACHMENTS: No

1



SUBJECT: Opening Remarks

BRIEF SUMMARY: Stacy Lowry, Chair, will provide opening remarks.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

2



SUBJECT: Approval of the October 25, 2018 Meeting Minutes

BRIEF SUMMARY: The minutes for the October 25, 2018 Mecklenburg Community Board

Meeting are attached for approval.

REQUESTED ACTION: Approve the minutes for the October 25, 2018 Mecklenburg Community

Board Meeting as presented.

ATTACHMENTS: Yes

3

Mecklenburg Community Board Meeting Minutes October 25, 2018

Members Present: Stacy Lowry, Chair, Sonja Goodwin, Vice Chair, and Deborah Page

Members Absent: Laura Berryhill and Beverly Corpening

Staff Present: Laurie Whitson, Ursula Cornwell, Dana Frakes, and Ruth Michel

Guests: Carolyn Green

1. Call to Order – Stacy Lowry, Chair, called the meeting to order at 6:20 p.m.

Matters of the Public Any citizen may address the Community Board. No citizens addressed the Community Board.

2. Opening Remarks

Opening remarks by Stacy Lowry, Chair. Stacy Lowry, Chair, welcomed Community Board Members and guests to the meeting.

3. Approval of the July 26, 2018 Meeting Minutes

The minutes from the Thursday, July 26, 2018 Mecklenburg Community Board meeting were reviewed.

Sonja Goodwin, Vice Chair, motioned to approve the minutes as presented. Deborah Page seconded the motion.

All in favor. Motion carried.

4. Local CFAC Update

No CFAC representative present to provide CFAC updates. Laurie Whitson, Senior Community Executive, updated to the Community Board on the CFAC Two Day Summit.

5. Special Presentations

A. Community Relations Report Laurie Whitson, Senior Community Executive, presented the Community Relations Report.

B. Annual Fiscal Year County Dashboard Laurie Whitson, Senior Community Executive, reviewed the Annual Fiscal Year County Dashboard.

C. Quality Assurance Annual Performance Improvement Plan Dana Frakes, Quality Manager, introduced Ursula Cornwell to the Board. Dana Frakes reviewed the Quality Assurance Annual Performance Improvement Plan.

4

D. Quality Management Annual Report Dana Frakes, Quality Manager, discussed the Quality Management Annual Report.

6. Community Updates

Stacy Lowry, Chair, requested community updates from the Board. Stacy Lowry, Chair, informed the Board that October is Homeless Awareness Month, the Veteran’s Day Parade is scheduled for November 11, 2018 and the Veteran Bridge Home 5k Walk/Run is being held this weekend. Laurie Whitson, Senior Community Executive, informed the Board that the Charlotte Mecklenburg Police Department are accepting applications for a Community Policing Crisis Response Team. Laurie Whitson updated the Board on a Stakeholder’s webcast that is scheduled for Friday, October 26, 2018 to discuss the NC DHHS 1115 Waiver. Deborah Page updated the Board on a State CFAC meeting that will be held next month to discuss the NC DHHS 1115 Waiver.

7. Closing remarks

Stacy Lowry, Chair, provided closing remarks. Stacy Lowry, Chair, informed the Board that the next Mecklenburg Community Board meeting is scheduled for January 24, 2019.

Sonja Goodwin, Vice Chair, motioned to adjourn the meeting. Stacy Lowry, Chair, seconded the motion. All in favor. Motion carried.

Meeting adjourned at 7:36 p.m.

Community Board Clerk Date

5



SUBJECT: Local CFAC Update

BRIEF SUMMARY: Laura Berryhill, CFAC Representative, will provide local CFAC updates.

REQUESTED ACTION: Information only

ATTACHMENTS: No

6


MEETING DATE: January 24, 2019 AGENDA ITEM: 5.A.

SUBJECT: Community Relations Report

BRIEF SUMMARY: Laurie Whitson, Senior Community Executive, will present the Community

Relations Report.


ATTACHMENTS: Appendix A

7


MEETING DATE: January 24, 2019 AGENDA ITEM: 5.B.

SUBJECT: Network Management Adequacy and Accessibility Analysis

BRIEF SUMMARY: Leslie Gerard, Network Development and Field Director, will present the

Network Management Adequacy and Accessibility Analysis.


ATTACHMENTS: Appendix B

8


MEETING DATE: January 24, 2019 AGENDA ITEM: 5.C.

SUBJECT: Community Operations Annual Report

BRIEF SUMMARY: Laurie Whitson, Senior Community Executive, will present the

Community Operations Annual Report.


ATTACHMENTS: Appendix C

9


MEETING DATE: January 24, 2019 AGENDA ITEM: 5.D.

SUBJECT: Corporate Training and Development Annual Report

BRIEF SUMMARY: Revella Nesbit, Corporate Education Training Director, will present the

Corporate Training Development Annual Report.


ATTACHMENTS: Appendix D

10



SUBJECT: Community Updates

BRIEF SUMMARY: Stacy Lowry, Chair, will request community updates from the Mecklenburg

Community Board.


ATTACHMENTS: No

11



SUBJECT: Closing Remarks

BRIEF SUMMARY: Stacy Lowry, Chair, will provide closing remarks.


