2019 Annual Report

Our Vision in Action

Leading Our Field in Whole Person Care

Introduction

Greetings from Alliance Health

Greetings

There is a saying that I’m told originated within the technology community in Silicon Valley that “we’re building the plane while we’re flying it.” It strikes me that this is an apt description of our work over the past year here at Alliance Health.

As always, our Alliance team of more than 500 exceptional professionals has focused daily on enhancing and managing innovative, evidence-based services and supports that allow members of our health plan to live healthier, more satisfying lives. At the same time we have been busy assembling the resources and building the infrastructure that will enable Alliance to thrive as a Tailored Plan in North Carolina’s new Medicaid landscape, serving the whole-person healthcare needs of people with severe mental illnesses, substance use disorders, and long-term needs including intellectual and developmental disabilities and traumatic brain injury.

I hope you will enjoy this new web-based format for sharing our 2019 highlights and accomplishments, and that it will successfully convey how our team has worked tirelessly and pooled its collective expertise to make great strides this year in these parallel endeavors.

We benefit greatly from the guidance of an outstanding Board of Directors, as well as the support of the Boards of County Commissioners and the County Managers and their staffs in our four counties. We thank them all, along with our exceptional professional staff, the Alliance Consumer and Family Advisory Committee, and our providers, partners and colleagues across the Alliance region.

Rob Robinson Chief Executive Officer

Community Health

Community Health and Well-Being

Community

Creating Pathways to Healthy, Fulfilling Lives

To better reflect our focus on the whole health of the people we serve, we’ve changed the name of our Community Relations department to Community Health and Well-Being.

This new name highlights our attention to the critical role of the social drivers of health – the conditions in which people are born, grow, live, work and age – on people’s well-being and quality of life.

The primary focus areas of Community Health and Well-Being are:

Promoting quality community partnerships and collaborative change.
Re-designing systems of care to improve health outcomes and promote healthy communities.
Improving quality of life for all the people we serve, helping them understand their health care better, and giving them tools and resources to actively engage in their care.
Connecting people to social and community supports that enhance recovery and well-being.

Learn More

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

Because reliable transportation is fundamental to a person’s access to health care services, Alliance has been piloting a transportation initiative since 2018 to help members get to their appointments.

Ensuring patient access to care includes making sure they can get to their appointments with providers. Our transportation pilot targets people who request services through our Access and Information Center, as well as people being discharged from inpatient or crisis services or the emergency department. Program success has encouraged us increase the number of rides available to each rider to four and to expand our scope to include follow-up appointments and pharmacy visits. In its first year, 246 different individuals used the service, with an average per-ride cost of $31. Since we began investing in this initiave we’ve seen engagement in community-based services increase significantly, while use of high-cost services such as inpatient and day treatment has decreased.

Download the Report

Transportation: A Vehicle for Wellness

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

In its first year

different individuals used our transportation service,

with an average per-ride cost of $31.

Law Enforcement Partnerships Build Safer Communities

Law enforcement officers are often first to respond to people in a behavioral health crisis. Knowing how to recognize what they’re dealing with and how to respond appropriately can defuse a potentially dangerous situation and get people to the help they need.

Since 2007 Alliance has become a national leader in offering Crisis Intervention Team (CIT) training to teach officers how to de-escalate dangerous situations and refer individuals, when appropriate, to treatment instead of emergency departments or jail. We’ve also developed an innovative, specialized 16-hour Veterans CIT module in addition to the normal 40-hour CIT training to help first responders who are military veterans themselves respond appropriately in situations involving other vets. Alliance has provided VCIT training to nearly 200 veteran law enforcement officers in our region, and has trained officers from Colorado to Delaware to train others and spread VCIT across the country.

In 2020 we will introduce a new Youth CIT module designed to give school resource officers more tools for dealing with young people in crisis.

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

Durham

5 CIT classes (141 trained)
2 Detention CIT (22 trained)

Wake

5 CIT classes (151 trained)
2 Detention (53 trained)
2 VCIT (37 trained)

Johnston

2 CIT classes (32 trained)
1 VCIT (9 trained)

People are more likely to encounter someone experiencing an emotional or mental health crisis than someone having a heart attack, and Mental Health First Aid (MHFA) training can empower everyday citizens to save lives.

