Cardinal Innovations Healthcare - 2019 Triad Community ...€¦ · Community Advisory Board. 2. Opening Remarks. Opening remarks by Leon Inman, Chair. He welcomed the Triad Community

2016 Board of Directors Meeting

2019 Triad

Community Advisory

Board Meeting

July 30, 2019


TRIAD COMMUNITY BOARD AGENDA July 30, 2019 DINNER (SERVED AT 5:00 p.m.)

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

PublicLeon Inman, Chair 1 Information

2. Opening Remarks Leon Inman, Chair 2 Information

3. Approval of April 11, 2019Meeting Minutes

Leon Inman, Chair 3 Action

4. Local CFAC Update Matthew Potter 6 Information

5. Presentations

A. Community Relations Report

Melissa Bunker 7 Information

B. MOE Funding Ronda Tatum 8 Information

C. Community Based Governance Update

King Jones 9 Information

6. Community Updates Leon Inman, Chair 10 Information

7. Closing Remarks Leon Inman, Chair 11 Information

Adjournment


TRIAD COMMUNITY ADVISORY BOARD MEMBERS

NAME PHONE EMAIL

Davie County Terry Renegar (336) 416-4158 [email protected]

Julie Whittaker (336) 751-5441 [email protected]

Laurie Cruse (336) 655-2465 [email protected]

Forsyth County Don Martin (336) 339-8064 [email protected]

Geraldine S. Harris (336) 830-1253 [email protected]

Mark Serosky (336) 749-4676 [email protected]

Rockingham County Reece Pyrtle (336) 613-2035 [email protected]

Ron Norwood (336) 613-3570 [email protected]

Felissa Ferrell (336) 342-1394 [email protected]

Stokes County Ronnie Mendenhall (336) 293-3359 [email protected]

Leon Inman, Chair (336) 575-3157 [email protected]

Pamela Tillman (336) 813-2051 [email protected]

CFAC Matthew Potter, Vice Chair (336) 409-3096 [email protected]

TRIAD AGENDA ITEM

MEETING DATE: July 30, 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

TRIAD AGENDA ITEM


SUBJECT: Opening Remarks

BRIEF SUMMARY: Leon Inman, Chair, will provide opening remarks.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

2

TRIAD AGENDA ITEM


SUBJECT: Approval of the April 11, 2019 Meeting Minutes

BRIEF SUMMARY: The minutes for the April 11, 2019 Triad Community Advisory Board

Meeting are attached for approval.

REQUESTED ACTION: Approve the minutes for the April 11, 2019 Triad Community Advisory

Board Meeting as presented.

ATTACHMENTS: Yes

3

Triad Community Advisory Board Meeting Minutes

April 11, 2019

Members Present: Leon Inman, Chair, Laurie Cruse, Felissa Farrell, Don Martin, Matthew Potter, Mark Serosky, Pam Tillman, and Julie Whittaker

Members Absent: Ronnie Mendenhall, David Mount, Reese Pyrtle, and Terry Renegar

Staff Present:

Guests:

Melissa Bunker, Anna Marshall, Tony Martin, Britney Phifer, and Derek Bitner

1. Call to Order –Leon Inman, Chair, called the meeting to order at 5:35 p.m.

Matters of the PublicAny citizen may address the Triad Community Advisory Board. No citizen addressed the TriadCommunity Advisory Board.

2. Opening RemarksOpening remarks by Leon Inman, Chair. He welcomed the Triad Community Advisory Board Membersand guests to the meeting.

3. Approval of the Triad Community Advisory Board January 31, 2019 Meeting MinutesThe minutes from the January 31, 2019 Triad Community Advisory Board meeting were reviewed.

Don Martin motioned to approve the minutes as presented. Mathew Potter seconded themotion.

All in favor. Motion carried.

4. Local CFAC UpdateMatthew Potter, CFAC Representative, provided updates to the Triad Community Advisory Board. Heprovided pertinent information to the Board regarding new CFAC by-laws and a proposed RelationalAgreement for the CFAC committees. Matthew informed the Board that Michael Thompson of StokesCounty, is the newest member of the Triad Consumer and Family Advisory Committee.

5. Special PresentationsA. Community Relations Report

Melissa Bunker, Senior Community Executive, presented the Community Relation Report.

Sarah Potter

4

B. Clinical Operations Annual Report

Tony Martin, I/DD Care Management Manager, and Britney Phifer, Utilization Management Manager, presented the Clinical Operations Annual Report.

6. Community UpdatesMatthew Potter, Vice Chair, requested community updates from the Triad Community Advisory Board.

7. Closing remarksMatthew Potter provided closing remarks.

Matthew Potter, Vice Chair, motioned to adjourn the meeting. Laurie Cruse seconded themotion.

All in favor. Motion carried.

Meeting adjourned at 7:50 p.m.

Community Board Clerk Date

5

TRIAD AGENDA ITEM


SUBJECT: Local CFAC Update

BRIEF SUMMARY: Matthew Potter, CFAC Representative, will provide local CFAC updates.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

6

TRIAD AGENDA ITEM

MEETING DATE: July 30, 2019 AGENDA ITEM: 5.A.

SUBJECT: Community Relations Report

BRIEF SUMMARY: Melissa Bunker, Senior Community Executive, will present the Community

Relations Report.

REQUESTED ACTION: Information only

ATTACHMENTS: Appendix A

7

TRIAD AGENDA ITEM

MEETING DATE: July 30, 2019 AGENDA ITEM: 5.B.

SUBJECT: Community Based Governance Update

BRIEF SUMMARY: King Jones, Community Health Director, will present the Community Based

Governance Update.


ATTACHMENTS: Appendix B

8

TRIAD AGENDA ITEM

MEETING DATE: July 30, 2019 AGENDA ITEM: 5.C.

SUBJECT: MOE Funding

BRIEF SUMMARY: Ronda Tatum, Deputy County Manager at Forsyth County, will provide MOE

funding updates.


ATTACHMENTS: No

9

TRIAD AGENDA ITEM


SUBJECT: Community Updates

BRIEF SUMMARY: Leon Inman, Chair, will request community updates from the Community

Board.


ATTACHMENTS: No

10

TRIAD AGENDA ITEM


SUBJECT: Closing Remarks

BRIEF SUMMARY: Leon Inman, Chair, will provide closing remarks.


ATTACHMENTS: No

11

12

APPENDIX A: Community Relations Report NOTES

13

14

Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.

TRIAD REGION COMMUNITY RELATIONS QUARTERLY REPORT

To improve the health and wellness of our members and their families.