ATTACHMENTS: No

12

APPENDIX A: Mecklenburg Community Relations Report NOTES

13

14

24 January, 2019

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.

MECKLENBURG COMMUNITY BOARD MEETING24 January, 2019

15


COMMUNITY RELATIONS REPORTLaurie Whitson, LCSWSenior Community Executive - Mecklenburg


Information provided in this presentation pertains only to the counties in the Cardinal Innovations Healthcare service area. This information is specific to the Cardinal Innovations service area and may not apply to other organizations, providers, stakeholders or individuals outside the Cardinal Innovations service area.

Presentation slides are brief, bullet-points of information and should not be used out of context.

Disclaimer

16


NC Medicaid Transformation

Under SL 2018- 48, DHHS will consider only LME/MCOs to become BH/IDD Tailored Plan managers. The statute specifies that BH/IDD Tailored Plan contract with those LME/MCOs selected will begin one year after the start date of the Standard Plan and DHHS is choosing to extend this to the start of the next fiscal year, July 1, 2020.

The statute also states that four years after the start date of the Standard Plan DHHS may competitively bid the BH/IDD Tailored Plan to non-profits and public managers only, presumably February 2024, which may be July 1, 2024 if DHHS aligns the start with the beginning of a new state fiscal year


Organizational Strategy“Five Pillars”

• Operational Readiness for a Tailored Plan • Community-Based Governance as a Differentiator• Clinical Operations as a Competitive Advantage • Providers as Allies• Employees as Change Agents

17


Organizational Goals

• Medicaid Transformation• Tailored Plan• Every Department; Every Employee• Accountability and Responsibility• 30 June, 2019


Community Initiative Spot Light

Charlotte Mecklenburg Police Department (CMPD)

Community Crisis Response Team

Lieutenant Lucas Veith

18


COMMUNITYOPERATIONS

Community Engagement

Community Relations

Member Engagement

Questions

19

20

APPENDIX B: Network Management Adequacy and

Accessibility Analysis NOTES

21

22

The Network Management Adequacy and Accessibility Analysis will be distributed at the January 24, 2019 meeting.

23

24

APPENDIX C: Community Operations Annual Report NOTES

25

26

July 1, 2017 – June 30, 2018

Community Operations End of Fiscal Year Report2017 - 2018



July 1, 2017 – June 30, 2018

FY 2017 – 2018: A total of 19,688 people were trained by Community Engagement employees during a total of 508 trainings.Community Engagement team members attended a total of 541 community events (excluding training) throughout all regions that we currently serve.

242 177 4 85

6512

7130

2062

3984

279 159 0 103

Northern Southern Statewide Triad

Total Community Engagement Trainings

Total Training Attendees

Total Other Events

FY 2017 ‐ 2018

128 106 63

22012059

1212

257 283 256

Northern Southern Triad

Total Community Engagement Trainings

Total Training Attendees

Total Other Events

FY 2016 ‐ 2017Total Trainings by Region

27



July 1, 2016 – June 30, 2017

FY 2016 – 2017: A total of 5,472 people were trained by Community Engagement employees during a total of 297 trainings.Community Engagement team members attended a total of 796 community events (excluding training) throughout all regions that we currently serve.

128

28

45

70

26

MHFA CIT QPR Cardinal Overview Other77

31

6

111

6

26

44

35

32

Cardinal Overview

CIT (Crisis Intervention Training)

Innovation Waiver Overview

MHFA (Mental Health First Aid)

Other

Psychosis Simulation

QPR (Question, Persuade, Refer)

Stigma

Trauma

FY 2016 ‐ 2017FY 2017 ‐ 2018Total Trainings by Type


Narrative outcome data is available upon request and may be accessed directly via SharePoint

A Champion Connection is a community stakeholder achievement that positively benefits or enhances services and supports to members or that contributes to various CIH business objectives.

There were a total of 72 Champion Connections during FY 2017 ‐ 2018. Please note that this data was not yet being captured in Q1.

Community Relations Champion Connections

41

8 7

3

23

2 3

13

4 5

27

7

25 4 4

22

Central Five County Mecklenburg Piedmont Triad

Q1 Q2 Q3 Q4

Cumulative

July 1, 2017 – June 30, 2018

28

Copyright © 2017 Cardinal Innovations Healthcare. All rights reserved.July 1, 2017 – June 30, 2018

6

11

4

23

79

2

22

9 10

4

20

Company Branding Political Gain Positive Media Exposure Strategic Alliance

Q2 Q3 Q4Company Branding: CR speaking opportunity and/or logo visibilityPolitical Gain: Interface results in positive connection or alignment with elected officialsPositive Media Exposure: CIH positively referenced in an article, news outlet or social mediaStrategic Alliance: Interface w/ key partners to promote CIH or community education

A Champion Connection is a community stakeholder achievement that positively benefits or enhances services and supports to members or that contributes to various CIH business objectives.

