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TRANSCRIPT
2016 Board of Directors Meeting
2019 Triad
Community Advisory
Board Meeting
July 30, 2019
2016 Board of Directors Meeting
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
2016 Board of Directors Meeting
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
MEETING DATE: July 30, 2019 AGENDA ITEM: 2
SUBJECT: Opening Remarks
BRIEF SUMMARY: Leon Inman, Chair, will provide opening remarks.
REQUESTED ACTION: Information Only
ATTACHMENTS: No
2
TRIAD AGENDA ITEM
MEETING DATE: July 30, 2019 AGENDA ITEM: 3
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
MEETING DATE: July 30, 2019 AGENDA ITEM: 4
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.
REQUESTED ACTION: Information only
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.
REQUESTED ACTION: Information only
ATTACHMENTS: No
9
TRIAD AGENDA ITEM
MEETING DATE: July 30, 2019 AGENDA ITEM: 6
SUBJECT: Community Updates
BRIEF SUMMARY: Leon Inman, Chair, will request community updates from the Community
Board.
REQUESTED ACTION: Information only
ATTACHMENTS: No
10
TRIAD AGENDA ITEM
MEETING DATE: July 30, 2019 AGENDA ITEM: 7
SUBJECT: Closing Remarks
BRIEF SUMMARY: Leon Inman, Chair, will provide closing remarks.
REQUESTED ACTION: Information only
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
July - September
15
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
MEDICAID TRANSFORMATION ROUNDTABLES
Every Region Held
Executive LeadershipProviders & Community FocusedStandard Plan – Nov. ‘19Maximus Broker Engagement
Triad – Wednesday, July 24
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
LME/MCOProvider Agency
(TFC)TherapeuticFoster Care
LME/MCOProvider Agency
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
QUESTIONS AND FEEDBACK
18
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
THANK YOU
Melissa M. Bunker
Senior Community Executive
Triad Region
19
20
APPENDIX B: Community Based Governance Update NOTES
21
22
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
COMMUNITY BASED GOVERNANCE UPDATE
To improve the health and wellness of our members and their families.
OUR MISSION
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
King Jones, Community Health Director
23
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
COMMUNITY FEEDBACK ON THE MODEL
Presentations on the new Community Governance Model occurred February through April
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
15 at Stakeholder Meetings2 at Member/Family Meetings6 at Provider Meetings
154 = Total Attendees (excludes CIH staff)
Southern Region: 21 presentations
13 at Stakeholder Meetings4 at Member/Family Meetings4 at Provider Meetings
232 = Total Attendees (excludes CIH staff)
Number of Presentations Given: 62 Number of Community Stakeholders: 683
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
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
Copyright © 2019 Cardinal Innovations Healthcare. All rights reserved.
THANK YOU
30
Davie County Dashboards
FYTD March 2019
County Funded Program Descriptions
County Funded Program
None
County Funded Program Description
31
Davie County Dashboards
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
Davie County Dashboards
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
Davie County Dashboards
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
Davie County Dashboards
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
BH Long Term Residential
IIHS
1915 (b)(3) Services
Crisis Services
Innovations
Inpatient
Emergency Department
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
BH Long Term Residential
IIHS
1915 (b)(3) Services
Crisis Services
Innovations
Inpatient
Emergency Department
Outpatient
Expenses by Service Category - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
35
Davie County Dashboards
FYTD March 2019
Members Served and Expenses by Service Category
Members Served is based on member's County of Residence not on the Provider's physical
location.
*Please see the Service Category Definitions (Pg. 4) for additional detail
Expenses by Service Categories is based on the Total Paid Amount.
0
1
2
22
34
23
41
131
0
0
1
22
26
28
45
167
0 50 100 150 200
Community Support
ACTT (Assertive CommunityTreatment Team)
Partial Hosp/Day Tx
Residential
Inpatient
Community
Crisis Services
Outpatient
Distinct Members Served - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
ACTT (Assertive CommunityTreatment Team)
Partial Hosp/Day Tx
Residential
Inpatient
Community
Crisis Services
Outpatient
Expenses by Service Category - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
36
Davie County Dashboards
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.
Members Served is based on member's County of Residence not on the Provider's physical
location.
Expenses by Service Categories is based on the Total Paid Amount.
3
23
5
14
0
5
10
15
20
25
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
9
29
14
30
0
5
10
15
20
25
30
35
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesState
Jul'17-Mar'18 Jul'18-Mar'19
$3,662 $3,540
$19,324
$2,715
$0
$5,000
$10,000
$15,000
$20,000
$25,000
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
$24,639
$4,949
$26,219
$8,249
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceState
Jul'17-Mar'18 Jul'18-Mar'19
37
Davie County Dashboards
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
Davie County Dashboards
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
Davie County Dashboards
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.