OUR MISSION


July - September

15


ORGANIZATIONAL UPDATES

Chief Strategy Officer – Rudy Dimmling

Medicaid Transformation Office ‐ HiringInterim Sr. Vice President Medical Director – Dr. Pamela Wright‐Etter

Vice President Network Operations – Deidra Cook

• Community Health Director – King Jones• Community Programs Director – Laurie Whitson

• Triad Senior Community Executive – Reid Thornburg• Piedmont Senior Community Executive –Melissa Bunker


TRANSFORMATION & MEMBER RATIO

Medicaid Member Plans – Three Phases1st Triad/Northern Region – Complete by November ‘192nd Rest of State – Complete by February ‘20

Standard Plan – 344,000 Tailored Plan ‐ 79,000 Some Interaction

40,000 Critical Interaction

LINK FOR MORE

16


MEDICAID TRANSFORMATION ROUNDTABLES

Every Region Held

Executive LeadershipProviders & Community FocusedStandard Plan – Nov. ‘19Maximus Broker Engagement

Triad – Wednesday, July 24


SB 630 A.K.A. “THE CRISIS/IVC BILL”

County Plans Ratified by BOCC – August/September

State Deadline – October 1, 2019

Trends for the TriadBHUC is #1 for Forsyth, Stokes & Davie (non‐aggressive)Novant/WFBH is #2 for Forsyth, Stokes & Davie (aggressive)

? Local ED’s for Rockingham (aggressive or non)? Who’s On First Transportation Process ‐MOE

17

Building a Child‐Focused Foster Care System: SB 549Breaking down barriers to support the health needs of children in foster care.

Current Foster Care System• Multiple agencies and bureaucracies working

against each other

• Child experiences frequent moves and placement instability

• Causes additional trauma to the child

• Incentivizes higher levels of care (therapeutic foster care)

Foster Care

DSS

(TFC)TherapeuticFoster Care

LME/MCOProvider Agency

(PRTF)ResidentialTreatment


(TFC)TherapeuticFoster Care


Future Foster Care SystemA collaborative of 4 county DSS representatives, LME/MCO, and community stakeholders came together to create –result is a proposed model with the following characteristics:

• Money follows the child, one unified model that ischild‐focused

• Increased placement stability

• Eliminate incentives forhigher levels of care

• Provides 24/7 clinical and crisis support for foster parents

• Reduces needs forhigher levels oftherapeutic care

Did you know? Nearly all

children entering the foster care system have experienced trauma.

Each move or new placement within the system causes additional trauma as the

child leaves their support system, school, friends and community.

Foster Care

Clinical/CrisisSupport (24/7)

Foster Parents

DSS

Provider Agencies

LME/MCO


QUESTIONS AND FEEDBACK

18


THANK YOU

Melissa M. Bunker

Senior Community Executive

Triad Region

19

20

APPENDIX B: Community Based Governance Update NOTES

21

22


COMMUNITY BASED GOVERNANCE UPDATE

To improve the health and wellness of our members and their families.

OUR MISSION


King Jones, Community Health Director

23


WHY CHANGE THE COMMUNITY MODEL?

• Cardinal Innovations Healthcare values the voice of thecommunities we serve

• Local Community Board members wanting change in contentand action of the meetings

• We want to engage our stakeholders to choose CardinalInnovations

• We believe it is the right thing to do


FEEDBACK FROM LOCAL COMMUNITY BOARDS ON CURRENT STRUCTURE

• Difficult to understand activities/ quality/ accountability without local reporting anddialogue.

• Lack of local advocacy• Not sure of Community boards effectiveness nor connection to governing board• Importance of hearing and knowing what’s happening in surrounding areas• Losing power/ oversight• Community needs and assessments could be improved (we could help)• Big Board doesn’t know what goes on in the community except through staff• The current "Oversight model" has been in place for a few years, seems to try to make

everything cookie cutter throughout the organization. The dashboard was an attempt tofit all communities in the same box.

• Keeping the administration as close to the people who are being served will be key tothe success of Cardinal. The greatest advocacy and voice for those who cannot speak forthemselves must come from the local level.

24


COMMUNITY FEEDBACK ON THE MODEL

Presentations on the new Community Governance Model occurred February through April


Proposed Detailed Structure

Five County Regional Health Council

(Franklin, Granville, Halifax, Vance, Warren)

Central Regional Health Council

(Alamance, Caswell, Chatham, Orange, Person)

Triad Regional Health Council

(Davidson, Davie, Forsyth, Rockingham, Stokes)

Southern Regional Health Council

(Cabarrus, Mecklenburg, Rowan, Stanly, Union)

Five County Regional Health Council

(Franklin, Granville, Halifax, Vance, Warren)

Central Regional Health Council

(Alamance, Caswell, Chatham, Orange, Person)

Triad Regional Health Council

(Davidson, Davie, Forsyth, Rockingham, Stokes)

Southern Regional Health Council

(Cabarrus, Mecklenburg, Rowan, Stanly, Union)

Provider Partners Council

Provider Partners Council

Operations CouncilOperations Council Operations CouncilOperations Council Operations CouncilOperations Council Operations CouncilOperations Council

Alamance Community

Advisory Council

Caswell Community

Advisory Council

Chatham Community

Advisory Council

Orange Community

Advisory Council

Person Community

Advisory Council

Davidson Community

Advisory Council

Davie Community

Advisory Council

Forsyth Community

Advisory Council

Rockingham Community

Advisory Council

Stokes Community

Advisory Council

Board of DirectorsBoard of Directors

Franklin Community

Advisory Council

Granville Community

Advisory Council

Halifax Community

Advisory Council

Vance Community

Advisory Council

Warren Community

Advisory Council

Cabarrus Community

Advisory Council

Mecklenburg Community

Advisory Council

Rowan Community

Advisory Council

Stanly Community

Advisory Council

Union Community

Advisory Council

25


PRESENTATIONS IN THE COMMUNITY

Northern Region: 18 presentations

10 at Stakeholder Meetings5 at Member/Family Meetings3 at Provider Meetings

297 = Total Attendees (excludes CIH staff)

Triad Region: 23 presentations



Southern Region: 21 presentations



Number of Presentations Given: 62 Number of Community Stakeholders: 683


SATISFACTION

25.27%

58.24%

10.99%

5.49%

A lot

A moderateamount

A little

Not at all

Attendees were surveyed after the presentation and

asked how they liked the Proposed

Governance Structure

83% were satisfied with the Proposed Governance Structure

26


FEEDBACK – A SAMPLING OF WHAT THE COMMUNITY LIKES

• This appears to be a more organized structure

• This provides more direct streamline into the governing body

• It’s obvious that there are cleargoals and expectations

• If followed, this will allow for clearlines of communication

• I see potential for less overlap

• I like that it gives each county/group more of a voice

• This structure provides more regional direction

• The Smaller Sub Groups Designated to each County allows for each group to establish a need specific totheir demographic

• This structure will allow for more Member input

• It allows for many relevant partneragencies to participate in the Health Council for each county

• It maintains client rights, memberrepresentation, and family input to give feedback about what is working and what are service gaps.

• Less “silo’d”, more cross‐talk and opportunity for feedback

• Utilizes Community Health Assessments for a knowledge base

Streamlined Process Community Voice Collaboration


FEEDBACK‐ KEY SUGGESTIONS

Hear what the people and families who actually use these services

think.

Form diverse groups.

Assure that agencies that

are affected can fully understand the new system and the benefits that it offers.

Start small with one area and see what works

and what doesn’t.

Keep transparent and inform partners

about discussions and progress toward reaching goals.

27


WHAT OUR KEY STAKEHOLDERS ARE SAYING

It seems simpler, less meetings required, better manageable.”‐County Commissioner

Seems to bring the key players back into the room and allows for participation.”‐Community Board Member

That it will be representative of all the demographic areas according to the make‐up of that area. Also the charters and by‐laws will be developed with the input of representatives from those demographic areas.”