Community Relations Champion Connections by Impact Type


0

1

0 00

1

0 00 0

1 1

0

1

3

1

Central Northern Southern Triad

Q1 Q2 Q3 Q4

Community Relations Legislative Inquiries

29


Community Relations Performance Highlights

1. Participated in Community Empowerment Initiatives2. Organized Health Care Agreement consensus in Halifax Integrated Healthcare Coalition3. Assisting with procedure development focusing on treatment v. placement at YFS4. Participated in Charlotte Observer interview related to First Responder Data Collaborative focus to reduce MHSUD

crisis calls for service to 911 5. Hand delivered Narcan Kits to key stakeholders across all communities6. Coordinated Mecklenburg FQHC meetings to support integrated care partnership and development of SUD

programming7. Initiated Business Associate Agreement with Community Care Services to support transitional and coordination of

care for high risk/need individuals with SPMI and prescribed an anti‐psychotic medication8. Participated in STEP Treatment Court Leadership with county contracted providers9. Facilitated development of the FY17‐18 Crisis Continuum Work plan with new/modified goals10. Participated in co‐meetings with County Behavioral Health Division to support development of a specialized

provider network to support youth and families in custody


Member EngagementTotal Prevention Strategies Presented

July 1, 2017 – June 30, 2018

614

370

33

447 456

50

FY 2016 – 2017 = 997FY 2017 – 2018 = 1,970

183139

11

348

279

37

30


Training Type Total Trainings

Achieving a Better Life Experience (ABLE Act) 6

Cardinal Innovations Healthcare Overview for Members 13

Guardianship and Alternatives for Intellectual/Developmental Disabilities and Mental Health 8

Member Engagement Overview 9

Peer Support Specialist 11

Prime for Life (Now That I Am 18) 6

Upward to Financial Stability 11

Wellness Recovery Action Plan (WRAP) 75

Whole Health Action Management (WHAM) 24

Other 85

Member Engagement Total Trainings = 248


Member Engagement Medical Loss Ratio (MLR) activities and hours completed

• Any quality reporting and related documentation in non‐electronic form for wellness and health promotion activities = 498.75 hours

• Coaching or education programs and health promotion activities designed to change member behavior and conditions (i.e., smoke or obesity) = 1,666.50 hours

• Coaching programs designed to educate individuals on clinically effective methods for dealing with specific chronic disease or condition = 905 hours

• Public Health education campaigns that are performed in conjunction with state or local health departments = 739.75 hours• Wellness Assessments = 310.50 hours• Blank = 682 hours

TOTAL MLR Hours Completed = 4,802.50

31

32

APPENDIX D: Corporate Training & Development

Annual Report NOTES

33

34

January 24, 2019


Corporate Training & Development

Community Board Annual Report

January 2019Revella H. Nesbit, M.Ed., LPCS, ODCP

Director, Corporate Training & Development

January 24, 2019

35


Cultural Competency

Diversity & Inclusion

Professional Continuing Education Credits

Learning Management System

Centralized Training

January 24, 2019

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.January 24, 2019

36

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.December 19, 2018


Cultural Competency Accomplishments Cultural Competence Provider Monitoring Tool Revision: Provider requested tool revision to allow for more flexibility in

implementing cultural competence

Cultural Competence Provider Monitoring Tool:70.4% of providers scored in the Full and Emerging categories (FY 17-18)

6 Active Cultural Competence Provider Councils: Provider – led & driven councils invested in promoting Cultural Competencethroughout the network

LGBTQ Learning Collaborative: Provider collaborative created to encourage a learning community for best practices in working with members who identify as LGBTQ.

Provider TIP Sheets: Transportation; Interpretation & Translation; Cultural Competence Monitoring; Cultural Humility; LGBTQ+; Culture

Trainings for providers & staff: 12 trainings were offered in 2018 related to Cultural Competency

Training Topics: Hispanic/Latino Culture; African American Trauma; LGBTQ+; Transgender; Ethics of Cultural Competence Pt. 1 & Pt. 2

Advisory Subcommittee for Latino Affairs (ASLA): Internal committee established to support the Latino community & bringawareness to how we serve this community; 1st Latino Forum – May 4, 2019

January 24, 2019

37



Inclusion @ Cardinal Innovations Appointment of Chief Diversity & Inclusion Officer

Creation of Diversity Leadership Council

Creation of Diversity & Inclusion Statement

Development of Diversity & Inclusion Strategy

January 24, 2019

38

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.Janurary 24, 2019


Continuing Education Credits NBCC = National Board Certified Counselor

NAADAC = The Association for Addictions

Professionals

Credits applied toward re-licensure for

clinicians

Support best practices/emerging practice

Januray 24, 2019

39


Continuing Education Credits - 2018 25 NBCC approved trainings

67.5 NBCC credit hours offered

266 NBCC certificates distributed to Cardinal Innovations staff

186 NBCC certificates distributed to stakeholders

1,010 Registrations for NBCC trainings

January 24, 2019

73%Completion


Continuing Education Accomplishments Future addition of web-based and home-based training options

Approved as a NAADAC continuing education provider

LMS integration providing more efficiency

Staff as subject matter experts

41 Trainers (Cardinal staff, providers, community experts)

7 Grand Rounds

Trainings located in all regions

January 24, 2019

40



Learning Management System Create a culture of learning and empowerment

Provide flexible learning opportunities

Provide on-demand reporting, analytics and dashboards

Automate registration management, tracking and evaluation

Maintain version control of curricula and training materials

Offer & maintain robust and relevant training resources

Centralize eLearning that is available any time/place to all users

Design & implement customizable training that is proprietary to CardinalInnovations

