2019 Piedmont Community Board Meeting...2019/01/17 · • NC Medicaid Transformation Updates State...

2016 Board of Directors Meeting

2019 Piedmont

Community Board

Meeting

January 17, 2019

PIEDMONT COMMUNITY BOARD AGENDA January 17, 2019 Dinner (SERVED AT 6:00 p.m.)

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

Public

Tregg Lindberg, Chair 1 Information

2. Opening Remarks


3. Approval of October 18, 2018 Meeting Minutes

Tregg Lindberg, Chair 3 Action

4. Local CFAC Update

Jean Anderson 6 Information

5. Presentations

A. Community Relations Report

Reid Thornburg 7 Information

B. Network Management Adequacy and Accessibility Analysis

Leslie Gerard 8 Information

C. Community Operations Annual Report

Reid Thornburg 9 Information

D. Corporate Training & Development Annual Report

Revella Nesbit 10 Information

6. Community Updates


7. Closing Remarks


Adjournment


PIEDMONT COMMUNITY BOARD MEMBERS

NAME PHONE EMAIL

Cabarrus County Redella Hedrick (704) 791-8120 [email protected]

Stephen M. Morris (704) 932-5126 [email protected]

Paula Yost (704) 436-2214 [email protected]

Davidson County Scott Craver (336) 474-2624 [email protected]

Keith Wingler (336) 787-3550 [email protected]

Zak Crotts (336) 242-2202 [email protected]

Rowan County Willi Beilfuss, Vice Chair (704) 279-4643 [email protected]

Wilson Cherry (704) 467-5909 [email protected]

Vacant

Stanly County Dale Poplin [email protected]

Bill Lawhon

(704) 982-1900

(704) 773-0155 [email protected]

Vacant

Union County Tregg Lindberg, Chair (704) 200-3280 [email protected]

Michelle Lancaster (704) 283-3656 [email protected]

Hezekiah Anderson (704) 490-0676 [email protected]

CFAC Jean Anderson [email protected]

mailto:[email protected]













PIEDMONT AGENDA ITEM

MEETING DATE: January 17, 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: Tregg Lindberg, Chair, will provide opening remarks.

REQUESTED ACTION: Information Only

ATTACHMENTS: No

2




SUBJECT: Approval of the October 18, 2018 Meeting Minutes

BRIEF SUMMARY: The minutes for the October 18, 2018 Piedmont Community Board Meeting

are attached for approval.

REQUESTED ACTION: Approve the minutes for the October 18, 2018 Piedmont Community Board

Meeting as presented.

ATTACHMENTS: Yes

3

Piedmont Community Board Meeting Minutes October 18, 2018

Members Present: Tregg Lindberg, Chair, Jean Anderson, Willi Beilfuss, Wilson Cherry, Scott Craver,

Redella Hedrick, T. Scott Efird, Dale Poplin, and Keith Wingler

Members Absent: Betty Babb, Judy Klusman, Michelle Lancaster, Stephen M. Morris, and Steve Shell Staff Present: Reid Thornburg, Jill Queen, and Ruth Michel

Guests: None

1. Call to Order – Tregg Lindberg, Chair, called the meeting to order at 6:35 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 Tregg Lindberg, Chair. Tregg Lindberg, Chair, welcomed Community Board Members and guests to the meeting. He welcomed New Community Board Member, Wilson Cherry of Rowan County, to the Piedmont Community Board.

3. Approval of the July, 19, 2018 Meeting Minutes

The minutes from the Thursday, July 19, 2018 Piedmont Community Board meeting were reviewed.

Tregg Lindberg, Chair, motioned to approve the minutes as presented. Jean Anderson seconded the motion.

All in favor. Motion carried.

4. Local CFAC Update

Jean Anderson, CFAC Representative, provided updates to the Community Board on the CFAC Two Day Summit.

5. Special Presentations

A. Community Relations Report Reid Thornburg, Senior Community Executive, presented the Community Relations Report.

B. Annual Fiscal Year County Dashboard Reid Thornburg, Senior Community Executive, reviewed the Annual Fiscal Year County Dashboard.

C. Quality Assurance Annual Performance Improvement Plan

4

Jill Queen, Quality Manager, reviewed the Quality Assurance Annual Performance Improvement Plan.

D. Quality Management Annual Report Jill Queen, Quality Manager, discussed the Quality Management Annual Report.

6. Community Updates

Tregg Lindberg, Chair, requested community updates from the Board. Tregg Lindberg, Chair, announced that Betty Babb of Cabarrus County and Wilson McCubbins of Rowan County has given their resignation as members of the Piedmont Community Board.

7. Closing remarks

Tregg Lindberg, Chair, provided closing remarks.

Tregg Lindberg, Chair, motioned to adjourn the meeting. T. Scott Efird seconded the motion.

All in favor. Motion carried.

Meeting adjourned at 7:40 p.m.

Community Board Clerk Date

5




SUBJECT: Local CFAC Update

BRIEF SUMMARY: Jean Anderson, CFAC Representative, will provide local CFAC updates.

REQUESTED ACTION: Information only

ATTACHMENTS: No

6



MEETING DATE: January 17, 2019 AGENDA ITEM: 5.A.

SUBJECT: Community Relations Report

BRIEF SUMMARY: Reid Thornburg, Senior Community Executive, will present the Community

Relations Report.


ATTACHMENTS: Appendix A

7



MEETING DATE: January 17, 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 17, 2019 AGENDA ITEM: 5.C.

SUBJECT: Community Operations Annual Report

BRIEF SUMMARY: Reid Thornburg, Senior Community Executive, will present

Community Operations Annual Report.