‐Minority Coalition Member


PROPOSED TIMELINE

July 2019 – September 2019• Form Health Council Membership• Develop Charter and Functions• Elect Membership to Operations Sub‐

councils

October 2019 – December 2019

• Develop Operations Sub‐councils

• Work with Health Councils to develop plan of work

• Member composition of CommunityAdvisory Councils (CAC)

January 2020 – March 2020• Quantitative data gathered for the Regional

Health Assessment • Gather quality assessment information

from CAC’s

April 2020 – June 2020

• Finalize Regional Health Plans• Goals and strategies created, plan of work

developed and shared with Board

28


BENEFITS OF THE NEW MODEL

• The Regional Health plans are driven by the communities

• Local voices drive the change in the communities

• Cardinal as a collaborative partner at the table, not just driving the change

• Creates a matrix model of leadership in the communities not a top down approach

• Uses current committees already in place and transforms them into actionable committees makingthe change in their communities

• Based on the final decision of membership/number of meetings, would either be cost neutral fromcurrent structure (around $10,000) or increase by no more than $25,000 annually


CHALLENGES OF THE NEW MODEL

• Some stakeholders may be unwilling to change to see the benefit of the newstructure

• Some stakeholders who have lost trust in Cardinal not convinced that we followthrough on the intent of the model being community focused

• Smaller counties hesitant that structure will not change with them being left out.Want to see it in action before believing they will be heard

• The coordination between stakeholders to transition to the new model

29


NEXT STEPS

• Regional Health Councils• Charter has been developed• Proposed membership has been outlined• Both will be presented for approval by Board of Directors in August


THANK YOU

30

Davie County Dashboards

FYTD March 2019

County Funded Program Descriptions

County Funded Program

None

County Funded Program Description

31


FYTD March 2019

Report data as of May 24, 2019. 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

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

Davie Funding

$0

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.

32


FYTD March 2019

Number of Members Served by Age and Diagnosis

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

165177

159181 190

162

191 200 195

17 15 12 14 13 10 12 12 9

5 5 4 2 2 3 3 1 20

50

100

150

200

250

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Child Members Served by DiagnosisAges 3 through 17

MH IDD SUD

172154

133148

136

113

147128 128

86 85 83 83 81 79 84 83 80

66 67 66 65 68 71 68 61 66

0

20

40

60

80

100

120

140

160

180

200

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Adult Members Served by DiagnosisAges 18 and over

MH IDD SUD

79

77

75

77

78 78 78

80 80

72

73

74

75

76

77

78

79

80

81

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

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.

337 331292

329 326

275

338 328 323

103 100 95 97 94 89 96 95 89

71 72 70 67 70 74 71 62 68

050

100150200250300350400

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

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.

33


FYTD March 2019

Service Category Definitions

Service Category

1915 (b)(3) Services

ACTT

ICF

Group settings that serve people across all disability groups.

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

specialized interventions.

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.

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

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.

Crisis Services

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

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.

Community

Psych Rehab

34


FYTD March 2019

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

5

4

5

3

3

9

31

19

16

22

18

25

53

62

89

690

2

4

6

6

7

11

17

18

19

19

22

23

51

58

70

708

0 200 400 600 800

Community Support

Psych Rehab

ACTT (Assertive CommunityTreatment Team)

MST

Partial Hosp/Day Tx

PRTF (Psychiatric ResidentialTreatment Facility)

Outpatient ED

ICF


IIHS


Crisis Services

Innovations

Inpatient


Outpatient

Distinct Members Served - Medicaid Funding

Jul'18-Mar'19 Jul'17-Mar'18

$28,187

$2,214

$45,682

$37,578

$29,992

$280,130

$3,214

$1,999,994

$394,207

$135,555

$61,566

$7,202

$2,130,218

$250,383

$64,245

$416,182

$5,066

$15,957

$57,993

$45,616

$25,912

$246,280

$2,105

$1,903,215

$406,122

$153,875

$113,508

$23,639

$1,953,722

$298,946

$50,482

$518,754

$0 $500,000$1,000,000$1,500,000$2,000,000$2,500,000

Community Support

Psych Rehab

ACTT (Assertive Community Treatment Team)

MST

Partial Hosp/Day Tx

PRTF (Psychiatric Residential Treatment Facility)

Outpatient ED

ICF


IIHS


Crisis Services

Innovations

Inpatient


Outpatient

Expenses by Service Category - Medicaid Funding


35


FYTD March 2019


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

location.



0

1

2

22

34

23

41

131

0

0

1

22

26

28

45

167

0 50 100 150 200

Community Support


Partial Hosp/Day Tx

Residential

Inpatient

Community

Crisis Services

Outpatient

Distinct Members Served - State Funding


$0

$4,212

$2,249

$155,707

$121,886

$121,333

$14,326

$13,519

$0

$0

$132

$166,238

$103,184

$134,040

$27,819

$22,420

$0 $50,000 $100,000 $150,000 $200,000

Community Support


Partial Hosp/Day Tx

Residential

Inpatient

Community

Crisis Services

Outpatient

Expenses by Service Category - State Funding


36


FYTD March 2019

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.


location.


3

23

5

14

0

5

10

15

20

25

Facility Based Crisis Mobile Crisis Management

Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid


9

29

14

30

0

5

10

15

20

25

30

35


Distinct Members Receiving FBC & MCM Crisis ServicesState


$3,662 $3,540

$19,324

$2,715

$0

$5,000

$10,000

$15,000

$20,000

$25,000


Expenses by FBC & MCM Crisis ServiceMedicaid


$24,639

$4,949

$26,219

$8,249

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000


Expenses by FBC & MCM Crisis ServiceState


37


FYTD March 2019

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.

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

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

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.

38


FYTD March 2019

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

DAYMARK Recovery Services, Inc.(Cabarrus Center) Comprehensive Community Clinics

Novant Medical Group, Inc. dba Rowan Psychiatric Associates Hospital

Wake Forest University Health Sciences Physician's Group of Hospitals

County of Davie Office of Finance Agent dba Davie County Health DepartmentLIP

Monarch Comprehensive Community Clinics

North Carolina Baptist Hospital Inpatient

DAYMARK Recovery Services, Inc. - Mobile Crisis Management / After Hours EmergencyAgency

Forsyth Memorial Hospital, Inc. dba Novant Health Forsyth Medical CenterInpatient

The Neil Group, Inc. LIP Group

InPatient Consultants of NC PC LIP Group

Access Call Center

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

Top 10 Providers by Members Served - Davie Entity Type

Provider Information

5,303 5,665 5,068 6,432 4,916 4,231 5,828 5,116 5,151

5 5 5

45 5

7

13

5

0

2

4

6

8

10

12

14

0

2000

4000

6000

8000

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

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%1.9% 1.8% 2.2%

2.7%

5.1%

2.3%

0%

2%

4%

6%

8%

10%

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Per

cen

t o

f C

alls

Ab

and

on

ed

Call Abandonment Rate

Access HEDIS Benchmark 8.6% Cardinal Innovations Target 5.0%

0101010203030406283456

167202

448956

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.

39


FYTD March 2019

Members Served by Age and Diagnosis

Members Served and Expense Amounts by Service Category - Medicaid

Members Served and Expense Amounts by Service Category - State

Trends in Utilization in FYTD1819:

- Outpatient services were the highest utilized in FYTD1819 at 708 members served, congruent with FYTD1718.

- Community Support services were the least utilized in FYTD1819 with 2 members served, congruent with FYTD718.