Alliance teaches MHFA classes regularly so that people in our communities have the tools they need to help each other. The class teaches a five-step action plan to offer immediate help to a person showing signs of a mental illness or crisis and to connect them with the appropriate professional, peer, social or self-help care. Alliance also offers Youth Mental Health First Aid for adults who regularly interact with young people.

All Mental Health First Aid trainings are listed in the Alliance online calendar, or call 800-510-9132 to schedule a training for your organization or group.

Mental Health First Aid: We Can All be Ready to Respond

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

Over the course of 77 classes, more than 1500 participants were trained in Youth or Adult Mental Health First Aid.

Mental Health First Aid empowers everyone in our communities with the tools to help people in crisis get connected to appropriate care in a timely manner.
James Osborn Alliance Director of Education and Outreach

Alliance CARES: Impacting the Communities Where We Live and Work

Our Alliance CARES (Community, Awareness, Resources, Education and Service) initiative engages our employees in our communities and helps them understand first-hand the importance of social drivers of health.

CARES gives our staff opportunities for education through “lunch and learns” and book clubs as well as volunteer opportunities in the community. During 2019 Alliance employees logged nearly 200 hours of community volunteer time. CARES activities included:

Helping the Boys and Girls Club of Durham move into its new location.
Distributing medication disposal packets at Durham Bulls games.
Collecting donations of school supplies for community schools in need and helping teachers prepare their classrooms for a new school year.
Collecting travel-sized toiletries for people experiencing homelessness.
Writing letters and postcards to brighten the holidays for military families.
Making “teacher appreciation” visits to schools in Durham County.
Doing needed yard work at transitional homes for working families who have experienced homelessness.
Preparing and serving meals for people in need.

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

We work to build and support community collaboratives to foster resilient communities in which schools, businesses, local organizations, and families partner to support the wellness of our youth and children.

Community Collaboratives bring community members, organizations and agencies together around a System of Care approach to create neighborhood and community environments that empower and support children and their families. These partnerships help identify and coordinate existing resources across child-serving agencies and within the community, and give a voice to children and families with severe and persistent mental illness, intellectual or developmental disabilities and substance use issues.

In 2019 the collaboratives in each of our counties hosted community forums to discuss the impending Medicaid transformation and other important legislation. Learn how to become part of the collaborative in your community.

Collaborating for Better Outcomes

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

Caring for Our Communities in Stressful Times

Traumatic and unexpected events can bring on a range of emotions including anger, frustration and sadness and cause people to feel stress and anxiety. At Alliance we swing into action following stressful events to support our communities by helping people recognize symptoms of trauma and learn about coping strategies that support the natural recovery process. We want to make sure people know where to turn for help if their symptoms persist or become overwhelming.

In April 2019 a gas leak caused an explosion in the in the Brightleaf District of downtown Durham, causing two deaths, injuring 25 people and causing widespread damage within the surrounding blocks. As soon as first responders and city officials had ensured safety in the area, Alliance staffers took to the streets to provide information about recognizing and responding to disaster-related stress. Teams of Alliance canvassers visited homes and businesses around the Brightleaf neighborhood to check in with community members, and our Community Health and Well-Being staff partnered with Duke Center for Child & Family Health, El Futuro and Duke Memorial United Methodist Church to plan and host a community conversation event.

More recently, when about 340 residents of McDougald Terrace in Durham were evacuated to hotels following reports of a massive gas leak and elevated carbon monoxide levels in their homes, Alliance staff worked with the city and county governments and the housing authority to make sure there was a coordinated mental and physical health response to support residents during the intensely stressful time. Alliance staffers met with residents at the complex and at hotels to help them access needed services, and more than 50 Alliance CARES volunteers staffed events such as activities days for the displaced children and youth at the Durham Boys and Girls Club of Durham. In addition, Alliance staff, along with a doctor from Duke, visited hotels in the Durham “City Hall on the Go” RV to provide a safe space for displaced residents to discuss concerns.

Creating Pathways to Healthy, Fulfilling lives Transportation: A Vehicle for Wellness Law Enforcement Partnerships Build Safer Communities Mental Health First Aid: We Can All be Ready to Respond Alliance CARES: Impacting the Communities Where We Live and Work Collaborating for Better Outcomes Caring for Our Communities in Stressful Times

Alliance Community Health and Well-Being personnel and partners from Duke/Lincoln Community Health and Daymark/Freedom House staffed a mobile clinic for displaced McDougald Terrace residents.