ATTACHMENTS: Appendix C

9



MEETING DATE: January 17, 2019 AGENDA ITEM: 5.D.

SUBJECT: Corporate Training & 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: Tregg Lindberg, Chair, will request community updates from the Community

Board.


ATTACHMENTS: No

11




SUBJECT: Closing Remarks

BRIEF SUMMARY: Tregg Lindberg, Chair, will provide closing remarks.


ATTACHMENTS: No

12


APPENDIX A: Community Relations Report NOTES

13


14

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.

PIEDMONT COMMUNITY BOARD COMMUNITY RELATIONS REPORT

Reid ThornburgSenior Community ExecutiveJanuary 17, 2019


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

January 17, 2019

15


• Piedmont Local Community Initiatives of Interest Cabarrus County

Detention Center Intervention

Davidson County

Domestic Violence/AIP

Rowan County

Community Needs Assessment

Stanly County

SUD Community Planning

Union County

Health Equity Collaborative

January 17, 2019

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.January 17, 2019

• NC Medicaid Transformation Updates

State Standard Plan RFP resulted in six vendors submitting proposals:• Aetna, AmeriHealth, BCBSNC, Carolina Complete Health, MyHealth,

Optima, United Health Care, WellCare State has chosen a contracted enrollment broker (MAXIMUS) for assisting members

with selecting a health plan and a primary care provider. DHHS intends to update stakeholders and public via scheduled webinars,

conference calls, and publications

State anticipates making a decision on MCO regionalization by July 2019

16


• Plans At-A-Glance

Depending on their diagnoses and/or level of need, all NC Medicaid enrollees will be enrolled in a Standard Plan or a BH I/DD Tailored Plan.

January 17, 2019


• Medicaid Transformation Informational Resources:

https://ncdhhs.gov/nc-medicaid-transformation

https://nciom.org/what-is-medicaid-transformation

https://i2icenter.org/category/medicaid-transformation

January 17, 2019

17


• NC Medicaid Transformation Section1115 DemonstrationWaiver

NCDHHS received approval from the federal Centers for Medicare & MedicaidServices (CMS) in October 2018 to implement the transition to Medicaidmanaged care and integrate physical health, behavioral health and pharmacybenefits (“whole person care”).

Provides the Department with the authority to implement Medicaid managed careand allows the Department to incorporate innovative features that require federalwaiver authority into its new managed care delivery system

Key approved waiver provisions: Behavioral Health Integration and TailoredPlans, Opioid Strategy, Healthy Opportunities Pilots(https://files.nc.gov/ncdhhs/SDOH-HealthyOpptys-FactSheet-FINAL-20181114.pdf)

January 17, 2019


COMMUNITY

OPERATIONS

Community Engagement

Community Relations

Member Engagement

Questions

18


APPENDIX B: Network Management Adequacy and

Accessibility Analysis NOTES

19


20


The Network Management Adequacy and Accessiblity Analysis will be distributed at the January 17, 2019 meeting.

21


22


APPENDIX C: Community Operations Annual Report NOTES

23


24

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

25



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

26

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

27


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 9115. 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

28


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 promotionactivities = 498.75 hours

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

• Coaching programs designed to educate individuals on clinically effective methods for dealing with specific chronicdisease 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

29


30


APPENDIX D: Corporate Training and Development

Report NOTES

31


32

January 17, 2019


Corporate Training & Development

Community Board Annual Report

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

Director, Corporate Training & Development

January 17, 2019

33


Cultural Competency

Diversity & Inclusion

Professional Continuing Education Credits

Learning Management System

Centralized Training

January 17, 2019


34

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 17, 2019

35



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 17, 2019

36

Copyright © 2016 Cardinal Innovations Healthcare. All rights reserved.Janurary 17, 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 17, 2019

37


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 17, 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 17, 2019

38



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 17, 2019

39


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 17, 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 17, 2019

40


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 17, 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 17, 2019

41



Centralized Training Model

Member/


Care Coordination

Finance

Service Center

Network

Clinical Operations

Quality Management

Compliance

Provider Training

Employee Training

42


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 17, 2019


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

advantage.”

Jack Welch

January 17, 2019

43


44

Cabarrus County Dashboards

FYTD September 2018

County Funded Program Descriptions

County Funded Program

Advanced Access Funds allocated for the cost associated with Labs and Medications through Daymark Recovery Services in Vance County.

County Funded Program Description

Daymark Funds allocated for the cost associated with Labs and Medications through Daymark Recovery Services in Vance County.

Daymark Medication Assistance

Daymark Mobile Crisis



Daymark FBC Union - Ind Meds

DD Emerg Back up Indigent Meds

45


FYTD September 2018

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

County Funded Programs*

Advanced Access

Daymark

Daymark

Daymark

Daymark

Daymark

Daymark

DD Emerg Back up

Total:

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

22.2%$126,561

25.0%

% Spent

25.0%$63,889

$22,867$137,200

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.

16.7%

$15,972

$32,471

$35,443

$1,674

FYTD

Expenses

$44,471$177,883

Cabarrus Funding

$26,478

$3,887

$6,189

$6,419

$105,911

$15,549

19.1%

16.7%

$570,020

18.1%

25.0%

25.0%

$279

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.

46


FYTD September 2018

Number of Members Served by Age and Diagnosis

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

739811

763

106 108 97

3 7 80

100

200

300

400

500

600

700

800

900

Jul'1

8

Au

g'1

8

Sep

'18

Child Members Served by DiagnosisAges 3 through 17

MH IDD SUD

871 907

805

351 349 352470 479418

0

100

200

300

400

500

600

700

800

900

1000

Jul'1

8

Au

g'1

8

Sep

'18

Adult Members Served by DiagnosisAges 18 and over

MH IDD SUD

144

146

147

142

143

144

145

146

147

148

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.