Trends in Expense in FYTD1819:

- Innovations services were the highest expense in FYTD1819 at $1,953,722, congruent with FYTD1718.

- ICF services were the second highest expense in FYTD1819 at $1,903,215, also congruent with FYTD1718.

- Outpatient ED services had the least expense in FYTD1819 at $2,105.

Other Changes in Utilization and Expense as compared to same time period in FYTD1718:

- Outpatient ED utilization decreased by 45% (31 to 17) and expense also decreased by 33% ($3,214 to $2,105).

- Partial hospitalization utilization increased by 133% (3 to 7 members) while expense decreased 14% ($29,992 to $25,912), with decreases in

expense shown for both partial hospitalization and day treatment program expenses.


- Outpatient services were the most utilized in FYTD1819 at 167 members; an increase of 27% from FYTD1718 at 131 members.

- Community Support and ACTT services were the least utilized in FYTD1819 with 0 members served, congruent with FYTD1718.


- Residential services were the highest expense in FYTD1819 at $166,238, congruent with FYTD1718.

- Community services were the second highest expense in FYTD1819 at $134,040.


- Outpatient service expense increased 66% ($13,519 to $22,420) with a 27% increase in utilization, as described above.

- Crisis service expenses increased 94% ($14,326 to $27,819), while utilization remained consistent between FYTD1718 and FYTD1819. The

increase may be related to an increase in expenses for Facility-Based Crisis services from $0 in FYTD1718 to $10,237.24 in FYTD1819.

- Child MH service utilization trended upwards inFYTD1819, while child IDD and SUD service utilization remained consistent.

- Adult MH service utilization trended downwards in FYTD1819, while adult IDD and SUD service utilization remained consistent.

- The number of members on the Registry of Unmet Needs decreased in Q1 FY1819 and then has continued to increase since Q2 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.

40


FYTD March 2019

Members Served and Expense Amounts for Crisis Services



- Outpatient services were the most utilized in FYTD1819 at 167 members; an increase of 27% from FYTD1718 at 131 members.

- Community Support and ACTT services were the least utilized in FYTD1819 with 0 members served, congruent with FYTD1718.


- Residential services were the highest expense in FYTD1819 at $166,238, congruent with FYTD1718.

- Community services were the second highest expense in FYTD1819 at $134,040.


- Outpatient service expense increased 66% ($13,519 to $22,420) with a 27% increase in utilization, as described above.

- Crisis service expenses increased 94% ($14,326 to $27,819), while utilization remained consistent between FYTD1718 and FYTD1819. The

increase may be related to an increase in expenses for Facility-Based Crisis services from $0 in FYTD1718 to $10,237.24 in FYTD1819.

- For members with Medicaid funding, Facility-Based Crisis utilization increased by 67% (3 to 5 members) and in expense by 428% ($3,662 to

$19,324). Between FY1718 and FY1819, it appears that at least two companies received contract rate increases for FBC services.

- For members with Medicaid funding, Mobile Crisis utilization decreased by 34% (23 to 14 members) and expense decreased by 23% ($3,540 to

$2,715).

- For members with State funding, Facility-Based Crisis utilization increased 56% (9 to 14 members) while expense remained consistent; While at

least one company appears to have received a rate increase, average length of stay also decreased more than one day between FYTD1718 and

FYTD1819.

- For members with State funding, Mobile Crisis utilization remained consistent between FYTD1718 and FYTD1819 while expense increased 67%

($4,949 to $8,249); This appears to be due to an increase in the average number of units billed per member.

With the exception of February 2019, speed to answer calls remained consistent. During January and February, new call software was

implemented and then discontinued when it was discovered that it negatively impacted speed to answer and call abandonment.

41

Forsyth County Dashboards

FYTD March 2019



Advisory CommitteesTriad Region community members, family and self-advocates, area providers who meet monthly- funded by Forsyth County offering grants to local non-profit

organizations and support problem solving gaps in services.


Daymark Recovery Services """Safety net"" provider serving adults with serious mental health and/or substance use issues through a broad continuum of services. "

Daymark Recovery Services Transportation Grant Subsidy


Enrichment CenterArts-based day program for individuals with IDD; includes innovative geriatric program offering a “retirement option” for individuals who are at/near

retirement age

Horizons Residential and respite services for medically fragile individuals

Monarch Major provider with a broad continuum of services

School Health Alliance Integrated medical/behavioral services in WS/FC Schools

UNC-G / Family Partners A “Family Partner”, a parent/relative of a youth receiving services, provides information and support to other families.

42


FYTD March 2019



Advisory Committees

Daymark Recovery Services



Enrichment Center

Horizons

Monarch

School Health Alliance

UNC-G / Family Partners

Total:


69.9%$1,106,576

38.6%

% Spent

0.0%$5,000

$1,750$7,000



66.7%

$0

$50,000

$200,000

$65,000

FYTD

Expenses

$11,590$30,000

Forsyth Funding

$759,319

$114,667

$33,333

$133,333

$1,012,425

$189,000

66.7%

25.0%

$1,583,425

66.7%

75.0%

60.7%

$43,333

FY Budget

Amount

37.0%$9,250$25,000


43


FYTD March 2019



1131 1175 1217

1430 13881237

1495 15111590

120 113 121 124 117 108 105 106 93

24 26 22 21 15 15 14 20 200

200

400

600

800

1000

1200

1400

1600

1800

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

2218 22372010

23162196

1897

2260 21932069

785 790 793 796 800 790 797 802 807

695 713 666 654 660 606 683 654 732

0

500

1000

1500

2000

2500

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

786

768

757753

749 747 745749

755

720

730

740

750

760

770

780

790

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



3349 3412 3227

3746 35843134

3755 3704 3659

905 903 914 920 917 898 902 908 900

719 739 688 675 675 621 697 674 752

0500

1000150020002500300035004000

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


All Diagnosis

MH IDD SUD


44


FYTD March 2019


Service Category


ACTT

ICF




Inpatient

MST

Outpatient

Innovations







Crisis Services



Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition



Residential

PRTF






Community

Psych Rehab

45


FYTD March 2019


physical location.




0

32

42

54

86

75

129

149

128

198

159

513

512

448

801

932

7305

1

28

33

52

78

85

125

133

135

206

225

377

503

540

752

930

7369

0 2000 4000 6000 8000

Community

Community Support

MST


Psych Rehab


IIHS

Partial Hosp/Day Tx

ICF


Crisis Services

Outpatient ED

Innovations


Inpatient


Outpatient



$0

$54,355

$378,899

$2,134,347

$471,262

$1,683,539

$1,112,326

$1,141,898

$14,890,922

$1,750,181

$85,739

$58,514

$21,760,220

$1,558,603

$3,879,575

$919,339

$3,978,441

$21,639

$35,911

$293,798

$1,755,794

$440,059

$2,105,787

$1,088,793

$829,834

$15,425,283

$1,846,088

$220,855

$41,763

$21,918,687

$1,840,904

$3,946,006

$1,009,106

$4,580,123

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

Community

Community Support

MST


Psych Rehab


IIHS

Partial Hosp/Day Tx

ICF


Crisis Services

Outpatient ED

Innovations


Inpatient


Outpatient



46


FYTD March 2019



location.