January 24, 2019

41


The Learning Center FY 17-18 100% of internal staff have used The Learning Center 60% on average internal staff use The Learning Center monthly 1216 = number of courses available 2861 = number of external training registrations 307 = number of CI trainings created 4.18 out of 5 = average course rating

January 24, 2019


External1. Triad Mental Health Awareness Event2. Provider Direct System Administrator Rules and

Regulations3. Starting a Private Practice Forum4. Sustaining Your Business through Medicaid

Reform5. Financial Matters: Understanding Your Business

by the Numbers

Top 5 Trainings Internal1. Compliance Courses2. Diversity and Inclusion

Curriculum3. Text Messaging Guidelines

for Care Coordination4. Member Home and

Community SafetyPractices

5. Blood Borne Pathogens forHealthcare Professionals

January 24, 2019

42


Consumer Family Advisory Council

CFAC Microsite Launched April 2018 43 CFAC members registered On-line courses completed include:

CFAC OrientationGetting Started in the Learning CenterMeetings that Get Results Upward to Financial Stability

January 24, 2019


The Learning Center Accomplishments Launch of CFAC Microsite Promotion of The Learning Center as an Employee Benefit Promotion of modules in The Learning Center that align with monthly

Communications’ Thematic Calendar 60 topical articles in 411 11 Trainings for users of Learning Center Learning Center Ticketing System created and enhanced to align with Training

Request Tool Automated employee assignments in The Learning Center

(HIPAA Remediation, Diversity & Inclusion, Compliance, New Hire Assignments) Increased reporting & data collection iCal Training Invitations

January 24, 2019

43



Centralized Training Model

Member/


Care Coordination

Finance

Service Center

Network

Clinical Operations

Quality Management

Compliance

Provider Training

Employee Training

44


Looking Forward

Centralization of Training Diversity & Inclusion Strategic Plan Latino Forum – May 6, 2019

Caminando en mis zapatos (Walking In My Shoes) CFAC Microsite Provider Microsite Receipt of electronic payment in The Learning Center NAADAC Continuing Education offering More robust data collection, trending, and outcomes

January 24, 2019


An organization’s ability to learn, and translate that learning into action rapidly, is the ultimate competitive

advantage.”

Jack Welch

January 24, 2019

45

46

Mecklenburg County Dashboards

FYTD September 2018

County Funded Program Descriptions

County Funded Program County Funded Program Description

47


FYTD September 2018

Report data as of November 24, 2018. All graphs are county specific unless otherwise noted.

County Funded Programs*

Total:

*Please see the County Funded Program Descriptions (Pg. 1) for additional detail

$0

% Spent

$0

Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report. The numbers for

the previous months will be updated each reporting period.

FYTD

Expenses

Mecklenburg Funding

FY Budget

Amount

NOTE: County “Maintenance of Effort” funds targeting local behavioral health needs may be managed by Cardinal Innovations or by the county. Data shown here only represents county funds managed by Cardinal Innovations. Some counties manage all of their "Maintenance of Effort" funding.

48


FYTD September 2018

Number of Members Served by Age and Diagnosis

Number of Members Served All Age and All Diagnosis Registry of Unmet Needs

32123466 3343

476 502 497

56 71 490

500

1000

1500

2000

2500

3000

3500

4000

Jul'1

8

Au

g'1

8

Sep

'18

Child Members Served by DiagnosisAges 3 through 17

MH IDD SUD

4586 4707

4238

1807 1800 1798

1322 1287 1230

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Jul'1

8

Au

g'1

8

Sep

'18

Adult Members Served by DiagnosisAges 18 and over

MH IDD SUD

1037

1026

1037

1020

1022

1024

1026

1028

1030

1032

1034

1036

1038

Jul'1

8

Au

g'1

8

Sep

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y

Innovations Registry of Unmet Needs

NOTE: Innovations slots and funding are allocated by the state. MCOs have no ability to fund or expand the number of Innovations slots.

7798 81737581

2283 2302 2295

1378 1358 1279

0000000000

2000

4000

6000

8000

10000

Jul'1

8

Au

g'1

8

Sep

'18

All Members Served Ages 3 and over

All Diagnosis

MH IDD SUD

NOTE: This is a distinct count of members served. Members with multiple diagnosis will only be counted once. The sum of the previous graph will not be equal to the total in this graph.

49


FYTD September 2018

Service Category Definitions

Service Category

1915 (b)(3) Services

ACTT

ICF

Group settings that serve people across all disability groups.

Inpatient

MST

Outpatient

Innovations

Services that are provided in the community.

Community based mental health and substance abuse rehabilitation services and interventions.

Services received in a crisis or emergency situation such as Mobile Crisis and Facility-based crisis.

Community

Crisis Services

A long-term residential program for people with behavioral health needs.

Services provided in a hospital Emergency Department on an outpatient basis.

Psych Rehab

A short-term service for acutely mentally ill children or adults designed to prevent hospitalizations or to serve as a step down for those leaving an

inpatient facility.

Psychiatric Residential Treatment Facilities provide residential care to persons under the age of 21 who need 24-hour supervision and specialized

interventions.

BH Long Term Residential

Community Support

Medicaid Waiver for individuals with Intellectual Disabilities.

Hospital-based psychiatric care.

Multisystemic Therapy is a family and community-based therapy for juveniles.