16101718

1568

457 457 449

473 486 426

0000000000

500

1000

1500

2000

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.

47


FYTD September 2018

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

48


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

3

4

16

15

23

30

36

57

60

61

78

130

143

220

221

2321

5

15

25

27

28

30

44

49

58

60

74

129

135

169

230

2309

0 500 1000 1500 2000 2500

MST

Community Support

PRTF (Psychiatric ResidentialTreatment Facility)

Partial Hosp/Day Tx


Psych Rehab

Crisis Services

IIHS

ICF

ACTT (Assertive CommunityTreatment Team)

Outpatient ED

Inpatient



Innovations

Outpatient

Distinct Members Served - Medicaid Funding

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

$11,093

$7,244

$331,973

$105,632

$261,239

$46,593

$29,888

$271,368

$2,212,886

$203,787

$9,166

$633,969

$118,290

$427,688

$3,072,832

$799,978

$32,478

$35,755

$237,846

$166,273

$325,609

$53,760

$66,891

$241,764

$2,051,798

$197,632

$7,077

$762,155

$122,416

$331,864

$3,469,731

$973,740

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

MST

Community Support

PRTF (Psychiatric Residential Treatment Facility)

Partial Hosp/Day Tx


Psych Rehab

Crisis Services

IIHS

ICF

ACTT (Assertive Community Treatment Team)

Outpatient ED

Inpatient



Innovations

Outpatient

Expenses by Service Category - Medicaid Funding


49


FYTD September 2018


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

location.



0

23

7

36

86

135

147

427

7

10

10

34

94

135

135

486

0 100 200 300 400 500 600

Community Support


Psych Rehab

Inpatient

Residential

Community

Crisis Services

Outpatient

Distinct Members Served - State Funding


$0

$20,412

$13,256

$201,358

$263,276

$176,137

$15,311

$61,528

$12,023

$34,018

$17,524

$191,328

$382,751

$207,385

$6,335

$114,839

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

Community Support


Psych Rehab

Inpatient

Residential

Community

Crisis Services

Outpatient

Expenses by Service Category - State Funding


50


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.


location.


15

2524 23

0

5

10

15

20

25

30

Facility Based Crisis Mobile Crisis Management

Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid


8172

93

44

0

20

40

60

80

100


Distinct Members Receiving FBC & MCM Crisis ServicesState


$26,142

$3,746

$62,491

$4,399

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000


Expenses by FBC & MCM Crisis ServiceMedicaid


$138,146

$11,376

$159,405

$4,915

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000

$160,000

$180,000


Expenses by FBC & MCM Crisis ServiceState


51


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.

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.

52


FYTD September 2018

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

The Charlotte - Mecklenburg Hospital Authority dba NorthEast Psychiatric Services, CHSInpatient/Outpatient

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

McLeod Addictive Disease Center, Inc. Agency

Center For Emotional Health, P.C. LIP Group

RHA Behavioral Health NC LLC Comprehensive Community Clinics

Carolinas Medical Center-Main (FAC) Inpatient

Monarch Comprehensive Community Clinics

The Arc of North Carolina, Incorporated Agency

Turning Point Homes, Inc. Agency

West Counseling, PLLC LIP Group

Access Call Center

Top 10 Providers by Members Served - Cabarrus Entity 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.

53


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


Medicaid funded Outpatient services continued to be the highest utilized service for 1st Qtr FY1819. Innovations had the highest expense

($3,469,731) followed by ICF ($2,051,798). Community Support had the largest increase in utilization of 275% (4 to 15) and in expense of 394%

($7,244 to $35,755). There were an additional 3 providers who provided Community Support services for 1st Qtr FY1819 when compared to the 1st

Qtr FY1718.

State funded Outpatient services were the highest utilized service for 1st Qtr FY1819. Residential services had the highest expense with an increase

of 45% ($263,276 to $382,751) when compared to 1st Qtr FY1718. State funded Community services had the second highest expense ($207,385)

followed by Inpatient ($191,328). ACTT services decreased in utilization by 57% (23 to 10) but increased by 67% in expense ($20,412 to $34,018)

for 1st Qtr FY1819. The same provider provided services for both 1st Qtr FY1718 and FY1819.

Medicaid and State funded Facility Based Crisis increased both in utilization and in expense for 1st Qtr FY1819. Medicaid Facility Based Crisis had

the largest increase in utilization of 60% (15 to 24) and in expense of 139% ($26,142 to $62,491). Medicaid and State funded Mobile Crisis

Management decreased in utilization with State funded Mobile Crisis Management having the largest percentage decrease of 39% (72 to 44) and in

expense of 57% ($11,376 to $4,915).

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

MH Child members served have been increasing whereas, MH Adult members served have been decreasing for 1st Qtr 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.