2

0

0

24

54

262

310

323

516

2358

0

2

2

31

49

235

413

457

489

2374

0 500 1000 1500 2000 2500

IIHS

Community Support

Psych Rehab


Partial Hosp/Day Tx

Residential

Community

Crisis Services

Inpatient

Outpatient



$11,877

$0

$0

$109,896

$68,145

$1,190,781

$1,264,770

$190,420

$3,177,655

$999,830

$0

$6,955

$10,647

$151,626

$51,208

$1,211,261

$1,269,966

$272,567

$2,865,516

$912,046

$0 $1,000,000 $2,000,000 $3,000,000 $4,000,000

IIHS

Community Support

Psych Rehab


Partial Hosp/Day Tx

Residential

Community

Crisis Services

Inpatient

Outpatient



47


FYTD March 2019




Amount.


location.


33

138

53

175

0

50

100

150

200




50

152162

222

0

50

100

150

200

250




$59,957

$21,550

$145,208

$37,773

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000




$81,130

$24,471

$315,734

$43,787

$0

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000




48


FYTD March 2019






LIP Group






Institution










Agency






Clinics




49


FYTD March 2019






North Carolina Baptist Hospital Inpatient



Insight Human Services Agency

Alexander Youth Network, Inc. Agency

Keystone WSNC, LLC dba Old Vineyard Behavioral Health ServicesInpatient

Access Call Center


Top 10 Providers by Members Served - Forsyth Entity Type


5,303 5,665 5,068 6,432 4,916 4,231 5,828 5,116 5,151

5 5 5

45 5

7

13

5

0

2

4

6

8

10

12

14

0

2000

4000

6000

8000

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.1% 2.0% 2.2%1.9% 1.8% 2.2%

2.7%

5.1%

2.3%

0%

2%

4%

6%

8%

10%

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030406283456

167202

448956

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



50


FYTD March 2019





- Outpatient services were the most utilized service in FYTD1819 at 7,369 members served, congruent with FYTD1718.

- Community services were the least utilized service in FYTD1819 at 1 member served, congruent with FYTD1718; the single service utilized by

this member was Developmental Day services.



- ICF services were the second highest expense in FYTD1819 at $15,425,283, congruent with FYTD1718.

- Community services were the least expensive in FYTD1819 at $21,639, commensurate with low utilization.

Other Changes in Utilization and Expense compared to same time period in FYTD1718:

- Crisis Service utilization increased 42% (159 to 225 members) with an increase in expense of 158% ($85,739 to $220,855). Within the crisis

services array, Facility-Based Crisis service increased in utilization by 61% (33 to 53 members) and Mobile Crisis service utilization increased 27%

(138 to 175 members) with Facility-Based Crisis increasing in expense by 142% ($59,956.86 to $145,208.48) and Mobile Crisis service utilization

increasing in expense 76% ($21,549.99 to $37,841.37). Additionally, Rapid Care services cost $35,300 in FYTD1819 whereas no expenses for Rapid

Care services appear in FYTD1718.


- Outpatient services were the most utilized service in FYTD1819 at 2,374 members served, consistent with FYD1718.

- Intensive In Home services were the least utilized service in FYTD1819, with 0 members served; 2 members were served in FYTD1718.


- Inpatient services were the highest expense in FYTD1819 at $2,865,516, but decreased in expense by 10% from FYTD1718.


- Crisis service utilization increased by 41% (323 to 457 members), commensurate with an expense increase of 43% ($190,420 to $272,567).

- Community services utilization increased by 33% (310 to 413) while expense remained consistent. The greatest service increases for Community

services occurred in Peer Support, Supported Employment and Transition to Community Living Services, whereas Day Activity, Personal Care and

Safety Supervision service utilization decreased.

- ACTT utilization increased by 29% (24 to 31 members) with an expense increase of 38% ($109,896 to $151,626).

- Child MH service utilization trended upwards across FYTD1819 while Child IDD and SUD service utilization remained consistent.

- Adult MH, IDD and SUD service utilization remained consistent across FYTD1819.

- The number of members on the Registry of Unmet Needs trended downwards across FYTD1819.

Analysis:



51


FYTD March 2019




- Outpatient services were the most utilized service in FYTD1819 at 2,374 members served, consistent with FYD1718.

- Intensive In Home services were the least utilized service in FYTD1819, with 0 members served; 2 members were served in FYTD1718.


- Inpatient services were the highest expense in FYTD1819 at $2,865,516, but decreased in expense by 10% from FYTD1718.


- Crisis service utilization increased by 41% (323 to 457 members), commensurate with an expense increase of 43% ($190,420 to $272,567).

- Community services utilization increased by 33% (310 to 413) while expense remained consistent. The greatest service increases for Community

services occurred in Peer Support, Supported Employment and Transition to Community Living Services, whereas Day Activity, Personal Care and

Safety Supervision service utilization decreased.

- ACTT utilization increased by 29% (24 to 31 members) with an expense increase of 38% ($109,896 to $151,626).

Medicaid and State funded Facility-Based Crisis and Mobile Crisis increased in both utilization and expense with State funded FBC having the

largest increase: with utilization increasing 224% (50 to 162) and expense increasing 289% ($81,130 to $315,734).



52

Rockingham County Dashboards

FYTD March 2019





Various Community Collaborative-KARTS

Various Community Collaborative-KARTS

53


FYTD March 2019




Various

Various

Total:


70.5%$233,850

75.0%

% Spent

0.0%$10,000

$0$10,000

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.

$0

FYTD

Expenses

$233,850$311,800

Rockingham Funding

0.0%

$331,800

FY Budget

Amount


54


FYTD March 2019



408 415395

449 444

362

456432

468

25 18 25 22 24 18 17 23 25

0 0 1 0 1 1 0 1 10

50

100

150

200

250

300

350

400

450

500

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

686728

620676

624569

725668

637

163 163 168 165 166 165 165 163 163

221 230 206 226194 172

225 204 215

0

100

200

300

400

500

600

700

800

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

118

113

115

114

115

117 117

115

114

110

111

112

113

114

115

116

117

118

119

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



1094 11431015

1125 1068931

11811100 1105

188 181 193 187 190 183 182 186 188221 230 207 226 195 173 225 205 216

0

200

400

600

800

1000

1200

1400

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


All Diagnosis

MH IDD SUD


55


FYTD March 2019


Service Category


ACTT

ICF




Inpatient

MST

Outpatient

Innovations





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.

Crisis Services



Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition



Residential

PRTF






Community

Psych Rehab

56


FYTD March 2019


physical location.




4

17

18

31

31

37

39

39

75

75

57

62

107

177

298

2386

4

12

18

23

32

36

37

40

60

73

80

87

107

178

291

2385

0 500 1000 1500 2000 2500 3000

MST

Community Support



Psych Rehab


ICF

Partial Hosp/Day Tx

IIHS

Outpatient ED

Crisis Services


Innovations

Inpatient


Outpatient



$43,076

$15,628

$829,493

$558,193

$188,502

$338,240

$4,298,474

$360,569

$615,874

$8,127

$42,992

$396,379

$4,113,337

$718,188

$256,120

$1,200,055

$37,881

$24,268

$969,668

$385,123

$201,002

$346,343

$4,116,219

$388,781

$500,507

$8,514

$53,185

$754,166

$4,446,420

$998,832

$256,052

$1,345,641

$0 $1,000,000$2,000,000$3,000,000$4,000,000$5,000,000

MST

Community Support

PRTF (Psychiatric Residential TreatmentFacility)


Psych Rehab


ICF

Partial Hosp/Day Tx

IIHS

Outpatient ED

Crisis Services


Innovations

Inpatient


Outpatient



57


FYTD March 2019



location.