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYTD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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
Davie County Dashboards
FYTD March 2019
Members Served and Expense Amounts for Crisis Services
Call Abandonment Rate
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYTD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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
County Funded Program Descriptions
County Funded Program
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.
County Funded Program Description
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
Daymark Recovery Services """Safety net"" provider serving adults with serious mental health and/or substance use issues through a broad continuum of services. "
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
Forsyth County Dashboards
FYTD March 2019
Report data as of May 24, 2019. All graphs are county specific unless otherwise noted.
County Funded Programs*
Advisory Committees
Daymark Recovery Services
Daymark Recovery Services
Daymark Recovery Services
Enrichment Center
Horizons
Monarch
School Health Alliance
UNC-G / Family Partners
Total:
*Please see the County Funded Program Descriptions (Pg. 1) for additional detail
69.9%$1,106,576
38.6%
% Spent
0.0%$5,000
$1,750$7,000
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.
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
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.
43
Forsyth County Dashboards
FYTD March 2019
Number of Members Served by Age and Diagnosis
Number of Members Served All Age and All Diagnosis Registry of Unmet Needs
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
Child Members Served by DiagnosisAges 3 through 17
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
Adult Members Served by DiagnosisAges 18 and over
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
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.
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 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.
44
Forsyth County Dashboards
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
45
Forsyth County Dashboards
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
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
PRTF (Psychiatric ResidentialTreatment Facility)
Psych Rehab
BH Long Term Residential
IIHS
Partial Hosp/Day Tx
ICF
ACTT (Assertive CommunityTreatment Team)
Crisis Services
Outpatient ED
Innovations
1915 (b)(3) Services
Inpatient
Emergency Department
Outpatient
Distinct Members Served - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
PRTF (Psychiatric Residential Treatment Facility)
Psych Rehab
BH Long Term Residential
IIHS
Partial Hosp/Day Tx
ICF
ACTT (Assertive Community Treatment Team)
Crisis Services
Outpatient ED
Innovations
1915 (b)(3) Services
Inpatient
Emergency Department
Outpatient
Expenses by Service Category - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
46
Forsyth County Dashboards
FYTD March 2019
Members Served and Expenses by Service Category
Members Served is based on member's County of Residence not on the Provider's physical
location.
*Please see the Service Category Definitions (Pg. 4) for additional detail
Expenses by Service Categories is based on the Total Paid Amount.
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
ACTT (Assertive CommunityTreatment Team)
Partial Hosp/Day Tx
Residential
Community
Crisis Services
Inpatient
Outpatient
Distinct Members Served - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
ACTT (Assertive CommunityTreatment Team)
Partial Hosp/Day Tx
Residential
Community
Crisis Services
Inpatient
Outpatient
Expenses by Service Category - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
47
Forsyth County Dashboards
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.
Members Served is based on member's County of Residence not on the Provider's physical
location.
Expenses by Service Categories is based on the Total Paid Amount.
33
138
53
175
0
50
100
150
200
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
50
152162
222
0
50
100
150
200
250
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesState
Jul'17-Mar'18 Jul'18-Mar'19
$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
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
$81,130
$24,471
$315,734
$43,787
$0
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceState
Jul'17-Mar'18 Jul'18-Mar'19
48
Forsyth County Dashboards
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.
49
Forsyth County Dashboards
FYTD March 2019
*Please see the Entity Type Definitions (Pg. 8) for additional detail
DAYMARK Recovery Services, Inc.(Cabarrus Center) Comprehensive Community Clinics
Monarch Comprehensive Community Clinics
Novant Medical Group, Inc. dba Rowan Psychiatric Associates Hospital
Forsyth Memorial Hospital, Inc. dba Novant Health Forsyth Medical CenterInpatient
North Carolina Baptist Hospital Inpatient
Wake Forest University Health Sciences Physician's Group of Hospitals
The Neil Group, Inc. LIP Group
Insight Human Services Agency
Alexander Youth Network, Inc. Agency
Keystone WSNC, LLC dba Old Vineyard Behavioral Health ServicesInpatient
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 - Forsyth 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.
50
Forsyth County Dashboards
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 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.
Trends in Expense in FYTD1819:
- Innovations services were the highest expense in FYTD1819 at $21,918,687, congruent with FYTD1718.
- 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.
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYTD1819:
- Inpatient services were the highest expense in FYTD1819 at $2,865,516, but decreased in expense by 10% from FYTD1718.
Other Changes in Utilization and Expense compared to same time period in 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:
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.
51
Forsyth County Dashboards
FYTD March 2019
Members Served and Expense Amounts for Crisis Services
Call Abandonment Rate
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYTD1819:
- Inpatient services were the highest expense in FYTD1819 at $2,865,516, but decreased in expense by 10% from FYTD1718.
Other Changes in Utilization and Expense compared to same time period in 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).