54

Davidson County Dashboards

FYTD September 2018




Family Services of DavidsonPsychiatric service offering individuals additioal hours of access to a clinican for addressing behavioral health needs. The service includes addressing the needs of

indiviudals who present for care as uninsured/underinsured (part time nurse practitioner)

Monarch Indigent Meds









56


FYTD September 2018



Advanced Access

Daymark

Daymark

Daymark

Daymark

Daymark

Daymark

DD Emerg Back up

Family Services of Davidson

Monarch

Total:


FY Budget

Amount

0.0%$0$15,000

16.7%

$709,200

25.0%

18.1%

19.1%

-4.2%

$331

-$3,125

$18,957

$18,455

$29,680

$1,987

FYTD

Expenses

$76,516$306,064

Davidson Funding

$7,618

$7,345

$4,614

$7,420

$42,066

$38,537

25.0%

25.0%

% Spent

25.0%$75,827

$17,764$106,584



16.7%

$75,000

$137,440 19.4%


57


FYTD September 2018

Registry of Unmet Needs


Number of Members Served All Age and All Diagnosis

532579 592

80 77 75

7 6 80

100

200

300

400

500

600

700

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

836 853

739

287 287 285350 354 337

0

100

200

300

400

500

600

700

800

900

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

109

110 110

108

109

110

111

Jul'1

8

Au

g'1

8

Sep

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



1368 14321331

367 364 360

357 360 345

0000000000200400600800

1000120014001600

Jul'1

8

Au

g'1

8

Sep

'18


All Diagnosis

MH IDD SUD


58


FYTD September 2018


Community

Psych Rehab

Residential

PRTF







Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition





inpatient facility.

Crisis Services


ACTT

ICF



interventions.

Inpatient

MST

Outpatient

Innovations




Service Category


59


FYTD September 2018



location.



3

11

17

26

21

29

37

37

78

51

60

96

108

157

174

1927

4

16

19

20

29

33

33

41

45

48

57

101

107

163

185

1916

0 500 1000 1500 2000 2500

Community Support


MST


Partial Hosp/Day Tx

IIHS

Psych Rehab

Crisis Services

Outpatient ED


ICF


Inpatient


Innovations

Outpatient



$8,138

$246,858

$119,243

$208,055

$151,278

$147,949

$62,719

$26,387

$9,017

$175,600

$1,983,612

$196,189

$572,312

$127,560

$2,331,584

$617,711

$10,383

$362,956

$123,709

$216,609

$141,959

$140,227

$72,923

$52,929

$4,813

$156,809

$1,784,902

$199,099

$460,444

$130,639

$2,503,637

$639,921

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

Community Support


MST


Partial Hosp/Day Tx

IIHS

Psych Rehab

Crisis Services

Outpatient ED


ICF


Inpatient


Innovations

Outpatient



60


FYTD September 2018





location.

0

1

1

15

74

72

107

65

443

1

1

2

17

68

73

80

138

539

0 100 200 300 400 500 600

Community Support

Partial Hosp/Day Tx

Psych Rehab


Residential

Community

Inpatient

Crisis Services

Outpatient



$0

$1,323

$4,334

$33,694

$204,268

$127,014

$423,602

$25,918

$51,476

$263

$132

$4,979

$52,486

$271,258

$161,314

$280,536

$14,641

$55,192

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

Community Support

Partial Hosp/Day Tx

Psych Rehab


Residential

Community

Inpatient

Crisis Services

Outpatient



61


FYTD September 2018


location.





Amount.

9

35

17

27

0

5

10

15

20

25

30

35

40




2329

92

43

0

20

40

60

80

100




$19,926

$6,462

$45,457

$4,193

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000




$30,987

$4,124

$173,246

$5,946

$0

$50,000

$100,000

$150,000

$200,000




62


FYTD September 2018







Clinics








Agency

Senate Bill 163




Institution







oversight required.





LIP Group

63


FYTD September 2018




Lorven Child & Family Development, LLC LIP

Nazareth Children's Home, Inc Agency


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

Daymark - Davidson Crisis Center Agency

Novant Medical Group, Inc. dba Rowan Psychiatric Associates Hospital

Therapeutic Alternatives, Inc. Agency

The Workshop of Davidson, Inc. Agency

Top 10 Providers by Members Served - Davidson Entity Type


Access Call Center

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


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



0101010203030407282937

146191

415868

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



64


FYTD September 2018






Analysis:




Medicaid funded Outpatient services were the highest utilized services for 1st Qtr FY1819. Innovations had the highest expense ($2,503,637)

followed by ICF ($1,784,902). Outpatient ED services had the largest decrease in utilization of 42% (78 to 45) with a 47% decrease in expense

($9,017 to $4,813). PRTF had the largest percentage increase in utilization of 45% (11 to 16) with a 47% increase in expense ($246,858 to

$362,956).

State funded Outpatient sevices had the highest utilization with a 22% increase (443 to 539) for 1st Qtr FY1819. Inpatient services had the highest

expense of $280,536, however, this was a 34% decrease ($423,602 to $280,536) because utilization dropped by 25% (107 to 80) when compared to

1st Qtr FY1718. Crisis services utilization had the highest percentage increase of 112% (65 to 138). State funded Residential services had the second

highest expense of $271,258.

Medicaid and State funded Facility Based Crisis increased in both utilization and expense for 1st Qtr FY1819. State funded Facility Based crisis had

the largest increase in utilization of 300% (23 to 92) with a 459% increase in expense ($30,987 to $173,246). State funded Mobile Crisis

Management had a 48% (29 to 43) increase in utilization with a 44% ($4,124 to $5,946) increase in expense.


MH Child members served have been increasing and MH Adult members served have been on a downward trend for 1st Qtr FY1819. Child and

Adult IDD and SUD have remained consistent.

65

Rowan County Dashboards

FYTD September 2018












66


FYTD September 2018



Advanced Access

Daymark

Daymark

Daymark

Daymark

Daymark

Daymark

DD Emerg Back up

Total:


FY Budget

Amount

16.7%

$492,000

18.1%

25.0%

25.0%

$211

$12,090

$24,577

$26,827

$1,267

FYTD

Expenses

$48,798$195,191

Rowan Funding

$20,041

$2,942

$4,685

$4,858

$80,164

$11,769

19.1%

25.0%

% Spent

25.0%$48,358

$17,308$103,847



16.7%

$110,932 22.5%


67


FYTD September 2018




606660 681

83 86 84

14 20 180

100

200

300

400

500

600

700

800

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

903 937

787

279 276 270443 448 432

0

100

200

300

400

500

600

700

800

900

1000

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

69

67 67

66

67

68

69

70

Jul'1

8

Au

g'1

8

Sep

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



1509 15971468

362 362 354457 468 450

0000000000

500

1000

1500

2000

Jul'1

8

Au

g'1

8

Sep

'18


All Diagnosis

MH IDD SUD


68


FYTD September 2018


Community

Psych Rehab

Residential

PRTF







Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition





inpatient facility.