2

0

8

44

102

91

115

735

1

2

5

35

78

95

138

688

0 200 400 600 800

Partial Hosp/Day Tx

Community Support


Community

Inpatient

Residential

Crisis Services

Outpatient



$3,705

$0

$30,131

$372,917

$436,947

$553,054

$60,316

$132,928

$265

$4,229

$11,664

$319,942

$387,864

$538,358

$57,469

$113,019

$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000

Partial Hosp/Day Tx

Community Support


Community

Inpatient

Residential

Crisis Services

Outpatient



58


FYTD March 2019




Amount.


location.


12

51

15

67

0

10

20

30

40

50

60

70

80




29

61

38

88

0

20

40

60

80

100




$29,503

$6,977

$35,848

$9,486

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000




$40,903

$10,895

$64,309

$10,002

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000




59


FYTD March 2019



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

groups.

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

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




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

children.







Agency


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.



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.


60


FYTD March 2019



YOUTH HAVEN SERVICES, LLC Agency

The Moses H. Cone Memorial Hospital Inpatient


Morehead Memorial Hospital Hospital

Neuropsychiatric Care Center, PLLC LIP

Faith in Families, Inc. Agency

Successful Transitions LLC Agency

Triad Psychiatric and Counseling Center, PA LIP Group


Access Call Center


Top 10 Providers by Members Served - RockinghamEntity Type


5,303 5,665 5,068 6,432 4,916 4,231 5,828 5,116 5,151

5 5 5

45 5

7

13

5

0

2

4

6

8

10

12

14

0

2000

4000

6000

8000

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.1% 2.0% 2.2%1.9% 1.8% 2.2%

2.7%

5.1%

2.3%

0%

2%

4%

6%

8%

10%

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030406283456

167202

448956

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



61


FYTD March 2019





- Outpatient services were the highest utilized at 2,385 members served in FYD1819, congruent with FYD1718.

- MST services were least utilized at 4 members served in FYD1819, congruent with FYTD1718.

Trends in Expense in FYD1819:

- Innovations services were the highest expense in FYTD1819 at $4,446,420, with utilization and expense congruent with FYTD1718.

- ICF services were the second highest expense in FYTD1819 at $4,116,219, with utilization and expense congruent with FYTD1718.

- Outpatient ED services were the least expense in FYTD1819 at $8,127, with utilization and expense congruent with FY1718.


- 1915(b)(3) services increased in utilization by 40% (62 to 87 members) and in expense by 90% ($396,379 to $754,166).

- Inpatient utilization remained consistent with FYTD1718, while expense increased by 39% ($718,188 to $998,832).

- BH Long Term Residential service utilization decreased by 26% (31 to 23 members) with a commensurate decrease in expense of 31% ($558,193

to $385,123).


- Outpatient services were the highest utilized in FYTD1819, congruent with FYTD1718.

- Partial Hospitalization/Day Treatment was the least utilized in FYTD1819 at 1 member served, congruent with FYTD1718.


- Residential services were the highest expense in FYD1819 at $538,358, with utilization and expense congruent with FYD1718.

- Inpatient services were the second highest expense in FYTD1819 at $387,864 with a 24% decrease in utilization between FY1718 to FY1819 (102

to 78 members) and an 11% decrease in expense ($436,947 to $387,864).

- Community services were the third greatest expense in FYTD1819 at $319,942 with a 20% decrease in utilization between FYD1718 and

FYTD1819 (44 to 35) and a 14% decrease in expense ($372,917 to $319,942).

- Partial Hospitalization/Day Treatment had the lease expense in FYTD1819 at $265.


- ACTT service utilization decreased by 38% (8 to 5 members) with a 61% decrease in expense ($30,131 to $11,664) between FYTD1718 to

FYTD1819.

- Child MH service utilization trended upwards slightly in FYTD1819, while child IDD and SUD service utilization remained consistent.

- Adult MH service utilization trended downwards slightly in FYD1819, while adult IDD and SUD service utilization remained consistent.

- The number of members on the Registry of Unmet Needs decreased slightly across FYTD1819.

Analysis:



62


FYTD March 2019




- Outpatient services were the highest utilized in FYTD1819, congruent with FYTD1718.

- Partial Hospitalization/Day Treatment was the least utilized in FYTD1819 at 1 member served, congruent with FYTD1718.


- Residential services were the highest expense in FYD1819 at $538,358, with utilization and expense congruent with FYD1718.

- Inpatient services were the second highest expense in FYTD1819 at $387,864 with a 24% decrease in utilization between FY1718 to FY1819 (102

to 78 members) and an 11% decrease in expense ($436,947 to $387,864).

- Community services were the third greatest expense in FYTD1819 at $319,942 with a 20% decrease in utilization between FYD1718 and

FYTD1819 (44 to 35) and a 14% decrease in expense ($372,917 to $319,942).

- Partial Hospitalization/Day Treatment had the lease expense in FYTD1819 at $265.


- ACTT service utilization decreased by 38% (8 to 5 members) with a 61% decrease in expense ($30,131 to $11,664) between FYTD1718 to

FYTD1819.

- For members with Medicaid funding, Facility-Based Crisis and Mobile Crisis increased in both utilization and in expense.

- For members with State funding, Facility-Based Crisis utilization increased 31% (29 to 38 members) and in expense by 57% ($40,903 to

$64,309).

- For members with State funding, Mobile Crisis utilization increased 44% (61 to 88) with a decrease in expense by 8% ($10,895 to $10,002).

While there was an increase in the total number of members served, the average number of units billed per member decreased.



63

Stokes County Dashboards

FYTD March 2019



None


64


FYTD March 2019



Total:


$0

% Spent



FYTD

Expenses

Stokes Funding

$0

FY Budget

Amount


65


FYTD March 2019



216231 238 234 225

209

254 252236

17 19 11 18 14 12 12 13 11

3 4 3 3 3 2 1 1 10

50

100

150

200

250

300

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

267299

253285

256

199

273

237220

89 90 91 91 92 92 91 89 90

90 94 99 97 103 98 98 99 107

0

50

100

150

200

250

300

350

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


MH IDD SUD

82

7877

75

77 7776

7877

70

72

74

76

78

80

82

84

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



483530

491 519481

408

527489

456

106 109 102 109 106 104 103 102 101

93 98 102 100 106 100 99 100 108

0

100

200

300

400

500

600

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19


All Diagnosis

MH IDD SUD


66


FYTD March 2019


Service Category


ACTT

ICF




Inpatient

MST

Outpatient

Innovations







Crisis Services



Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition



Residential

PRTF






Community

Psych Rehab

67


FYTD March 2019


physical location.




