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February Alliance Board Meeting Cancelled

Due to inclement weather forecasted for our area, Alliance has decided to cancel today’s Alliance board meeting. Our next board meeting is scheduled for March 5, 4pm at 5200 W. Paramount Parkway, Morrisville.

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Alliance collaborates to Care for McDougald Terrace Residents

Alliance mobile clinic team

Alliance Community Education Specialist Denene Hinton (second from left), SVP-Community Health and Well-Being Ann Oshel (third from left) and partners from Duke/Lincoln Community Health and Daymark/Freedom House staffed a mobile clinic for displaced McDougald Terrace residents.

In early January 2019 the Durham Housing Authority evacuated 280 households from the McDougald Terrace public housing complex because of unsafe conditions, including elevated levels of carbon monoxide in some of the apartments.

The displacement disrupted families’ routines, separated them from neighbors and community friends, and left many with no kitchens or appliances to cook food in their temporary hotel quarters. Many had to move out so quickly they did not have time to pack adequate belongings. Such a situation can create feelings of fear, anger, frustration and sadness. One resident told reporters the displacement was “stressful and depressing.”

From the outset of the crisis, Alliance staff worked with Durham city and county governments and the housing authority to put together a coordinated mental and physical health response to support residents during the intensely stressful time.

“We are responding like we do with any acute, traumatic event to make sure people are engaged in services, connected with their providers and receiving supports,” said Alliance Senior Vice President–Community Health and Well-Being Ann Oshel. “We are trying to help mitigate some of the long-term effects of trauma, just making sure people know how to access help when they need it.”

Immediately following the evacuations, Alliance staffers met with residents at the complex and at hotels to identify unmet needs and help people access needed services. Alliance staff also participated in all forums and events the housing authority organized for residents.

In addition, Alliance collaborated with Duke Health, Lincoln Community Health and Daymark/Freedom House to set up a mobile clinic for displaced residents. The partners borrowed Durham’s “City Hall on the Go” RV to visit the hotels hosting residents to provide a confidential space to discuss their health and well-being concerns.

“Recruiting our partners to launch a mobile clinic as part of a crisis response was a logical and important step to take,” Oshel said. “We are trying to make a health and well-being response as mobile as possible instead of saying ‘here’s an appointment’ and making people come to us.”

The situation has been especially difficult for children, who have limited space and opportunity to play or see friends in the hotels. The Alliance CARES volunteers stepped up to help staff “MLK Play Days” organized by the housing authority for children and youth at area recreation centers. Altogether more than 50 Alliance staff members volunteered as part of our response.

In speaking of Alliance’s approach to the coming days and weeks, Alliance CEO Rob Robinson promised city and county leaders that the community “can count on Alliance Health to be there for the long haul to support the residents of McDougald Terrace as they begin the journey of rebuilding their homes and lives.”

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VCIT helps address unique needs of veterans in crisis

Air Force veteran Nick Blalock was in crisis and felt he had just “lost it.” His life was not going well shortly after he left the military, and when his girlfriend left him and took their dog with her, his only sources of comfort were gone.

“I exploded and everything that I’d been holding in and dealing with came to a head,” he said.
Nick’s father called police for help and mentioned his son’s veteran status to the dispatcher, who sent officers who were also veterans.

“The veterans who responded took it upon themselves to identify themselves as veterans and it put us on that level playing field to bring my tension and my anger down.” Nick said.

The encounter did more than just help Nick begin to get through his time of crisis. The City of Apex, NC, police officers involved were inspired to create specialized training for first responders who have served in the military so they could better assist veterans in crisis.

“There wasn’t any training that I could find going on anywhere in the country,” said Blair Myhand, one of the original officers involved and now chief of the Clayton Police Department. He realized that forging a personal connection with a law enforcement officer who understands the military experience could offer a lifeline to veterans struggling with mental illness, substance abuse, or post-traumatic stress disorder.

Officer Myhand reached out to Alliance Health, a national leader in providing 40-hour Crisis Intervention Team (CIT) training developed to give first responders the skills to de-escalate dangerous situations involving people in behavioral health crisis and refer individuals, when appropriate, to treatment instead of emergency departments or jail.

The partnership led to the development of Veterans Crisis Intervention Team (VCIT) training, an innovative 16-hour module addition to CIT that explores the ways officers can use their shared military experiences to assist veterans in crisis. VCIT is only available to first responders who are veterans and have completed the main CIT training.

“More departments are recognizing the unique needs of veterans and the importance of handling their crisis situations appropriately,” said Alliance Criminal Justice Specialist Roosevelt Richard.

Nearly 200 first responders from all four North Carolina counties in Alliance’s coverage area–Wake, Durham, Johnston and Cumberland–now use the training, which is also spreading across the country thanks to “Train the Trainer” courses offered by Alliance. Twenty-two people from other states, including California, Colorado, Connecticut, Delaware, New Hampshire, New Mexico, Ohio and Vermont have come to Wake County to learn how to train their teams on this curriculum.

New MH/IDD Website

NC DHHS has launched ComplexMHIDD-NC.org, a new website for parents, caregivers, community members, and primary care physician offices, and other professionals who live with and care for people with both I/DD and mental health challenges. This website is a collection of information and resources designed to provide an overview and guidance on such topics as communication, trauma, behavioral health crisis, and medication.

New CMO Bolsters Alliance’s Transition to Integrated Care

Alliance Health’s transformation to integrated care took a leap forward in October when we welcomed aboard new Chief Medical Officer Dr. Mehul Mankad, MD. Dr. Mankad brings a wealth of integrated care experience from 15 years of work as Chief of Psychiatry at the Durham VA Medical Center and  Assistant Professor at the Duke University Department of Psychiatry.