Services received in the community including evaluation, therapy, and psychiatric care.

Outpatient ED

Partial Hosp/Day Tx

Mandated service categories effective 7/1/2013.

IIHS

Definition

Additional supports for Medicaid recipients such as Community Guide and Individual Support.

Assertive Community Treatment Team - services received in the community that address functional areas of the identified population.

Residential

PRTF

Emergency Department

Service to help adults with psychiatric disabilities manage their illness and their lives with as little professional intervention as possible.

Hospital emergency department.

Intermediate Care Facility for individuals with Intellectual Disabilities.

Intensive In-Home Services - services provided in the person's home by a small team with at least one Licensed Professional.

50


FYTD September 2018

Members Served is based on Member's County of Medicaid Eligibility not on the Provider's physical

location.

Expenses by Service Categories is based on the Total Paid Amount.

*Please see the Service Category Definitions (Pg. 4) for additional detail

Members Served and Expenses by Service Category

0

64

108

98

139

174

294

278

196

372

438

824

711

1162

1045

1132

10086

1

64

73

100

123

220

264

276

315

350

401

689

712

1045

1057

1189

9968

0 2000 4000 6000 8000 10000 12000

Residential

MST

PRTF (Psychiatric ResidentialTreatment Facility)

Partial Hosp/Day Tx


Community Support

IIHS

ICF

Crisis Services

ACTT (Assertive CommunityTreatment Team)

Psych Rehab

Inpatient

Outpatient ED



Innovations

Outpatient

Distinct Members Served - Medicaid Funding

Jul'18-Sep'18 Jul'17-Sep'17

$0

$329,138

$2,351,813

$512,544

$1,316,413

$321,390

$1,639,546

$9,130,561

$107,612

$1,157,920

$992,235

$3,167,604

$81,934

$1,151,853

$2,643,881

$20,448,497

$4,264,053

$12,670

$391,855

$1,584,482

$642,615

$1,155,383

$394,278

$1,374,325

$8,856,640

$305,991

$1,109,974

$988,134

$2,658,315

$90,804

$1,138,674

$2,655,849

$21,410,315

$4,904,690

$0 $10,000,000 $20,000,000

Residential

MST

PRTF (Psychiatric Residential Treatment Facility)

Partial Hosp/Day Tx


Community Support

IIHS

ICF

Crisis Services

ACTT (Assertive Community Treatment Team)

Psych Rehab

Inpatient

Outpatient ED



Innovations

Outpatient

Expenses by Service Category - Medicaid Funding


51


FYTD September 2018

Members Served and Expenses by Service Category

Members Served is based on member's County of Residence not on the Provider's physical

location.

*Please see the Service Category Definitions (Pg. 4) for additional detail


0

0

7

34

74

125

144

602

941

1762

1

2

32

39

70

184

206

587

1019

2036

0 500 1000 1500 2000 2500

MST

IIHS

Community Support

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient

Distinct Members Served - State Funding


$0

$0

$13,953

$47,016

$177,219

$819,905

$236,147

$2,589,875

$191,127

$648,616

$1

$13,943

$43,278

$47,646

$199,575

$972,345

$213,479

$2,483,300

$202,431

$877,779

$0 $1,000,000 $2,000,000 $3,000,000

MST

IIHS

Community Support

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient

Expenses by Service Category - State Funding


52


FYTD September 2018

Members Served and Expense Amounts - Facility Based Crisis & Mobile Crisis Management Services

Medicaid Member served for Facility Based Crisis & Mobile Crisis Services are based on the

Consumers Eligibility. Expenses by Facility Based Crisis & Mobile Crisis Services are based on the total Adjudicated

Amount.

Members Served is based on member's County of Residence not on the Provider's physical

location.


28

170

65

265

0

50

100

150

200

250

300

Facility Based Crisis Mobile Crisis Management

Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid


109

319

137

346

0

50

100

150

200

250

300

350

400


Distinct Members Receiving FBC & MCM Crisis ServicesState


$81,937

$25,674

$186,788

$118,103

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000

$200,000


Expenses by FBC & MCM Crisis ServiceMedicaid


$176,250

$45,437

$212,895

$54,889

$0

$50,000

$100,000

$150,000

$200,000

$250,000


Expenses by FBC & MCM Crisis ServiceState


53


FYTD September 2018

Entity Type Definitions

Psych State Institution State run Psychiatric care facility for children and adults.

Agencies provide one or more enhanced clinical/therapeutic/rehabilitative/habilitative service to MH, SUD, IDD, or multiple diagnosis groups.

Residential Facility located in-catchment but affiliated with another MCO/LME with local Quality Management mandated site visits and limited

oversight required.Senate Bill 163

Other Other entity not elsewhere defined.

County Agency Public health agency.

Neuro Behavioral Center State

Institution

State run medical and nursing care facility for individuals with severe or moderate developmental disability (IDD) and medical conditions of a

serious or chronic nature requiring 24 hour care.

ICFMR State Institution Intermediate Care Facilities for Persons with Mental Retardation (ICF/MR) - State run Intermediate Care Facility serving IDD Adults and children.

ADATC State InstitutionAlcohol Drug Abuse Treatment Center (ADATC) State Institution-A state run SUD Adult facility which provides medical detox and medically

monitored residential treatment.