I believe the heart of the work of Community Health and Well-Being starts with compassion for the people we serve. It drives us every day to do what we have to do to make sure that people reach their full potential and that their communities flourish.
Denene Hinton Community Education Specialist

Complete care

Alliance Complete Care

Care Management

Bringing Together a Team: Creating Effective Whole Person Care

Alliance is evolving the way we manage care for the people we serve in preparation for the changes Medicaid transformation will bring in North Carolina. In our new role as operator of a Tailored Plan, we will manage comprehensive whole-person care – that is, physical and behavioral healthcare plus pharmacy services – for North Carolinians with severe mental illnesses, substance use disorders, and long-term care needs, including those with an intellectual/developmental disability or traumatic brain injury.

We call our new model of care coordination “care teams,” because they bring together a diverse team of professionals to better meet the complex and diverse needs of our members. Each member’s care team is led by a care navigator, who serves as the point of contact for that member and their family.

The care navigator helps the member and their family maneuver through not only the physical and behavioral health system, but also guides them through the system of supports for social drivers of health such as housing, food and transportation.

Based on a member’s specific needs, a care team may include nurses, a pharmacist, community health workers, senior clinicians, and others. Care teams also include service consultants, who are the main point of contact for providers.

Leveraging Technology to Make Teamwork Easier

Making the transition more effective is Jiva, a cutting-edge software platform that allows the care teams to apply advanced population health management approaches to improve overall outcomes.

Through standard screenings and data analytics, Jiva can help care navigators determine who should be part of a member’s care team and reveal opportunities for interventions that will most effectively address the broad range of an individual's health needs. These interventions may include physical or behavioral strategies, but they may also connect members with community services to address social drivers of health such as food or housing insecurity. Our goal is to decrease ED and inpatient readmissions and reduce lengths of stay by delivering the right care or service, in the right amount, at the right time. In the end, we can use public funds wisely while making tangible improvements to people’s healthcare outcomes and quality of life.

Bringing Together a Team: Creating Effective Whole Person Care TBI Waiver: Helping Life Go On

People will still have one point of contact to guide their journey through the system, but now they will also have an expert team tailored to support their unique whole-health needs.
Jeff Payne Senior Director, Care Management

TBI Waiver: Helping Life Go On

Alliance is the only North Carolina MCO selected to pilot the Traumatic Brain Injury (TBI) waiver, which provides an array of community-based rehabilitative services and supports as an alternative to more expensive and restrictive facility care for eligible individuals.

More than a year into the project, the quality of life of men and women across our region who have experienced TBI as an adult is being enhanced by the the waiver. The Alliance TBI team is aggressively promoting community awareness of the TBI waiver, working with local media outlets, through our social media platforms, and by collaborating with other stakeholders to implement a strategic outreach plan. We have built a robust TBI provider network that includes 12 residential and periodic service providers and eight allied health providers. We also continue to partner with the Brain Injury Association of NC to provide TBI-specific training across the Alliance provider network and to increase community awareness of the waiver through outreach to primary care providers, hospital discharge staff, support groups and other potential referral sources.

If you or a loved one experienced a serious head injury on or after age 22 and live in the Alliance region, reach out to the Alliance Access and Information Center at 800-510-9132 for more eligibility criteria and information.

Bringing Together a Team: Creating Effective Whole Person Care TBI Waiver: Helping Life Go On

Life changed for Tim on August 2, 2018, when he sustained a traumatic brain injury in a serious car crash, leading to 14 weeks in the hospital.

Children and youth

Helping Children and Youth Thrive in Their Communities

Children

Tiered Care Coordination Works to Keep Youth Out of the Judicial System

In 2019 Alliance wrapped up a successful two-year pilot implementing North Carolina’s Child Tiered Care Coordination (TCC) model in Durham County, and started a new two-year pilot of the model in Cumberland County.

Alliance was the first MCO to implement the TCC pilot, which aims to connect two at-risk populations of youth and their families to behavioral health services. The project was designed to decrease the impact of trauma and unidentified and untreated behavioral health needs of young people involved with social services and the justice system.

An evaluation of the pilot conducted by UNC Greensboro showed increased enrollment in services and service delivery, improved engagement and an almost two-fold improvement in identification of trauma during the pilot.