3

1

14

9

10

20

18

15

38

35

26

64

60

90

105

973

2

6

9

9

11

15

21

24

31

34

36

41

59

87

103

974

0 200 400 600 800 1000 1200

Community Support

MST



ICF


Psych Rehab


Partial Hosp/Day Tx

Crisis Services

IIHS

Outpatient ED

Innovations

Inpatient


Outpatient



$6,278

$2,319

$93,957

$266,846

$1,243,591

$292,788

$100,663

$19,048

$775,289

$20,892

$246,580

$7,377

$2,199,239

$510,610

$93,120

$583,589

$6,377

$63,394

$93,634

$580,988

$1,358,936

$303,874

$124,598

$81,670

$646,603

$22,143

$297,209

$5,291

$2,213,346

$293,291

$95,614

$698,301

$0 $500,000$1,000,000$1,500,000$2,000,000$2,500,000

Community Support

MST



ICF


Psych Rehab


Partial Hosp/Day Tx

Crisis Services

IIHS

Outpatient ED

Innovations

Inpatient


Outpatient



68


FYTD March 2019



location.



0

4

3

18

32

43

50

295

1

2

4

19

34

34

55

308

0 100 200 300 400

Community Support

Partial Hosp/Day Tx


Residential

Community

Inpatient

Crisis Services

Outpatient



$0

$22,594

$2,592

$81,933

$129,625

$231,187

$19,458

$89,867

$1,057

$3,339

$13,932

$98,831

$124,333

$140,938

$21,175

$110,089

$0 $50,000 $100,000 $150,000 $200,000 $250,000

Community Support

Partial Hosp/Day Tx


Residential

Community

Inpatient

Crisis Services

Outpatient



69


FYTD March 2019




Amount.


location.


6

34

10

21

0

5

10

15

20

25

30

35

40




6

32

16

39

0

5

10

15

20

25

30

35

40

45




$13,503

$7,390

$13,078

$4,915

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000




$7,737$4,709

$34,144

$10,586

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000




70


FYTD March 2019






LIP Group






Institution










Agency






Clinics




71


FYTD March 2019



YOUTH HAVEN SERVICES, LLC Agency






PQA Healthcare, Inc. Agency

Insight Human Services Agency


Access Call Center


Top 10 Providers by Members Served - Stokes Entity Type


5,303 5,665 5,068 6,432 4,916 4,231 5,828 5,116 5,151

5 5 5

45 5

7

13

5

0

2

4

6

8

10

12

14

0

2000

4000

6000

8000

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Spee

d t

o A

nsw

er (

secs

)

# o

f C

alls


2.1% 2.0% 2.2%1.9% 1.8% 2.2%

2.7%

5.1%

2.3%

0%

2%

4%

6%

8%

10%

Jul'1

8

Au

g'18

Sep

'18

Oct

'18

No

v'18

Dec

'18

Jan

'19

Feb

'19

Mar

'19

Per

cen

t o

f C

alls

Ab

and

on

ed



0101010203030406283456

167202

448956

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



72


FYTD March 2019




Trends in Utilization in FYD1819:

- Outpatient services were the most utilized in FYTD1819 at 974 members served, congruent with FYTD1718.

- Community Support services were the least utilized in FYTD1819 at 2 members served, congruent with FYTD1718.



- ICF services were the second highest expense in FYD1819 at $1,358,936, congruent with FYTD1718.


- 1915(b)(3) service utilization increased by 60% (15 to 24 members) with an expense increase of $329% ($19,048 to $81,670). FY1819

demonstrated marked increases in expense for Peer Support services in addition increases in Peer Bridger, Individual Respite, Transitional Living,

Individual Supported Employment, Individual Support Services, and Community Guide.

- MST service utilization increased by 500% (1 to 6 members) and expenses increased by 2,634% ($2,319 to $63,394). This increase in expense

appears only be related to the increase in utilization. No changes in average number of units billed or contract rate occurred.

- While PRTF utilization did not change between FYTD1718 and FYTD1819 at 9 members served in both time periods, expense increased by 118%

($266,846 to $580,988).


- Outpatient services were the most utilized in FYTD1819 at 308 members served, congruent with FYD1718.

- Community Support services were the least utilized in FYD1819 at 1 member served, congruent with FYD1718.


- Inpatient services were the highest expense in FYTD1819 at $140,938, though expenses decreased by 39% from $231,187 in FYTD1718.

Utilization also decreased 21% (43 to 34) between FYTD1718 and FYTD1819.


- ACTT service utilization increased in utilization by 33% (3 to 4 members), but increased 438% in expense ($2,592 to $13,932).

- Partial Hospitalization/Day Treatment utilization decreased by 50% (4 to 2 members) and expenses decreased by 85% ($22,594 to $3,339).

- Child MH service utilization trended upward slightly across FYTD1819 while Child IDD and SUD service utilization remained stable.

- Adult MH service utilization trended downward slightly across FYTD1819 while Adult IDD and SUD service utilization remained stable.

- Number of members on the Registry of Unmet Needs trended downwards across FYTD1819.

Analysis:



73


FYTD March 2019




- Outpatient services were the most utilized in FYTD1819 at 308 members served, congruent with FYD1718.

- Community Support services were the least utilized in FYD1819 at 1 member served, congruent with FYD1718.


- Inpatient services were the highest expense in FYTD1819 at $140,938, though expenses decreased by 39% from $231,187 in FYTD1718.

Utilization also decreased 21% (43 to 34) between FYTD1718 and FYTD1819.


- ACTT service utilization increased in utilization by 33% (3 to 4 members), but increased 438% in expense ($2,592 to $13,932).

- Partial Hospitalization/Day Treatment utilization decreased by 50% (4 to 2 members) and expenses decreased by 85% ($22,594 to $3,339).

- For members with Medicaid funding, Facility-Based Crisis utilization increased by 67% (6 to 10 members) while expense in FYTD1819 remained

consistent with FYTD1718.

- For members with Medicaid funding, Mobile Crisis utilization decreased by 38% (34 to 21 members) with a commensurate expense decrease of

33% ($7,390 to $4,915).

- For members with State funding, Facility-Based Crisis utilization increased by 167% (6 to 16 members) and expenses increased by 341% ($7,737

to $34,144).

- For members with State funding, mobile Crisis utilization increased by 22% (32 to 39 members) and expenses increased by 125% ($4,709 to

$10,586).



74

Triad Community OfficeQuality Management Dashboard

FYTD December 2018

## ##

% Served

14%

Incidents

Medicaid Population - FYTD March 2019

Members

Served

17,732

20,155

13,390

18,218

10,207

% Eligible in

Cardinal

Innovations

Population

25%

33%

19%

23%

12%

Eligible

Population

130,726

174,698Mecklenburg

Five County 14%

103,488

122,804

15%66,183

The number of Level II incidents reported in the Triad catchment area increased by 88% from the previous quarter, with 101 incidents during the 2nd Qtr. of

FY1819, and 190 incidents during the 3rd Qtr. of FY1819. Sixty seven percent (128/190) of the Level II incidents in the 3rd Qtr. of FY1819 were Member

Behavior Incidents.

The volume of incidents reported in Qtr 3 increased over the 2nd Qtr due to a spike in Member Behaviors, which increased by 137% (54 to 128). Aggressive

Behaviors increased by 113% (24 to 51) and AWOL Behaviors increased by 236% (11 to 37).