Licensed Independent Practitioner (LIP) Groups are a group of clinicians, Therapists, Psychiatrists, Psychologists, etc. providing outpatient services

such as therapy, psychiatric care, assessment, and testing. They contract with the MCO as a group.

Mandated Entity types effective 11/1/2017.

Entity Type Definition

Agency

LIPLicensed Independent Practitioner (LIP) - Individual Clinicians, Therapists, Psychiatrists, Psychologists, etc. that are individually contracted with

the MCO. They provide outpatient services such as therapy, psychiatric care, assessment and testing.

LIP Group

Hospital Non-contracted Hospitals for which we reimburse Emergency Department services and Inpatient services.

Physician's Group of HospitalsA group of physicians, contracting or non-contracting, associated with hospitals but not employed by the facility. Considered non-contracting

unless otherwise specified.

Inpatient Hospital providing contracted behavioral health Inpatient and Emergency Department services.

Comprehensive Community

Clinics

Agency based entities providing a number of services, including assessment, enrollment, Outpatient and Psychiatric services, and serve at least

two disabilities. They are designated points of entry that ensure easy access for members.

Inpatient/Outpatient Hospital providing contracted behavioral health Emergency Department and Outpatient services.

54


FYTD September 2018

*Please see the Entity Type Definitions (Pg. 8) for additional detail

Carolinas Medical Center-Main (FAC) Inpatient

Monarch Comprehensive Community Clinics

Anuvia Prevention and Recovery Center, Inc. Agency

The Arc of North Carolina, Incorporated Agency

Center For Emotional Health, P.C. LIP Group

McLeod Addictive Disease Center, Inc. Agency

Matrix Mental Health Alliance, LLC dba CriSys Agency

Novant Medical Group, Inc. dba Rowan Psychiatric Associates Hospital

Person Centered Partnerships, Inc.dba Amara Wellness, Inc. Agency

Developmental Disabilities Resources, Inc. Agency

Access Call Center

Top 10 Providers by Members Served - MecklenburgEntity Type

Provider Information

5,303 5,665 5,068

5 5 5

0

1

2

3

4

5

6

0

2000

4000

6000

8000

Jul'1

8

Au

g'1

8

Sep

'18

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls

Total Number of Calls and Speed to Answer

2.1% 2.0% 2.2%

0%

2%

4%

6%

8%

10%

Jul'1

8

Au

g'1

8

Sep

'18

Per

cen

t o

f C

alls

Ab

and

on

ed

Call Abandonment Rate

Access HEDIS Benchmark 8.6% Cardinal Innovations Target 5.0%

0101010203030407282937

146191

415868

0 200 400 600 800 1000

Other

Neuro Behavioral Center State Institution

County Agency

ADATC State Institution

Inpatient/Outpatient

ICFMR State Institution

Psych State Institution

Comprehensive Community Clinics

Inpatient

Physician's Group of Hospitals

Hospital

LIP Group

LIP

Agency

Total Providers

All Cardinal Innovations Providers by Entity Type

Note: The Top 10 Providers by Members Served is based on member's County of Medicaid Eligibility not on the Provider's physical location.

55


FYTD September 2018

Members Served by Age and Diagnosis

Members Served and Expense Amounts by Service Category - Medicaid

Members Served and Expense Amounts by Service Category - State

Members Served and Expense Amounts for Crisis Services

Call Abandonment Rate

Registry of Unmet Needs

The number of members on the Innovations Registry of Unmet needs slightly dropped for August'18.

Outpatient services were the most utilized Medicaid funded service and Innovations services had the highest expense of $21,410,315, followed by

ICF services of $8,856,640 for 1st Quarter FY1819. PRTF services had the largest decrease in utilization of 32% (108 to 73) and in expense of 33%

($2,351,813 to $1,584,482) when compared to 1st Quarter FY1718.

Outpatient Services continued to be the most utilized State funded Service followed by Crisis Services with both service groups having an increase

in utilization for 1st Qtr FY1819. Residential services had the highest expense of $2,483,300 followed by Inpatient services of $927,345. Inpatient

services also experienced an increase in utilization of 47% (125 to 184) and in expense of 19% ($819,905 to $972,345).

Utilization and Expense for Facility Based Crisis and Mobile Crisis Management increased for both Medicaid and State funding compared to 1st Qtr

of FY1718. Medicaid funded Facility Based Crisis had the largest increase in utilization of 132% (28 to 65), and Mobile Crisis Management also

experienced an increase of 56% (170 to 265). As a result, expenses for Facility Based Crisis increased by 128% ($81,937 to $186,788) and expenses

for Mobile Crisis Management increased by 360% ($25,674 to $118,103). The large increase in expense for Medicaid FBC can be attributed a

provider who accounted for approximately 65% of the total cost. This provider did not provide Facility Based Crisis services for 1st Qtr FY1718.

Average speed to answer and call abandonment rate remained consistent for the quarter.

The number of Child MH members served have been increasing, whereas Adult MH members served have been slightly decreasing for 1st Qtr of

FY1819.

Analysis:

Please note that providers have up to 90 days to submit claims and that this will affect the number of members served and expense amounts on this report. The

numbers for the previous months will be updated each reporting period.