View Full Report

Tiered Care Coordination Works to Keep Youth Out of the Judicial System School Partnership Bridges Gaps to Improve Engagement Teamwork Keeps Youth Safe in School

Improved Engagement

Average times for assessment decreased and the number of youth moved from referral to assessment within seven days increased, even with an increase in overall referrals.

12.9

Pre-TCC

During-TCC

14.6

Post-TCC

Number of Days Between Referral and Assessment

6.1 days

Post TCC average time from assessment to contact

39.4

Pre-TCC

46.5

During-TCC

47.4

Post-TCC

Percentage of Youth Assessed w/in 7 days

School Partnership Bridges Gaps to Improve Engagement

Alliance’s award-winning School-Based Care Coordination (SBCC) partnership with the Wake County Public School System promotes safer learning environments and better educational outcomes by addressing the mental health, behavioral and social needs of kids attending Wake County schools.

With seven specialized program areas, the innovative and successful initiative uses a “wraparound” model to improve student connections with the services they need to reduce the severity of their behavioral health symptoms.

A total of 624 youths and their families were served by the program in the 2018-19 school year.

Originally, SBCC was designed to connect students and families with the highest level of crisis and need to assessment and treatment to improve school engagement and success. This traditional program, developed in partnership with Easter Seals, increased its engagement rate from 24% to 74% during school year 2018-2019 and won an i2i Innovation Award for Quality Commitment in 2019.

The family partner program provides a peer specialist – a professional with lived experience – to support youth and families with unusually complex needs. In 2019 the family specialist created an innovative web-based caregiver support group that provides a safe space for caregivers to share their fears, challenges, and their successes without fear of being judged or excluded.

Download the Report

Teamwork Keeps Youth Safe in School

Grant money enabled Alliance and Johnston County Public Schools to form an award-winning partnership aimed at improving student safety and crisis prevention in public schools.

PREPaRE school crisis prevention and intervention curriculum training, an evidence-based module, empowers school personnel to establish school safety and crisis response teams. The curriculum teaches effective response to students’ behavioral health needs in times of crisis, establishes and maintains building-level safety, and meets the behavioral health needs of students and staff following a school-associated crisis event.

In suicide prevention training, counselors, social workers, nurses, student advocates, school psychologists, behavior specialists, and exceptional children specialists complete an intensive module that includes strategies for response when students at risk for suicide are referred for evaluation.

A multi-media campaign produced by Alliance and JCPS proved effective in informing school professionals, parents, caregivers, and community members about the appropriate steps to take when a child is struggling with mental health or substance use issues. Print materials focusing on students in crisis and how to access help were distributed at all county schools, and 10 powerful billboards with information about help for kids in crisis were displayed across the county.

Tiered Care Coordination Works to Keep Youth Out of the Judicial System School Partnership Bridges Gaps to Improve Engagement Teamwork Keeps Youth Safe in School

Crisis continuum

Crisis Continuum: Providing the Right Care at the Right Time

Crisis Continuum

For the third consecutive year Alliance had the lowest rate of emergency department admissions of individuals with a primary behavioral healthcare diagnosis in the state in 2019. Over 8,500 people were served in 2019 by Alliance Crisis and Assessment Centers. 58,447 calls answered by the Alliance Access and Information Center, 98.5% within 30 seconds. Thousands more outbound calls made to ensure that people receive the care they need.

When a behavioral health crisis emerges, it's best to get help right away. But hospital emergency departments and our jails are not the best answer for people in behavioral health crisis. That’s why Alliance has built a continuum of crisis services anchored by our Crisis and Assessment Centers and designed to provide access to quality, community-based clinical care. By providing the right care in the right place at the right time, we can often avoid the unnecessary use of emergency departments and jails.

Behavioral Health Urgent Care Centers

Often, a mental health or substance use crisis can be prevented with a timely clinical intervention, but sometimes it takes weeks to get an appointment with a provider. To address this problem Alliance has partnered with two members of our provider network to create behavioral health urgent care centers (BHUCs) in Wake and Durham counties.

BHUCs bridge the gap in access to care for individuals experiencing significant behavioral health distress that does not rise to the level that requires care from a crisis center or emergency department. Much like traditional medical urgent care centers, people can walk in and get needed treatment, including an assessment and brief counseling, and leave with a prescription if needed. The BHUCs also link individuals back to their regular source of behavioral health care or connect people not yet in treatment to a local provider. The centers screen for unmet social drivers of health and make referrals to community-based organizations who can help address these needs.

