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IDD Town Hall: Medicaid Transformation and County Action Plan

Cardinal Innovations Healthcare — December 10, 2020 — 4 min read
During a virtual town hall on December 7, CEO Trey Sutten was joined by CCO Ashley Conger and COO Dietrick Williams to discuss Medicaid Transformation, county engagement, and more. Hear more in this recorded video:

Medicaid Transformation and the Tailored Plan RFA

Medicaid Transformation is back on track. Trey Sutten begins the town hall with explaining Medicaid Transformation and our role in the State’s transition to integrated health care.

To prepare for Transformation, we are applying to the North Carolina Department of Health and Human Services (NCDHHS) Request for Application (RFA). This application is to become a Behavioral Health and IDD Tailored Plan. Trey talks more about our communication with NCDHHS to get our Tailored Plan application ready to submit before the February deadline.

Before we receive a response from the State, our organization will be making changes to prepare for integrated care. Integrated care is the combination of physical health, behavioral health, and pharmaceutical health services.

County Changes

Trey also discusses the changes in our county engagement, clarifying what issues led to frustrations within some of the counties we serve.

To better serve all our 20 counties, we have created a County Action Plan. Regardless of county engagement or disengagement, our team is focused on improving the experience and care of all our members and their families.

Dietrick Williams describes the main steps of our County Action Plan, which include:
  • Expanding our network of providers, especially to benefit our members in the IDD community
  • Removing administrative barriers (site-specific contracting requirements for therapeutic foster care homes, prior authorization requirements, etc.)
  • Committing to a 72-hour turnaround time for processing treatment authorization requests (TARs)
  • Updating our member resources to improve ease of access
  • Developing a new program to help individuals with mental or behavioral health needs transition out of the emergency room setting
Members, providers, and other stakeholders will get regular updates about this action plan, including information on Cardinal Innovations’ progress with each step.

Robert Wood Johnson Foundation Grant

Ashley Conger shares the exciting news about a three-year grant from the Robert Wood Johnson Foundation. Through the grant and the Center to Advance Consumer Partnership (CACP), we are one of six health plans across the United States chosen to participate in Member Journey Mapping. This process is meant to help us build our organization's culture to better understand our member's experiences.

Since January, we have implemented Member Journey Mapping for 40 members and guardians. This program follows each member through their entire health journey with our organization, from first diagnosis or referral and onward.

Ashley explains the impact this program has had and will continue to have on the way we operate. The Journey Map has helped our team identify what works and doesn’t work for our members during their time with us. Essentially, this program is shifting our focus to “outside in,” which means the member voice will influence how we continue to serve our members and communities.

Answering Questions

The leadership team answers questions regarding the IDD community and our organization as a whole.

When will the State approve or decline the disengagement request?

We will likely receive a final answer around May 2021, based on similar instances in the past.

What will happen to (b)(3) services if counties disengage?

Our hope is that (b)(3) services are considered in whatever transition plan has been created for each county. We will work to support a smooth transition for (b)(3) services, but some service categories are specific to certain LME/MCOs.

How will Cardinal Innovations address the State-funded population who feel left out of changes implemented because of the pandemic?

Appendix K was intended to support this population. Right now, we are limited with behavioral health specialty services, clinicians, and practitioners. To address these needs, we are evolving our staffing model.

How is Cardinal Innovations ensuring that every department is on the same page and avoids information silos?

We are hosting more town halls and increasing communication across the board level. 

Why did it take potential county disengagement and media attention to get Cardinal Innovations to start making changes?

We have been working to improve many of these issues before they received media attention. The grant we received from the Robert Wood Johnson Foundation is one example of this. Member Journey Mapping (which began in January 2020) has helped us better understand what’s important to our members and where we need to make changes.

We also began developing on our new Child Welfare Program in February 2020, months before talks of a potential county disengagement. Our team recognized that there were problems in the program and has been working actively to better operations.

Are we going to move forward with Personal Outcome Measures as a potential basis for value-based funding?


Can you give us more information about the recruitment of qualified health professionals to care for those with unique behavioral health needs?

We have a responsibility to contract with qualified providers who can deliver outstanding services. We want to avoid recruiting by volume and instead recruit professionals who will best serve our members.

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