Crisis Services


ACTT

ICF



interventions.

Inpatient

MST

Outpatient

Innovations




Service Category


69


FYTD September 2018



location.



7

6

20

23

23

33

58

52

31

58

112

150

172

149

200

2475

5

8

18

23

25

34

48

52

53

57

82

120

122

161

201

2307

0 500 1000 1500 2000 2500 3000

Community Support

MST


Partial Hosp/Day Tx


Psych Rehab

Crisis Services


IIHS

ICF

Outpatient ED

Inpatient


Innovations


Outpatient



$19,536

$29,731

$250,067

$141,901

$210,528

$65,901

$43,718

$161,669

$158,535

$1,922,148

$15,357

$714,458

$145,520

$2,158,756

$466,255

$876,761

$10,433

$55,664

$347,851

$112,259

$296,247

$69,835

$51,151

$171,713

$245,194

$1,898,679

$10,148

$376,766

$107,327

$2,281,827

$450,993

$907,631

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

Community Support

MST


Partial Hosp/Day Tx


Psych Rehab

Crisis Services


IIHS

ICF

Outpatient ED

Inpatient


Innovations


Outpatient



70


FYTD September 2018





location.

0

6

11

37

65

80

92

423

1

4

9

45

68

88

101

394

0 100 200 300 400 500

Community Support

Psych Rehab


Residential

Inpatient

Community

Crisis Services

Outpatient



$0

$10,749

$37,582

$82,963

$233,644

$91,861

$9,118

$14,184

$1,449

$6,450

$28,122

$142,480

$232,045

$140,342

$5,456

$35,331

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

Community Support

Psych Rehab


Residential

Inpatient

Community

Crisis Services

Outpatient



71


FYTD September 2018


location.





Amount.

25

38

21

32

0

5

10

15

20

25

30

35

40




61

40

73

39

0

10

20

30

40

50

60

70

80




$38,204

$4,537

$47,543

$3,609

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000




$90,783

$5,637

$121,638

$5,396

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000




72


FYTD September 2018







Clinics








Agency

Senate Bill 163




Institution







oversight required.





LIP Group

73


FYTD September 2018



Rowan Psychiatric and Medical Services, PA LIP Group


Natalie Errante, PMH-NP LIP

Nazareth Children's Home, Inc Agency




Rowan Regional Medical Center, Inc. dba Novant Health Rowan Medical CenterHospital


Top 10 Providers by Members Served - Rowan Entity Type


Access Call Center

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


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



0101010203030407282937

146191

415868

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



74


FYTD September 2018






Analysis:




Medicaid funded Outpatient services were the highest utilized services for 1st Qtr FY1819. Innovations had the highest expense of $2,281,827

followed by ICF of $1,898,679. Inpatient services had the largest percentage decrease in expense of 47% ($714,458 to $376,766) with only a 20%

decrease in utilization (150 to 120).

State funded Outpatient services had the highest utilization for 1st Qtr FY1819. Inpatient had the highest expense of $232,045. Residential had the

second highest expense of $142,480 with a 22% increase in utilization (37 to 45) and a 72% increase in expense ($82,963 to $142,480).

Medicaid funded Facility Based Crisis slightly decreased in utilization but increased in expense from $38,204 to $47,543. State funded Facility Based

Crisis increased in utilization by 20% (61 to 73) and in expense by 34% ($90,783 to $121,638) for 1st Qtr FY1819. State funded Mobile Crisis

Management remained fairly consistent in utilization and expense; however, Medicaid funded Mobile Crisis Management slightly decreased in

utilization by 16% (38 to 32) and in expense by 20% ($4,537 to $3,609).


Child MH members served have been increasing, whereas Adult MH members served have been decreasing for 1st Qtr FY1819.

75

Stanly County Dashboards

FYTD September 2018




Monarch Indigent Meds









76


FYTD September 2018



Advanced Access

Daymark

Daymark

Daymark

Daymark

Daymark

Daymark

DD Emerg Back up

Monarch

Total:


FY Budget

Amount

-4.2%-$1,042$25,000

16.7%

$205,160

25.0%

18.1%

19.1%

$87

$4,968

$4,836

$26,690

$520

FYTD

Expenses

$20,801$83,202

Stanly Funding

$1,996

$1,925

$1,209

$6,672

$11,023

$10,099

25.0%

25.0%

% Spent

25.0%$19,870

$3,987$23,920



16.7%

$40,602 19.8%


77


FYTD September 2018




230 237

202

18 24 21

4 6 30

50

100

150

200

250

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

533 527

453

139 137 140179 168 149

0

100

200

300

400

500

600

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

47 47

45

44

45

46

47

48

Jul'1

8

Au

g'1

8

Sep

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



763 764655

157 161 161183 174 152

0000000000

200

400

600

800

1000

Jul'1

8

Au

g'1

8

Sep

'18


All Diagnosis

MH IDD SUD


78


FYTD September 2018


Community

Psych Rehab

Residential

PRTF







Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition





inpatient facility.

Crisis Services


ACTT

ICF



interventions.