BHUC is a wonderful resource, allowing people with urgent needs to receive appropriate and timely mental health care in their community and outside the emergency room.
Dr. Alexandra Spessot Chief Medical Officer, Monarch

The rapid access that BHUC provides to high quality, compassionate care is critical to helping people get on the road to recovery and back to living their lives.
Marissa Holsten Durham Site Manager, Carolina Outreach

Behavioral Health Urgent Care By the Numbers

Over 0

individuals served by Durham BHUC.

0 %

of the individuals who come to the Durham BHUC see a physician/prescriber on the same day.

0 %

leave the Durham BHUC with a prescription for needed medication.

0 %

of individuals with Medicaid who visited the Durham BHUC had an ED visit in the following 30 days.

Over 0

individuals served by the Wake BHUC.

Facility-Based Crisis and Detox Services for adults help people during an average stay of 5-7 days to gain the skills they need to resolve their crisis, begin recovery, and return to their community with continued treatment services in place to avoid future crises. This service is an alternative to hospitalization for individuals in crisis, reducing the need for inpatient psychiatric hospitalization and emergency department evaluations.

Over 3,900 individuals served by Facility Based Crisis/Detox Facilities in 2019.

Mobile Crisis Teams support people experiencing a behavioral health crisis in their home or other community setting. The goal is to stabilize the crisis situation and link them to appropriate treatment and community services, helping them avoid trips to emergency departments and crisis facilities.

More than 1,200 individuals were helped by a Mobile Crisis Team in 2019.

Enhanced Mobile Crisis, an innovative partnership between Alliance, Wake County and a community provider, integrates mobile crisis clinicians into the Wake EMS system to provide on-scene risk assessment, provider referrals, linkages to long-term community resources, and 30-day follow-up for people receiving EMS assistance with a mental health crisis as their primary complaint. The program allows people to remain in their homes and communities while getting help if possible, avoiding hospitalization.

Enhanced Mobile Crisis began in March 2019 and has served 50 individuals, 70% of whom were stabilized in the community.

Advance Practice Paramedics deploys specially-trained paramedics in Durham, Wake and Johnston counties to help route people with mental health or substance use crises to facilities other than the emergency room for their care when no other medical emergency exists.

Advanced Practice Paramedics served more than 3,200 people in our communities in 2019.

NC START for people with intellectual/developmental disabilities and their families is a crisis prevention and intervention program providing crisis response, clinical consultation, training and respite. Connection with START is shown to result in a decrease in the use of costly and restrictive psychiatric services for this population.

Housing

Housing: The Foundation for Well-Being

Housing

Research shows that housing stability among people with behavioral health challenges not only leads to improved health outcomes, it also reduces hospital stays and health care costs. Alliance’s commitment to the principle of supportive housing as a platform for improving quality of life and a foundation for recovery has resulted in a robust continuum of partnerships that move people with complex needs from homelessness to housing and help them stay there

We’ve used grant money and reinvestment funds in collaboration with private and nonprofit housing developers to secure current and future access to 55 housing units. These investments have paid off, as all units we have options on are full and stay full, providing crucial housing security for people we serve. Although budget cuts have depleted our ability to continue monetary investments, we continue our supportive partnerships with affordable housing developers to help secure future access.

In partnership with the Fayetteville Metropolitan Housing Authority, Alliance was awarded access to 47 mainstream vouchers from the US Department of Housing and Urban Development (HUD) to help people we serve in Cumberland County to afford housing. The vouchers are prioritized for people with disabilities living in homelessness and those returning to the community from institutional care. They represent a leap forward in Alliance’s efforts to ensure housing stability for the people we serve in Cumberland County. Alliance also currently has access to 11 vouchers in Durham and 15 in Wake County.

We launched Coming Home, a brand-new pilot initiative in partnership with human services nonprofit Resources for Human Development (RHD), Durham Local Re-entry Council and the Durham Housing Authority. It provides supportive housing to justice-involved people who are in recovery from mental health or substance use disorders and returning to the community. The program currently houses four individuals, with more referrals in the works.