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.
52
Rockingham County Dashboards
FYTD March 2019
County Funded Program Descriptions
County Funded Program
Daymark Recovery Services """Safety net"" provider serving adults with serious mental health and/or substance use issues through a broad continuum of services. "
County Funded Program Description
Various Community Collaborative-KARTS
Various Community Collaborative-KARTS
53
Rockingham County Dashboards
FYTD March 2019
Report data as of May 24, 2019. All graphs are county specific unless otherwise noted.
County Funded Programs*
Daymark Recovery Services
Various
Various
Total:
*Please see the County Funded Program Descriptions (Pg. 1) for additional detail
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
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.
54
Rockingham County Dashboards
FYTD March 2019
Number of Members Served by Age and Diagnosis
Number of Members Served All Age and All Diagnosis Registry of Unmet Needs
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
Child Members Served by DiagnosisAges 3 through 17
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
Adult Members Served by DiagnosisAges 18 and over
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
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.
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 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.
55
Rockingham County Dashboards
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
56
Rockingham County Dashboards
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
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
PRTF (Psychiatric ResidentialTreatment Facility)
BH Long Term Residential
Psych Rehab
ACTT (Assertive CommunityTreatment Team)
ICF
Partial Hosp/Day Tx
IIHS
Outpatient ED
Crisis Services
1915 (b)(3) Services
Innovations
Inpatient
Emergency Department
Outpatient
Distinct Members Served - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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)
BH Long Term Residential
Psych Rehab
ACTT (Assertive Community Treatment Team)
ICF
Partial Hosp/Day Tx
IIHS
Outpatient ED
Crisis Services
1915 (b)(3) Services
Innovations
Inpatient
Emergency Department
Outpatient
Expenses by Service Category - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
57
Rockingham County Dashboards
FYTD March 2019
Members Served and Expenses by Service Category
Members Served is based on member's County of Residence not on the Provider's physical
location.
*Please see the Service Category Definitions (Pg. 4) for additional detail
Expenses by Service Categories is based on the Total Paid Amount.
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
ACTT (Assertive CommunityTreatment Team)
Community
Inpatient
Residential
Crisis Services
Outpatient
Distinct Members Served - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
ACTT (Assertive CommunityTreatment Team)
Community
Inpatient
Residential
Crisis Services
Outpatient
Expenses by Service Category - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
58
Rockingham County Dashboards
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.
Members Served is based on member's County of Residence not on the Provider's physical
location.
Expenses by Service Categories is based on the Total Paid Amount.
12
51
15
67
0
10
20
30
40
50
60
70
80
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
29
61
38
88
0
20
40
60
80
100
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesState
Jul'17-Mar'18 Jul'18-Mar'19
$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
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
$40,903
$10,895
$64,309
$10,002
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceState
Jul'17-Mar'18 Jul'18-Mar'19
59
Rockingham County Dashboards
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 InstitutionIntermediate 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.
60
Rockingham County Dashboards
FYTD March 2019
*Please see the Entity Type Definitions (Pg. 8) for additional detail
DAYMARK Recovery Services, Inc.(Cabarrus Center) Comprehensive Community Clinics
YOUTH HAVEN SERVICES, LLC Agency
The Moses H. Cone Memorial Hospital Inpatient
DAYMARK Recovery Services, Inc. - Mobile Crisis Management / After Hours EmergencyAgency
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
Monarch Comprehensive Community Clinics
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 - RockinghamEntity 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.
61
Rockingham County Dashboards
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 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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).
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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:
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.
62
Rockingham County Dashboards
FYTD March 2019
Members Served and Expense Amounts for Crisis Services
Call Abandonment Rate
Trends in Utilization in FYTD1819:
- 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.
Trends in Expense in FYD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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.
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.
63
Stokes County Dashboards
FYTD March 2019
County Funded Program Descriptions
County Funded Program
None
County Funded Program Description
64
Stokes County Dashboards
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
Stokes 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.
65
Stokes County Dashboards
FYTD March 2019
Number of Members Served by Age and Diagnosis
Number of Members Served All Age and All Diagnosis Registry of Unmet Needs
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
Child Members Served by DiagnosisAges 3 through 17
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
Adult Members Served by DiagnosisAges 18 and over
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
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.
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 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.
66
Stokes County Dashboards
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
67
Stokes County Dashboards
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
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
ACTT (Assertive CommunityTreatment Team)
PRTF (Psychiatric ResidentialTreatment Facility)
ICF
BH Long Term Residential
Psych Rehab
1915 (b)(3) Services
Partial Hosp/Day Tx
Crisis Services
IIHS
Outpatient ED
Innovations
Inpatient
Emergency Department
Outpatient
Distinct Members Served - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
ACTT (Assertive Community Treatment Team)
PRTF (Psychiatric Residential Treatment Facility)
ICF
BH Long Term Residential
Psych Rehab
1915 (b)(3) Services
Partial Hosp/Day Tx
Crisis Services
IIHS
Outpatient ED
Innovations
Inpatient
Emergency Department
Outpatient
Expenses by Service Category - Medicaid Funding
Jul'18-Mar'19 Jul'17-Mar'18
68
Stokes County Dashboards
FYTD March 2019
Members Served and Expenses by Service Category
Members Served is based on member's County of Residence not on the Provider's physical
location.