Report data from June 10th, 2019

Triad

Northern Region

Central

Region

Southern

12%

13%

15%

11%56,621 8,011

44 34 38 43 22 36 75 53 62

5.67

4.30

5.08 5.29

2.80

5.06

9.12

6.55

7.45

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

10.00

0

10

20

30

40

50

60

70

80

Jul'18 Aug'18 Sep'18 Oct'18 Nov'18 Dec'18 Jan'19 Feb'19 Mar'19

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

Level II Incidents Rate/1,000 Members Served

FYTD: July 2018 - March 2019

75


FYTD December 2018

Incidents (continued)

The number of Restrictive Interventions reported in the Triad catchment area during the 3rd Qtr. of FY1819 fell slightly from the previous quarter (12 to 10

Restraints). Eighty Percent (8/10) of Restrictive Interventions were for Child Mental Health members. Of the 10 Level II Restrictive Interventions, 9 were Standing,

and 1 was Supine.

For the 3rd Qtr. of FY1819:

- Level III incidents increased by 16% (25 to 29) with an increase occurring across all categories, which include Abuse/Neglect/Exploitation, Member Behavior,

Member Death, and Member Injury.

- There were 20 Level III Alleged Abuse/Neglect/Exploitation incidents (7 Sexual Abuse, 7 Physical Abuse, 5 Neglect, and 1 Verbal Abuse) There were 5

Substantiated incidents, including 3 Neglect, 1 Physical and 1 Sexual. All Level III Abuse/Neglect/Exploitation incidents were reported to the appropriate

authorities and reviewed by the Quality Management Department.

-There were 4 Level III Member Deaths that consisted of Unknown Cause, Accident, Suicide, and Overdose.

-There were 4 Level III Member Behavior Incidents (2 AWOL Behaviors, 1 Aggressive Behavior, and 1 Illegal Act).

8 12 5 10 10 5 8 9 12

1.03

1.52

0.67

1.231.27

0.70

0.97

1.11

1.44

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

0

2

4

6

8

10

12

14


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

Level III Incidents Rate/1,000 Members Served


5 5 6 6 4 6

1

0.77

0.00

0.670.74 0.76

0.00

0.49

0.74

0.00

0.000.100.200.300.400.500.600.700.800.90

0

1

2

3

4

5

6

7


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

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


76


FYTD December 2018

FYTD1819 in the Triad catchment, 94% (31/33) of the Restrictive Interventions occurred in the CMH population. The ADD population

accounted for 33% (10/30) of the Injury incidents of which the majority were due to Trip/Fall Incidents (70%, 7/10).

92% (210/229) of the incidents reported in the Triad catchment area were received within 3 days of the incident being learned during the 3rd Qtr. of FY1819.

Incidents (continued)

A total of 52% (271/519) of incidents reported during FY1819 were due to Member Behavior, of which 80% (218/271) occurred with the CMH population. In

FYTD1819, 22% (114/519) of incidents reported were due to Abuse, Neglect or Exploitation. The CMH population accounted for 68% (78/114) of the incidents

for this Category, followed by ADD with 17% (19/114).

0

50

100

150

200

250

300

Abuse, Neglect orExploitation

RestrictiveInterventions

Member Behavior Member Death Member Injury Expulsion Fire Medication Error Suspsension

Incidents by Type & Target Population

ADD AMH ASA CDD CMH CSA


77


FYTD December 2018

58 69 200 81 72

Piedmont

Catchment

Mecklenburg

Catchment

Central

Catchment

Five County

Catchment

23

150

2

17

34

Triad

Catchment

21

9

7

29

0

4

2

2

Measure Subcategory

Does Not Apply

12

1

2

57

15

0

Total # Grievances Not Against Provider or MCO

0

Total # of Grievances by

Disability

321

Child

Adult

Unknown

Does Not Apply

Total # Grievances by Age Group

MH Only

IDD Only

SUD Only

Multi-Disability

TBI Only

Unknown

Total # Grievances Against Providers

Total # Grievances Against Cardinal Innovations

0

24

Total # Grievances Resulting in Investigations

14% 41%

0

348

133

0

0

12%

0

Average Days to

Resolve% Resolved within 30

Days

For Resolved Grievances

Total # Grievances Pending

20.3 21.5

5

1

1

13

44

0

0

45

0

99%

21.4

25

1

13 34

3

54

15

39

54

145

55

0

31

1

23

1

4

1

98%

20.7

15%

99.5%

0 0 0

99%

22.3

99%

Grievances - FYTD March 2019

16

12

143

1

4

76

All Grievances

182

99

25

14

6

12

26

11

1

2316

0

5

3

1

47

0

0

20

48

12

57

0

3

4

62

133 49

21.8

100%

0

Total # of Grievances 17%

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

Catchment.

482

7 9 11 7 7 6 7 9 9

0.90

1.14

1.47

0.86 0.89 0.84 0.85

1.11 1.08

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

0

2

4

6

8

10

12


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

Grievances Rate/1,000 Members Served


78


FYTD December 2018

Grievances (continued)

1

2

2

2

3

3

3

5

7

14

0 2 4 6 8 10 12 14 16

Abuse

Lack of Coordination of Benefits

Delay in Treatment

Potential Fraud

Inadequate Treatment

Customer Service (CS) Telephone Responsiveness

Staff Unavailable to Provide Services

Lack of Choice/Provider Availability

Neglect

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

Top 10 Grievances TypesFYTD: March 2019

1

1

1

2

3

3

4

4

5

16

0 2 4 6 8 10 12 14 16 18

Child Adolescents Day Treatment


Facility-Based Crisis Program

Inpatient

Substance Abuse Intensive…

Innovations

Outpatient Services

Assertive Community Treatment Team

Opioid Treatment

Residential Services

Top 10 Services with GrievancesFYTD: March 2019

79


FYTD December 2018

A total of 442 claims were reviewed during the 56 reviews completed during the 3rd Quarter of FY1819.

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 3rd Qtr. of FY1819, 7 providers of the 15 reviewed scored 100%. One provider scored below the 85% target on their NC Provider Monitoring Reviews in

the Triad catchment area.

1

1

1

7

23

5

12

12

1

1

2

1

9

2

9

11

11

3

1

5

5

12

15

15

0 20 40

QCIRC

Justified Cause Audit

POC Follow-up

EOR

Clinical Quality Review

Unlicensed AFL Review

Concern Module

Innovations Annual AFLReview

New Unlicensed SiteReview

Cultural Competency

NC Provider MonitoringReview

Monitoring Reviews

Jul-Sep'18 Oct-Dec'18 Jan-Mar'19

92.2%97.6% 94.3% 95.5% 94.0%

0%

25%

50%

75%

100%

Five County Central Mecklenburg Piedmont Triad

NC Provider Monitoring Review Scores

85% Target

July 2018 - March 2019


80


FYTD December 2018

Provider Monitoring Reviews (All)

Compared to Q1 and Q2, the 3rd Quarter of FY 1819 had a similar volume of paybacks and more POCs. Of the 56 reviews completed during the 3rd Quarter, 27%

required a POC to be completed to bring the provider into compliance, and 14% required a payback. Plans of Correction primarily involved issues with

documentation and staff out of compliance.

87

8

1111

15

0

2

4

6

8

10

12

14

16

Jul-Sep'18 Oct-Dec'18 Jan-Mar'19

Monitoring Review Outcomes

Reviews requiring Paybacks Reviews requiring POC's

July 2018 - March 2019 by

81

Documents

Cardinal Innovations Healthcare - 2019 Triad Community ...€¦ · Community Advisory Board. 2. Opening Remarks. Opening remarks by Leon Inman, Chair. He welcomed the Triad Community