The Health and Housing Case Management Program, a partnership between Alliance, RHD and Duke University, serves chronically homeless people referred by two Duke outpatient clinics. Through RHD, Alliance connects these people with housing and the supportive services they need to stay in that housing and manage their health conditions. Since it began in 2017, the initiative has put 39 people who were classified as chronically homeless into homes. Data from RHD show an overall 66% reduction in hospitalizations among participants compared to one year prior to being housed, and an 83% reduction among those who were first housed during 2019.

Having four walls where you get to decide who you want to be inside of those and how you want to live just like every other person does — that should be a right for people, not a privilege.
- Malcolm White Alliance Tenancy Support Coordinator

DASH (Durham Area Supportive Housing), funded by the Department of Housing and Urban Development, provides permanent supportive housing to chronically homeless individuals and families. The program currently houses 30 people in 14 households.

People experiencing homelessness with substance use disorders may have difficulty obtaining secure housing and in turn, lack of housing acts as a barrier to recovery. To address this we are in the planning stages of a partnership to create Recovery Residences, our first harm-reduction housing program, to provide supportive housing to people with substance use disorders.

The Independent Living Initiative Program (ILI) is a short-term and one-time assistance program for adults and children receiving services through Alliance who are behind on their rent and/or utility payments and facing possible eviction or utility disconnection, or who need start-up funds to move into permanent housing following short-term life circumstances. In 2019 the ILI program provided assistance to 140 households.

TCLI: A Chance to Thrive in the Community

The Alliance Transitions to Community Living Initiative (TCLI) focuses on transitioning individuals with serious mental illness from adult care homes and state psychiatric hospitals and diverting individuals from entering institutional settings in compliance with the 2012 Olmstead Settlement Agreement between the United States and North Carolina. The program completed 132 new moves in 2019.

The Olmstead Settlement Agreement requires that the state provide community-based supported housing to people who currently reside in, or are at risk of entry into, adult care homes. It also ensures that thousands of people with mental illness have access to critical community-based mental health services and expands their employment opportunities by providing supported employment services.

Alliance connected 127 individuals with severe mental illness in 2019 with services to find competitive employment and the support to keep their jobs.

Substance Use Disorder

Substance Use Disorders

Substance

Taking an Evidence-Based Approach to Substance Use

As the country continues to wrestle with a crisis of substance use disorders and addiction, particularly concerning opioids, Alliance continues to explore innovative, data-driven solutions. Part of our strategy has been to increase access to medication-assisted treatment, an evidence-based whole-person approach that combines medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose.

We have grown our network of medication-assisted treatment (MAT) providers to include six opioid treatment programs where new patients go every day for their medication, and seven office-based opioid treatment providers where people get a prescription for their medication. As a result there has been a dramatic two-year increase in the number served with this effective treatment.

Until it happened to me, I had never thought about how somebody could be doing OK one day and be homeless just weeks later.
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Until it happened to me, I had never thought about how somebody could be doing OK one day and be homeless just weeks later.”

In 2016 JC became ill and needed serious heart surgery and eventually a pacemaker. His long hospital stay, without insurance, led to him losing his job and his housing. His substance use got worse and he spent the next two years living in his van. The treatment that he was able to piece together for his substance use didn’t help a lot, and housing he was finally able to secure wasn’t ideal to maintaining his sobriety.

“Then, after two long years, I began receiving regular medication-assisted treatment from a member of the Alliance provider network and was referred to a peer support specialist, also funded by Alliance. This was a big load off my mind because I didn’t have to go and chase $15 dollars a day for the medication that I needed to stay in recovery. Between the treatment and a lot of help from my peer support specialist, things turned around and I could start to rebuild my life.”

Because of her own lived experience, JC’s peer support specialist could understand JC’s experience. She helped him apply for charity care to assist with his medical bills, connect to disability advocates, and successfully access SSI benefits and Medicaid coverage.

Today, JC is set to return to school at Durham Technical Community College and to move into safer, more secure housing. Most importantly, he is experiencing hope for the first time in a long time.

“It changed everything for me, knowing what kind of help was out there. Thanks to Alliance and my providers, I’ve been able to continue to address my health concerns and find a purpose for my life again. I know first-hand that recovery is possible, and I’m really grateful.