Inpatient

MST

Outpatient

Innovations




Service Category


79


FYTD September 2018



location.



2

1

4

1

11

6

23

19

25

42

63

41

45

71

76

1047

1

1

1

3

4

5

10

20

24

38

48

51

68

69

76

976

0 200 400 600 800 1000 1200

Community Support

MST


Partial Hosp/Day Tx

IIHS


Crisis Services

Psych Rehab

ICF


Inpatient

Outpatient ED



Innovations

Outpatient



$5,597

$5,481

$78,310

$7,915

$55,255

$48,070

$18,151

$40,663

$851,346

$132,834

$278,446

$5,177

$96,011

$70,740

$1,258,014

$272,518

$1,715

$10,051

$253

$24,123

$15,234

$47,350

$14,225

$48,448

$885,832

$124,735

$116,169

$5,554

$201,376

$77,986

$1,232,565

$257,797

$0 $400,000 $800,000 $1,200,000

Community Support

MST


Partial Hosp/Day Tx

IIHS


Crisis Services

Psych Rehab

ICF


Inpatient

Outpatient ED



Innovations

Outpatient



80


FYTD September 2018





location.

7

18

29

34

51

42

345

5

11

17

39

49

57

301

0 100 200 300 400

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient



$10,135

$29,159

$103,006

$48,119

$252,673

$4,026

$20,274

$11,811

$37,258

$73,602

$68,975

$243,543

$2,131

$31,348

$0 $50,000 $100,000 $150,000 $200,000 $250,000 $300,000

Psych Rehab


Inpatient

Community

Residential

Crisis Services

Outpatient



81


FYTD September 2018


location.





Amount.

9

19

67

0

5

10

15

20




17

24

37

26

0

5

10

15

20

25

30

35

40




$14,404

$3,746

$13,125

$1,100

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000




$26,855

$4,193

$62,237

$5,156

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000




82


FYTD September 2018







Clinics








Agency

Senate Bill 163




Institution







oversight required.





LIP Group

83


FYTD September 2018





Veleka Y. Barbee Therapy Services, Inc. LIP Group


Western Carolina Emergency Physicians, PLLC Physician's Group of Hospitals

Creative Counseling and Learning Solutions, PLLC LIP Group

RHA Behavioral Health NC LLC Comprehensive Community Clinics

Easter Seals UCP North Carolina & Virginia, Inc. Agency


Top 10 Providers by Members Served - Stanly Entity Type


Access Call Center

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


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



0101010203030407282937

146191

415868

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



84


FYTD September 2018






Analysis:




Medicaid funded Outpatient services had the highest utilization with a slight decrease (1047 to 976) for 1st Qtr FY1819 when compared to same

quarter FY1718. Innovations had the highest expense of $1,232,565 followed by ICF of $885,832. PRTF had the largest decrease in expense of 99%

($78,310 to $253) with only one provider providing services for this quarter compared to 11 providers from the previous quarter of FY1718.

State funded Outpatient services were the highest utilized services for 1st Qtr FY1819 and Residential services had the highest cost of $243,543.

Inpatient services had the largest decrease in utilization of 41% (29 to 17) and in expense of 29% ($103,006 to $73,602).

Medicaid funded Facility Based Crisis and Mobile Crisis Management decreased in both utilization and expense. Medicaid funded Mobile Crisis

Management had the largest percentage decrease in utilization of 63% (19 to 7) and in expense of 71% ($3,746 to $1,100). State funded Facility

Based Crisis and Mobile Crisis Management both increased in utilization and expense with Facilty Based Crisis having the largest percentage

increase in utilization of 118% (17 to 37) and in expense of 132% ($26,855 to $62,237).


Child MH and Adult MH members served have been on a downward trend for 1st Qtr FY1819.

85

Union County Dashboards

FYTD September 2018


County Funded Program County Funded Program Description

86


FYTD September 2018



Total:


$0

% Spent



FYTD

Expenses

Union Funding

$0

FY Budget

Amount


87


FYTD September 2018


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

683 704

819

110 118 116

8 12 80

100

200

300

400

500

600

700

800

900

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

657 646597

339 337 334

242 238 243

0

100

200

300

400

500

600

700

Jul'1

8

Au

g'1

8

Sep

'18


MH IDD SUD

160

159 159

158

159

160

161

Jul'1

8

Au

g'1

8

Sep

'18

Nu

mb

er o

f M

emb

ers

on

Reg

istr

y



1340 1350 1416

449 455 450

250 250 251

0000000000200400600800

1000120014001600

Jul'1

8

Au

g'1

8

Sep

'18


All Diagnosis

MH IDD SUD


88


FYTD September 2018


Service Category


ACTT

ICF



interventions.

Inpatient

MST

Outpatient

Innovations






inpatient facility.

Crisis Services



Community Support





Outpatient ED

Partial Hosp/Day Tx


IIHS

Definition



Residential

PRTF






Community

Psych Rehab

89


FYTD September 2018


location.




1

3

0

21

19

29

43

33

34

34

46

58

101

147

111

239

2037

0

2

8

19

20

26

29

32

33

33

44

55

87

105

137

248

1921

0 500 1000 1500 2000 2500

Residential

Community Support

MST



Partial Hosp/Day Tx

Crisis Services

Psych Rehab


IIHS

ICF

Outpatient ED

Inpatient



Innovations

Outpatient



$7,256

$4,182

$0

$408,733

$167,696

$192,025

$42,645

$81,225

$117,282

$187,970

$1,418,792

$8,346

$456,783

$170,130

$161,909

$2,894,300

$746,584

$0

$429

$53,791

$367,337

$178,834

$213,747

$49,638

$85,123

$114,367

$156,249

$1,388,204

$5,023

$469,583

$98,882

$281,573

$3,030,512

$782,432

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

Residential

Community Support

MST



Partial Hosp/Day Tx

Crisis Services

Psych Rehab


IIHS

ICF

Outpatient ED

Inpatient



Innovations

Outpatient



90


FYTD September 2018



location.