Call Center information in the charts above reflect Cardinal Innovations data and are not county specific.

56

Mecklenburg Community OfficeQuality Management Dashboard

FYTD September 2018

## ##

% Served

NOTE: Starting in December of 2017, any Abuse/Neglect/Exploitation incident naming a staff member was automatically classified as Level III. As a result, the

number of Level II incidents decreased, and the number of Level III incidents increased, even though the combined number of incidents remained consistent.

Report data from November 29, 2018

Southern

Mecklenburg

Triad

Northern Region

Central

11%51,357 5,740Five County 11%

10%

Incidents

Level II Incidents reported in the Mecklenburg catchment area in the remained consistent from the 4th Qtr. of FY1718 to the 1st Qtr. of FY1819 (from 266 to

258). Of the Level II Incidents in Mecklenburg in the 1st Qtr. of FY1819, 73% (189/258) were due to Member Behavior.

Medicaid Population - FYTD September 2018

Members

Served

11,498

13,097

8,739

12,554

6,814

% Eligible in

Cardinal

Innovations

Population

24%

33%

19%

23%

12%

Eligible

Population

117,034

159,012

93,531

110,761

8%

9%

11%

11%59,404

Region

81 69 108

7.10

5.87

9.75

0.00

2.00

4.00

6.00

8.00

10.00

12.00

0

20

40

60

80

100

120

Jul'18 Aug'18 Sep'18

Level II Incidents Count & Rate of Incidents Per 1,000 Members Served

Level II Incidents Rate/1,000 Members Served

FYTD: July 2018 - September 2018

57


FYTD September 2018

Level III Incidents reported in the Mecklenburg catchment area in the remained consistent from the 4th Qtr. of FY1718 to the 1st Qtr. of FY1819 (from 52 to 51).

The majority (69% - 35/51) of the Level III Incidents reported in the Mecklenburg catchment area in the 1st Qtr. of FY1819 were due to Abuse, Neglect, or

Exploitation, and 97% (34/35) of these were Alleged (10 Alleged Verbal Abuse, 9 Alleged Physical Abuse, 9 Alleged Sexual Abuse/Assault/Rape, and 6 Alleged

Neglect). There was one Incident of Substantiated Neglect, which received MCO intervention. There were 10 Member Deaths in the 1st Qtr. of FY1819 (7

Unknown Cause, 2 Accidents, and 1 Suicide). There were 5 Level III Incidents involving Member Behavior (2 Aggressive Behavior, 2 Illegal Acts by a Member, and

1 AWOL > 3 Hours), and 1 Medication Error (Other) reported during the 1st Qtr. of FY1819.

Incidents (continued)

The number of Restrictive Interventions in the 1st Qtr. of FY1819 decreased 24% (from 202 to 154) compared to the previous quarter (4th Qtr. of FY1718). Of

the 154 Level II Restrictive Interventions in the 1st Qtr. of FY1819, there were 61 Physical Restraint - Standing, 43 Physical Restraint - Seated, 39 Physical Restraint -

Supine, and 11 Seclusion. There were no Level III Restrictive Interventions in the 1st Qtr. of FY1819.

10 29 12

0.88

2.47

1.08

0.00

0.50

1.00

1.50

2.00

2.50

3.00

0

5

10

15

20

25

30

35


Level III Incidents Count & Rate of Incidents Per 1,000 Members Served

Level III Incidents Rate/1,000 Members Served


56 63 35

4.915.36

3.16

0.00

1.00

2.00

3.00

4.00

5.00

6.00

0

10

20

30

40

50

60

70


Restrictive Intervention Count & Rate of Incidents Per 1,000 Members Served

Level II Incidents Level III Incidents Rate/1,000 Members Served


58


FYTD September 2018

42% (194/463) of Incidents reported were due to Member Behavior, of which 75% (145/194) occurred in the CMH population. 33% (154/463) of Incidents

reported were due to Restrictive Interventions, of which 97% (150/154) also occurred in the CMH population.

Incidents (continued)

81% (377/463) of the Incidents reported in the Mecklenburg catchment area were received within 3 days of learning of the incident during the 1st Qtr. Of FY1819.

Abuse, Neglect or Exploitation Incidents comprised 10% (47/463) of all incidents reported in the Mecklenburg catchment area. 55% (26/47) of these involved the

CMH population and 40% (19/47) involved the ADD population. 66% (25/38) of Member Injury Incidents involved ADD members.

0

50

100

150

200

250

Abuse, Neglect orExploitation

Restrictive Interventions Member Behavior Member Death Member Injury Medication Error Suspsension

Incidents by Type & Target Population

ADD AMH ASA CDD CMH CSA


59


FYTD September 2018

15 24 66 33 27

20

0

16%

100.0%

0 0 0

100%

21.3

100%

20.8 22.5

14%

0

20

There was an increase of 22% (from 54 to 66) in the number of Grievances received from the 4th Qtr. of FY1718 to the 1st Qtr of FY1819. Some of this can be

attributed to an increase (from 1 to 5) in Grievances related to Lack of Choice/Provider Availability.