Number of people served by MAT

Unique among North Carolina MCOs, Alliance participates in a learning collaborative with the US Department of Justice/Bureau of Justice Assistance addressing the use of MAT in correctional settings. Studies show that providing access to MAT there can reduce overdose risk, the spread of costly infectious diseases such as HIV and hepatitis C, and recidivism. We’ve forged a dynamic partnership with the Durham County Sheriff’s Office, Durham County Department of Public Health, NCDHHS, UNC and other organizations to make MAT available to detainees at the Durham County Detention Facility. The initiative, one of the first in the state, provides MAT medications to people who were receiving them prior to arrest, and has recently expanded to offering the MAT program for all inmates with opioid use disorder. The program also includes on-site and community-based peer support to assist with transition to post-release treatment. The program has served 43 people since it began in September 2019.

We are also continuing efforts with other initiatives in our communities to grow the substance use disorder system of care, including:

Working with Duke and Duke Regional emergency departments to refer people from emergency department settings and get them successfully connected to care.
Collaborating with Duke to speed treatment connections for people with very high-risk, expensive-to-treat medical conditions resulting from IV drug use, such as hepatitis, HIV, endocarditis and sepsis.
Getting people in detox at Durham Recovery and Response Center started in medication-assisted treatment before discharge, and using peer-support specialists – people with lived experience with substance use disorders and recovery – to help connect them with ongoing care.
Continuing development of a program with UNC Health Care-WakeBrook to engage people with aftercare, non-hospital detox and facility-based crisis treatment.
Through peer support specialists in our programs and embedded at treatment facilities, we are addressing potential barriers to continued recovery such as lack of transportation, food or housing insecurity, and other social drivers of health.

Keeping Medications from Misuse

Alliance has distributed over 23,000 drug disposal pouches that allow people to safely discard unused opioids and other dangerous prescription drugs. Care Coordinators have shared them with high-risk members and our Community Health and Well-Being team has disseminated them at Mental Health First Aid trainings and at hundreds of community events across our service area, including Durham Bulls baseball games. We have also given pouches to partner organizations which share our goal of impacting the epidemic, including NC Harm Reduction, as well as police forces in Raleigh, Morrisville, Wake County, Durham, Garner and Clayton and at Duke University and NC Central University.

Educating our Community to Take Action

Our Alliance For Action on Opioids website (AllianceForAction.org) continues to offer information to help individuals, family members, and professionals take small but important steps in their lives and work to help stem the tide of the opioid epidemic. The website highlights small steps individuals and professionals can take that may prevent opioid misuse and overdose deaths.

Financials

Financials

Based on Audited Statements

Medicaid

$374,712,927

Federal & State

$41,564,036

Local

$36,931,381

Grants/Miscellanous

$134,926

Administrative

$55,852,703

Revenue

Medicaid

$376,697,573

Federal & State

$60,786,649

Local

$36,786,649

Grants/Miscellanous

$134,926

Administrative

$61,158,821

Expenses

Alliance met or exceeded all requirements of Senate Bill 208 governing performance of LME-MCOs:

Financial reports submitted in accordance with our Medicaid contract

Ratio of current assets to current liablilities at 1.76 for FY19, exceeding the 1.0 requirement every month

99% of claims paid in a timely manner, providing training and technical support to providers to ensure submission of error-free claims

Successful sending and receiving of HIPAA-required data files

Combating Fraud and Abuse

Alliance is serious and proactive about minimizing the impact of fraud and abuse in the Medicaid system, as well as provider regulatory issues like proper licensure and accreditation. Our Office of Compliance includes 16 professionals focusing on claims audits, special investigations, protection of health information, and our own compliance with regulatory requirements and the Alliance Code of Ethics.

In FY19 the Alliance Special Investigations Unit logged 153 allegations of noncompliance and initiated 82 investigations. 13 cases of suspected fraud were referred to the NC Division of Health Benefits Office of Compliance and Program Integrity.

140 findings of provider regulatory non-compliance resulted in one or more actions or sanctions issued by Alliance, ranging from warning letters, plans of correction, and notices of overpayment to suspension of new referrals and termination of provider contracts.

During FY19, Alliance issued action to recover over $212,000 in overpayments as a result of investigation and audit findings that providers billed for services that did not meet required standards. Alliance does not take action to recover overpayments that are associated with suspected fraud until the NC Medicaid Office of Compliance and Program Integrity confirms that Alliance can issue such action.