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Message from the CEO - July 2018

Cardinal Innovations Healthcare — July 11, 2018

Wow, a lot has happened since our last member newsletter. As I am sure you are aware, the NC General Assembly recently passed significant legislation that directly impacts our members.

House Bill 403 is the culmination of many years of discussion and debate regarding Medicaid Transformation, and sets forth the framework through which the healthcare of complex populations will be managed in the future.

As expected, the bill outlines the creation of Tailored Plans, and the transition of the current LME/MCOs into Tailored Plans. While there are many details yet to be clarified by the Department, our IDD members and a large subset of our MHSUD members will continue to be served by Cardinal Innovations. In addition to our expertise and network in behavioral healthcare, we will also begin the management of Integrated Care, something Cardinal has long championed for the benefit of our members. Significantly, the bill also currently defines care coordination as a function of the LME/MCOs, and we believe this is of great importance to our members and our teams here working on their behalf.

Shortly after the bill passed, I was in Raleigh with my fellow LME/MCO CEOs for our regular meeting with NC DHHS leadership. The Department shared their intent to launch Tailored Plans in July of 2021, and Secretary Cohen conveyed her support for the LME/MCO system as Medicaid reform moves forward. I left Raleigh energized by the discussion and ideas that were shared, and I am particularly excited about the work Cardinal Innovations is undertaking to become operationally ready to serve our members as a Tailored Plan.

As many of you also know, the budget passed by the legislature makes additional cuts to LME/MCO state-funded service dollars. This is the fourth consecutive year of cuts to state funds; if this trend in reductions continues, there may come a time where we will need to use our collective voices to advocate against further reductions to this resource.

I'd like to take the opportunity this month to also talk about a sometimes difficult topic: “the Registry of Unmet Needs," otherwise known as the Innovations Waiver waitlist. The Innovations Waiver is a health plan for people with intellectual and/or developmental disabilities in North Carolina. It lets people on this health plan receive services and supports in their homes and communities instead of an institution. You can read more about the Innovations Waiver and the waitlist here. Many of you have family, friends or loved ones who have been or are currently on this list. While the number of “slots" on this list are out of our control, the list itself is managed by Cardinal Innovations. When we receive notice that a slot has opened, our teams are poised to get services up and running for that member as soon as possible. For families that have been on the waitlist, this means something that only a few of us can possibly understand.

Our teams recently recognized that people on the Registry waitlist were eligible to receive more b(3) services than they were utilizing. Together our Member Engagement and Registry teams began an initiative to more effectively and personally reach out and engage those on the Registry to get them connected with services while they remain on the Registry. If you are on the Registry of Unmet Needs and want to discuss your options to receive services in the meantime, I urge you to contact us here.

I also wanted to share some data that highlights the successes our MH/SUD Care Coordination team is having around Complex Case Management. Complex Case Management is a set of activities designed to effectively assist members and their caregivers in managing medical conditions and co-occurring psychosocial factors. By using Complex Case Management, our team seeks to stabilize the lives of people with multiple behavioral health and physical health diagnoses who are also dealing with other unrelated issues that can affect their health, such as involvement with the criminal justice system or access to housing.

The last 20 people who successfully “graduated" from our Complex Case Management program, who each spent an average of 384 days in the program, have seen dramatic differences post-discharge.

For example:

  • Before Complex Case Management, 11 of these members spent over 2,500 days in psychiatric residential treatment facilities (PRTFs).
  • After working with our Complex Case Management teams, none of these members have experienced crisis events or returned to PRTFs.
  • Before or during Complex Case Management, 15 of these members had over 100 visits to hospital emergency departments. After working with our Complex Case Management teams, none of these members have visited a hospital emergency department.
  • The last 20 members who successfully completed our Complex Case Management program are averaging over 300 crisis-free days per person.

This program is giving people the appropriate services and supports they need to remain stable and stay out of residential – and emergency – settings. It's a lot of work, but we have proof that it is working, and we plan to keep it up so that our members and their families are served together in their communities.

Lastly, I want to thank each of you for your continued engagement with Cardinal Innovations. Our Board Meeting Schedule for 2018 is now posted on our website, and as you will see, we are traveling around our counties to give as many of you an opportunity to attend our meetings as possible. We are also seeing many more of you sign up to receive this newsletter, which is a great way to learn about topics and events that may be important to you. Please keep reading, and more importantly, keep sending us topic ideas and input, so that this can truly be by you, for you. Enjoy the height of summer, stay cool, and I will see you back here in August!

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