*Please see the Service Category Definitions (Pg. 4) for additional detail
Expenses by Service Categories is based on the Total Paid Amount.
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
ACTT (Assertive CommunityTreatment Team)
Residential
Community
Inpatient
Crisis Services
Outpatient
Distinct Members Served - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
$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
ACTT (Assertive CommunityTreatment Team)
Residential
Community
Inpatient
Crisis Services
Outpatient
Expenses by Service Category - State Funding
Jul'18-Mar'19 Jul'17-Mar'18
69
Stokes County Dashboards
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.
Members Served is based on member's County of Residence not on the Provider's physical
location.
Expenses by Service Categories is based on the Total Paid Amount.
6
34
10
21
0
5
10
15
20
25
30
35
40
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
6
32
16
39
0
5
10
15
20
25
30
35
40
45
Facility Based Crisis Mobile Crisis Management
Distinct Members Receiving FBC & MCM Crisis ServicesState
Jul'17-Mar'18 Jul'18-Mar'19
$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
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceMedicaid
Jul'17-Mar'18 Jul'18-Mar'19
$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
Facility Based Crisis Mobile Crisis Management
Expenses by FBC & MCM Crisis ServiceState
Jul'17-Mar'18 Jul'18-Mar'19
70
Stokes County Dashboards
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.
71
Stokes County Dashboards
FYTD March 2019
*Please see the Entity Type Definitions (Pg. 8) for additional detail
DAYMARK Recovery Services, Inc.(Cabarrus Center) Comprehensive Community Clinics
YOUTH HAVEN SERVICES, LLC Agency
Novant Medical Group, Inc. dba Rowan Psychiatric Associates Hospital
Monarch Comprehensive Community Clinics
Forsyth Memorial Hospital, Inc. dba Novant Health Forsyth Medical CenterInpatient
Wake Forest University Health Sciences Physician's Group of Hospitals
The Neil Group, Inc. LIP Group
PQA Healthcare, Inc. Agency
Insight Human Services Agency
DAYMARK Recovery Services, Inc. - Mobile Crisis Management / After Hours EmergencyAgency
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 - Stokes 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.
72
Stokes County Dashboards
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 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.
Trends in Expense in FYTD1819:
- Innovations services were the highest expense in FYTD1819 at $2,213,346, congruent with FYTD1718.
- ICF services were the second highest expense in FYD1819 at $1,358,936, congruent with FYTD1718.
Other Changes in Utilization and Expense as compared to same time period in 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).
Trends in Utilization in FYD1819:
- 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.
Trends in Expense in FYTD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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:
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.
73
Stokes County Dashboards
FYTD March 2019
Members Served and Expense Amounts for Crisis Services
Call Abandonment Rate
Trends in Utilization in FYD1819:
- 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.
Trends in Expense in FYTD1819:
- 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.
Other Changes in Utilization and Expense as compared to same time period in FYTD1718:
- 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).
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.
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
Triad Community OfficeQuality Management Dashboard
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
Jul'18 Aug'18 Sep'18 Oct'18 Nov'18 Dec'18 Jan'19 Feb'19 Mar'19
Level III Incidents Count & Rate of Incidents Per 1,000 Members Served
Level III Incidents Rate/1,000 Members Served
FYTD: July 2018 - March 2019
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
Jul'18 Aug'18 Sep'18 Oct'18 Nov'18 Dec'18 Jan'19 Feb'19 Mar'19
Restrictive Intervention Count & Rate of Incidents Per 1,000 Members Served
Level II Incidents Level III Incidents Rate/1,000 Members Served
FYTD: July 2018 - March 2019
76
Triad Community OfficeQuality Management Dashboard
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
FYTD: July 2018 - March 2019
77
Triad Community OfficeQuality Management Dashboard
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
Jul'18 Aug'18 Sep'18 Oct'18 Nov'18 Dec'18 Jan'19 Feb'19 Mar'19
Grievance Count & Rate of Complaints Per 1,000 Member Served
Grievances Rate/1,000 Members Served
FYTD: July 2018 - March 2019
78
Triad Community OfficeQuality Management Dashboard
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
Emergency Department
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
Triad Community OfficeQuality Management Dashboard
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
FYTD: July 2018 - March 2019
80
Triad Community OfficeQuality Management Dashboard
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