6

9

24

50

67

147

426

3

8

30

40

63

144

429

0 100 200 300 400 500

Psych Rehab


Inpatient

Residential

Community

Crisis Services

Outpatient



$7,218

$23,975

$104,444

$165,632

$105,953

$11,959

$18,414

$2,522

$25,919

$143,475

$198,044

$95,895

$7,341

$44,993

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

Psych Rehab


Inpatient

Residential

Community

Crisis Services

Outpatient



91


FYTD September 2018




Amount.


location.


19

32

19

12

0

5

10

15

20

25

30

35




89

48

111

27

0

20

40

60

80

100

120




$34,687

$4,331

$45,926

$3,712

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

$50,000




$156,813

$6,393

$175,067

$4,777

$0

$50,000

$100,000

$150,000

$200,000




92


FYTD September 2018






LIP Group


oversight required.Senate Bill 163




Institution










Agency






Clinics




93


FYTD September 2018




Thrive Counseling Services, PLLC LIP Group


InReach, Inc. Agency


DAYMARK Recovery Services, Inc. - CRC Unit - Union County Agency

Developmental Disabilities Resources, Inc. Agency


Union Family Services, PLLC LIP Group

Access Call Center

Top 10 Providers by Members Served - Union Entity Type


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


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



0101010203030407282937

146191

415868

0 200 400 600 800 1000

Other


County Agency






Inpatient


Hospital

LIP Group

LIP

Agency

Total Providers



94


FYTD September 2018






Medicaid funded Outpatient services continue to be the most utilized services for 1st Qtr FY1819. Emergency Department services decreased in

utilization by 29% (147 to 105) with a 42% ($170,130 to $98,882) increase in expense. Innovations had the highest expense of $3,030,512 followed

by ICF with an expense of $1,388,204. For 1st Qtr FY1718, no members received MST; however, 8 members received this service in 1st Qtr FY1718.

State funded Outpatient services continue to be the most utilized services for 1st Qtr FY1819. Residential services had the highest expense of

$198,044 followed by Inpatient of $143,475 with both services having increases in expense when compared to same quarter of FY1718.

Medicaid funded Facility Based Crisis utilization remained consistent, whereas State funded Facility Based Crisis increased in utilization by 25% (89

to 111) and in expense by 12% ($156,813 to $175,067). Medicaid and State funded Mobile Crisis Management both had decreases in utilization

with Medicaid Mobile Crisis Management having the largest percentage decrease in utilization of 63% (32 to 12) and only a 14% decrease in

expense ($4,331 to $3,712).


Child MH members served have been increasing while Adult MH members served have been decreasing for 1st Qtr FY1819.

Analysis:




95

Piedmont Community OfficeQuality Management Dashboard

FYTD September 2018

## ##

% Served

Report data from November 29, 2018

Southern

Mecklenburg

Triad

Northern Region

Central

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

10%

Incidents

The number of Level II incidents in the Piedmont catchment area for the 1st Qtr. of FY1819 decreased 19% (254 to 207) compared with the 4th Qtr. of FY1718.

Level II Incidents involving Member Behavior were the most prevalent for the 4th Qtr. of FY1718 (53% - 109/207), but with a decrease of 27% (150 to 109) over

the previous quarter, this category also accounted for the majority of the decrease in Level II incidents overall. There was also a 54% (50 to 23) decrease with the

category AWOL >3 Hours from the 4th Qtr. of FY1718 to the 1st Qtr. of FY1819.

NOTE: Starting in December of 2017, any Abuse/Neglect/Exploitation incident naming a staff member was automatically classified as Level 3. As a result, the

number of Level 2 incidents decreased, and the number of Level 3 incidents increased, even though the combined number of incidents remained consistent.

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

73 80 54

7.237.68

5.42

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

0

50

100

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

97


FYTD September 2018

Incidents (continued)

Level III Incidents reported in the Piedmont catchment area in the 1st Qtr. of FY1819 remained consistent (from 45 to 43) compared to the previous quarter (4th

Qtr. of FY1718). Abuse, Neglect, and Explotiation accounted for 63% (27/43) of the Level III Incidents in the 1st Qtr. of FY1819, of which 30% (8/27) were

Alleged Emotional Abuse Incidents. One Incident involved 6 members, which resulted in 6 of the 8 Alleged Emotional Abuse Incidents. During the 1st Qtr. of

FY1819 there was 1 Incident of Substantiated Physical Abuse, 1 Incident of Substantiated Sexual Abuse/Assault/Rape, and 1 Incident of Substantiated Neglect. All

3 of these Incidents received QM intervention, and 2 of them resulted in staff termination. There were 24 Level III Alleged Abuse, Neglect, and Exploitation

Incidents for the 1st Qtr. of FY1819 (8 Emotional Abuse, 7 Physical Abuse, 5 Sexual Abuse, 2 Exploitation, 1 Verbal abuse, and 1 Neglect). There were 11 Level III

Member Deaths (9 Unknown Cause, 1 Accident, and 1 Homicide) Of the rest of the Level III Incidents were 4 Member Behaviors (2 Illegal Acts, 1 Aggressive

Behavior, and 1 Suicide Attempt), and 1 Member Injury (Suicide Attempt).