0

0

6

13

6

18

0

2

3

20

43

Please Note: The State benchmark for grievances requires that 90% of grievances are resolved within 30 days of submission. Three Grievances were Out-

of-Catchment

Grievances - FYTD September 2018

7

5

49

0

3

24

All Grievances

62

28

3

3

4

5

11

4

1

5

0

2

1

8

39% 20%

20.6

100%

0

0

0

01

0

11

0

1

0

11

0

13

1

17

7

13

16

50

2

20

1

8

100%

18.5

0

11

1

0

122

46

0

0

0

4

11

0

4

For Resolved Grievances

Total # Grievances Pending

Total # of Grievances

Total # Grievances Against Providers

Total # Grievances Against Cardinal Innovations

0

100%

21.4

168

Total # Grievances Resulting in Investigations

1

0

9%

0

Total # Grievances Not Against Provider or MCO

0

Measure

Total # of Grievances by

Disability

110

Child

Adult

Unknown

Does Not Apply

Total # Grievances by Age Group

Subcategory

MH Only

IDD Only

SUD Only

Multi-Disability

TBI Only

Unknown

Does Not Apply

Average Days to

Resolve% Resolved within 30

Days

0

1

21

6

0

Piedmont

Catchment

Mecklenburg

Catchment

Central

Catchment

Five County

Catchment

13

53

2

6

15

Triad

Catchment

8

2

3

11

0

2

24 27 15

2.102.30

1.35

0.00

0.50

1.00

1.50

2.00

2.50

0

5

10

15

20

25

30


Grievance Count & Rate of Complaints Per 1,000 Member Served

Grievances Rate/1,000 Members Served


60


FYTD September 2018

Grievances (continued)

6

9

9

9

10

12

13

19

31

59

0 10 20 30 40 50 60 70

Individual Budget Tool

Inadequate Treatment

Customer Service (CS) Telephone Responsiveness

Other Administrative Issues

Lack of Coordination of Benefits

Complaint Against Department

Neglect

Potential Fraud

Delay in Treatment

Conflict with Provider (disagreement with treatment, diagnosis, etc)

Top 10 Grievances TypesFYTD: September 2018

6

8

9

10

11

17

21

33

34

47

0 5 10 15 20 25 30 35 40 45 50

Psychosocial Rehabilitation

IDD Care Coordination

Community Support Team

Inpatient

Intensive In-Home Services

Peer Support Services

Assertive Community Treatment Team

Outpatient Services

Innovations

Residential Services

Top 10 Services with GrievancesFYTD: September 2018

61


FYTD September 2018

During the 1st Qtr. of FY1819, there were 1,719 claims reviewed in the Mecklenburg catchment area.

Provider Monitoring Reviews

Please note: Cardinal Innovations Quality Management requires any provider receiving out of compliances on selected review items and trending out of

compliance areas to complete a POC as a standard measure to prevent future out of compliances.

In the 1st Qtr. of FY1819, 9 providers of the 28 reviewed scored 100%. Three Mecklenburg providers scored below the 85% target on their NC Provider

Monitoring Reviews (83.1%, 82.7%, 81.7%).

1

1

2

3

4

10

10

26

28

28

230

0 20 40 60 80 100 120 140 160 180 200 220 240 260

Grievance Module

EOR

Self-Audit

Clinical Quality Review

Investigation

New Unlicensed SiteReview

Unlicensed AFL Review

Cultural Competency

Concern Module

NC Provider MonitoringReview

Innovations Annual AFLReview

Monitoring Reviews

Jul-Sep'18

98.8% 99.0%92.8% 97.5%

90.9%

0%

25%

50%

75%

100%

Mecklenburg Central Mecklenburg Piedmont Triad

NC Provider Monitoring Review Scores

85% Target

July 2018 - September 2018


62


FYTD September 2018

Provider Monitoring Reviews (All)

In the 1st Qtr. of FY1819, the number of Reviews requiring Paybacks increased by 40% (from 20 to 28) over the 4th Qtr. Of FY1718, while the number of POC's

remained consistent. 54% of the Reviews requiring Paybacks in the 1st Qtr. Of FY1819 were the result of NC Provider Monitoring Reviews.

28

36

0

5

10

15

20

25

30

35

40

Jul-Sep'18

Monitoring Review Outcomes

Reviews requiring Paybacks Reviews requiring POC's


63


FYTD September 2018

Please note: The Identified Payback amount is in the recoupment and reconsideration process.

Provider Monitoring Reviews - Paybacks

92% of the paybacks identified have been recouped for the Mecklenburg catchment area for FY1819. One provider accounted for 37% ($22,220.80/$60,625.49) of

the payback amounts for the 1st Qtr. of FY1819, resulting from out of compliance claims in a Provider Concern Review. One provider is responsible for 63%

($3,229.29/$5,130.36) of the amount yet to be recouped for FY1819, and their recoupment status is currently pending. The remaining providers with paybacks yet

to be recouped have either been invoiced or have payment plans in place.

$76,734.88

$77,312.36

$55,495.13

$60,625.49

$0 $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000 $80,000 $90,000

Amount Recouped

Identified Payback

Amount Recouped

Identified Payback

FY

1718

FY

1819

Payback Amounts from Post Payment Reviews

Jul-Sep

64

Documents

2019 Mecklenburg Community Board Meeting...2019/01/24 · NC Medicaid Transformation Under SL 2018- 48, DHHS will consider only LME/MCOs to become BH/IDD Tailored Plan managers. The