Innovation and Specialization

​While it is important to set standards of accountability that apply broadly throughout our network of care, it is also important to ensure specialized and innovative care is available for specific population subsets. Effective behavioral health interventions are often not "one-size-fits-all."  Access to specialized interventions is vital for high-risk and/or high-cost populations. We will further review how Cardinal Innovations discovers and manages special needs populations elsewhere, but briefly we prioritize intensive interventions and monitoring for three population subsets:​

  • Members transitioning from high to lower levels of care (e.g., inpatient to outpatient or residential to community)
  • Members with complex comorbidities (e.g., dual diagnoses or complex medical problems)
  • Members with unstable, high-risk behavioral health conditions (e.g., sexually reactive youth, significant legal involvement due to illness, or youth at high risk of out-of-home placement)

Specialized care may include enhancing existing services by adding service team members with expertise in high-risk conditions, or may require the development of specialized services not currently available within existing benefits. It may also include allowing for multiple services together which are typically excluded under standard benefit limitations. Such high-risk and high-cost cases are detected through a number of means, including standard authorization reviews, retrospective utilization reviews, routine care coordination activities, data monitoring, incident monitoring, grievance resolution activities, and provider/advocate referrals. We also work in coordination with CCNC to identify special populations.

When current best practice resources fail to promote desired outcomes, often innovation is required.  Cardinal Innovations is committed to working with its partners to develop, implement and fund innovative solutions. This process requires documentation of resource use in addition to efficacy and outcome measurement. Cardinal Innovations is fortunate to have world-class research institutions, as well as smaller and often more nimble providers in our network. Such providers are constant sources of innovation and up-to-date research data, helping to find innovative solutions. These provider relationships are vital to the development of a robust and effective system of care. Moreover, the 1915(b) Waiver provides flexibility to use (b)(3) services to promote innovation throughout our system.​