The number of Restrictive Interventions reported in the Piedmont catchment area decreased 35% (110 to 72) from the 4th Qtr. of FY1718 to the 1st Qtr. of

FY1819. Of the 72 Level II Restrictive Interventions, all were Physical Restraint (51 Standing, 21 Seated). Three were no Level III Restrictive Intervention

reported during the 1st Qtr.

24 10 9

2.38

0.96 0.90

0.00

0.50

1.00

1.50

2.00

2.50

0

5

10

15

20

25

30


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

Level III Incidents Rate/1,000 Members Served


18 24 30

1.78

2.30

3.01

0.00

1.00

2.00

3.00

4.00

0

10

20

30

40


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

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


98


FYTD September 2018

35% (113/322) of the Incidents reported were due to Member Behavior, of which 59% (67/113) occurred with the CMH population. 15% (47/322) of the

Incidents reported were due to Abuse,Neglect, and Exploitation of which 49% (23/47) also occurred with the CMH population.

Incidents (continued)

86% (278/322) of the Incidents reported in the Piedmont catchment area were received within 3 days of learning of the incident during the 1st Qtr. of FY1819.

There were 3 incidents reported in the Piedmont catchment area during FY1819 that did not have a target population listed: 2 Member Behavior, and 1 Injury.

88% (23/26) of the Medication Errors occurred with the ASA population. 85% (22/26) of the Medication Errors in the 1st Qtr. Of FY1819 were due to

Medication Refusals, and Suboxone was the medication for 100% (22/22) of these refusals.

0

20

40

60

80

100

120

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


99


FYTD September 2018

15 24 66 33 27

All grievances were resolved in 30 days in the Piedmont Catchment area.

20

In the Piedmont catchment area, the number of Grievances reported remained consistent (34 to 33) from the 4th Qtr. Of FY1718to the 1st Qtr. of FY1819.

0

16%

100.0%

0 0 0

100%

21.3

100%

20.8

14%

0

4

0

20

0

1

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

39% 20%

20.6

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

100%

0

1

0

01

0

22.5

11

0

1

21

6

0

13

1

17

7

13

16

50

20

Total # of Grievances

Total # Grievances Against Providers

Total # Grievances Against Cardinal Innovations

0

100%

21.4

168

Total # Grievances Resulting in Investigations

1

8

100%

18.5

0

11

4

0

122

46

2

0

0

4

11

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

For Resolved Grievances

Total # Grievances Pending

0

Piedmont

Catchment

Mecklenburg

Catchment

Central

Catchment

Five County

Catchment

13

53

2

6

15

Triad

Catchment

8

2

3

11

0

2

1

2

0

1

0

11

12 14 7

1.19

1.34

0.70

0.00

0.50

1.00

1.50

0

2

4

6

8

10

12

14

16


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

Grievances Rate/1,000 Members Served


100


FYTD September 2018

Grievances (continued)

4

5

6

6

6

7

7

8

10

33

0 5 10 15 20 25 30 35

Neglect

Confidentiality/HIPAA violation by Provider/Facility

Inadequate Treatment

Potential Fraud

Complaint Against Department

Customer Service (CS) Telephone Responsiveness

Individual Budget Tool

Lack of Coordination of Benefits

Delay in Treatment

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

Top 10 Grievances TypesFYTD: September 2018

3

3

3

5

5

6

8

10

26

37

0 5 10 15 20 25 30 35 40

Medication Administration

Assertive Community Treatment Team

Respite

Inpatient

Child Adolescents Day Treatment

Intensive In-Home Services

Peer Support Services

Outpatient Services

Innovations

Residential Services

Top 10 Services with GrievancesFYTD: September 2018

101


FYTD September 2018

During the 1st Qtr. Of FY1819, there were 837 claims reviewed in the Piedmont 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, 11 providers of the 19 reviewed in the Piedmont catchment area scored 100%. Zero providers scored below 85% during the 1st Qtr. of

FY1819.

1

1

2

2

4

15

15

17

19

26

0 20 40

Justified Cause Audit

Grievance Module

Self-Audit

Unlicensed AFL Review

Clinical Quality Review

Concern Module

New Unlicensed SiteReview

Cultural Competency

NC Provider MonitoringReview

Innovations Annual AFLReview

Monitoring Reviews

Jul-Sep'17

98.8% 99.0%92.8% 97.5%

90.9%

0%

25%

50%

75%

100%

Five County Central Mecklenburg Piedmont Triad

NC Provider Monitoring Review Scores

85% Target

July 2018 - September 2018

July 2018 - September 2018

102


FYTD September 2018

Provider Monitoring Reviews (All)

Compared to the previous quarter, the number of Reviews Requiring POC's in the Piedmont catchment area decreased by 13% (23 to 20), while the number of

Reviews requiring paybacks decreased by 56% (18 to 8). Three providers were responsible for 71% (32/45) of the claims involving paybacks, and all three were the

result of NC Provider Monitoring Reviews.

8

20

0

10

20

30

Jul-Sep'18

Monitoring Review Outcomes

Reviews requiring Paybacks Reviews requiring POC's

FYTD: July 2018 - September 2018 by Quarter

103


FYTD September 2018

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

Provider Monitoring Reviews - Paybacks

46% of the paybacks identified in FYTD1819have been recouped thus far. There are three providers responsible for the Paybacks yet to be recouped in the 1st

Qtr. of FY1819, and one provider is responsible for 53% ($876.05/$1,651.42) of the total yet to be recouped.

$3,494.48

$3,494.48

$1,417.48

$3,068.90

$0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000

Amount Recouped

Identified Payback

Amount Recouped

Identified Payback

FY

1718

FY

1819

Payback Amounts from Post Payment Reviews

Jul-Sep

104

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