Dr. Mankad said he hopes his experience working in integrated care can help Alliance get to the next step in our journey. “One of the many pieces I learned at the VA is that the lower the barriers and the fewer obstacles you present to communication between physical and mental health, the better for the patient.”

“The idea that mind and body are separate has been something that we’ve accepted for a few centuries, ever since the era of philosopher René Descartes, who famously separated mind from body in his writing,” Dr. Mankad said. “But it’s a false separation. The mind is part of the brain, and the brain is part of the body, and the body is all connected. So the idea that we should move toward whole health is long overdue, but there’s no time like the present. We have to move in that direction.”

Dr. Mankad said that the hoped-for benefit of delivering integrated care to the people we serve is that improving people’s mental health improves their physical health. “And we’ve certainly seen that at Alliance since the inception of the company,” he said. “But I think the piece that a lot of people are excited about, including myself, is that improving people’s physical health will improve their mental health as well. And then the third piece that I would add is what were called the social determinants of health, which we now call the social drivers of health. Being respectful of the social drivers of health can actually be more impactful on the physical and mental health of our members than anything else we can do.”

The transition to integrated care delivery through North Carolina’s upcoming Medicaid Tailored Plan need not be difficult, Dr. Mankad said, but it involves building relationships, and opening communication and freer exchange of information – within applicable rules and regulations, of course.

“I’m hopeful that some of the advanced information systems that Alliance has invested in over the past few years, namely the Jiva care management platform, will help facilitate this exchange and also bring in the social drivers of health,” he said. “Then I guess the next step is to use the powerful information that we have to educate providers on the mental health and physical health side as the patients that they care for are changing. If we can deliver information in a proactive way, then we can help the providers intervene early.”

“The way that I’m looking at the Tailored Plan transition is more as an opportunity than a reason to be afraid,” Dr. Mankad said. “It’s going to allow Alliance to focus on those people Alliance is best at helping. The members who are identified as being in the future Tailored Plan are precisely the ones we’re good at caring for. That is more exciting to me than anything else.”

Dr. Mankad cited Alliance’s intellectual power as one of the things that attracted him to the organization. “People here are doing so many great things simultaneously; they are very thoughtful about Medicaid Transformation and often serve as advisers to the state. Whether it’s in state government or even the legislature, people often turn to Alliance, not just because they are close by, but because they know that people at Alliance have been thinking about critical issues for the future of our most vulnerable people in North Carolina,” he said.

“The other thing is putting your money where your mouth is. Alliance really does deliver on its promise to be a leader in managed mental health in North Carolina. For example, the kinds of things being done with Alliance’s care management system are on the cutting edge, and I think that’s really impressive. So on the one hand, the folks at Alliance are leading the charge with our daily work, but the other thing that people are doing simultaneously at Alliance is thinking very intently about the future. The language that I’ve heard a lot of people use here is that they are building this airplane while it’s in flight, and it’s scary, but it’s necessary.”

Dr. Mankad’s experience at the VA also aligns well with Alliance’s position of having more veterans and military families in our service area than any other North Carolina MCO. “I’m very excited that one of Alliance’s areas is in Cumberland county,” he said.

One in nine North Carolinians is either a veteran or active duty military, and while the VA focuses on services to veterans themselves, the agency does not currently focus on direct service to dependents of veterans. “A lot of people don’t realize that not all veterans have health coverage for their family members, and so Alliance may have a very critical role to play for the halo of people that surround veterans. I’m happy to help the employees at Alliance, and to whatever extent the providers that work with Alliance, develop their veteran-friendly approach,” he said.

Alliance and Fayetteville Housing Authority Awarded 47 HUD Mainstream Vouchers

In partnership with the Fayetteville Metropolitan Housing Authority, Alliance Health recently received access to 47 mainstream vouchers from the US Department of Housing and Urban Development (HUD) to help people we serve in Cumberland County afford housing.

Alliance Health is the managed care organization for publicly funded behavioral healthcare services for the people of Durham, Wake, Cumberland and Johnston counties. Alliance works with a network of almost 2200 private providers to serve the needs of 386,000 Medicaid-eligible and uninsured individuals within a total population of 1.8 million.
Mainstream vouchers are a part of HUD’s housing choice voucher program (often called Section 8 in reference to the federal Housing Act of 1937), which helps very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. The mainstream vouchers are specifically for families that include a person with disabilities.

Alliance Senior Vice President, Community Health and Well-Being Ann Oshel said the 47 vouchers, which is the entire amount requested, represent a leap forward in Alliance’s efforts to ensure housing stability for the people we serve in Cumberland County. These vouchers are prioritized for persons with disabilities living in homelessness and those returning to the community from institutional care.

Demand for housing choice vouchers always surpasses supply and the waiting list is “longer than anyone would be able to access,” Oshel said. “When housing authorities are able to open up the waiting list they typically do it for people who are both elderly and disabled, which leaves a lot of people we serve off because they are not elderly.”

“People with disabilities are much more susceptible to homelessness because they don’t have income and have difficulty accessing treatment and staying on their medication,” and the vouchers are the only way a person who depends upon Supplemental Security Income (SSI) can afford a place to live, she said.

Voucher recipients are free to choose any housing that meets program requirements and are not limited to living in subsidized housing projects. The housing authority pays the subsidy, which is generally the lesser of a pre-determined payment standard or the gross rent for the unit, minus 30% of the family’s monthly income, directly to the landlord. The family pays the remainder.

The vouchers are permanent, which means that as long as the participants abide by their leases and do not commit a crime they will never have to pay more than 30% of their income on rent.

Securing housing is just the first step, Oshel said, because vulnerable people need support to remain in housing. “Supportive housing is the combination of safe, decent, affordable housing and support services that are necessary for someone to live successfully. That is the marriage between Alliance and the Fayetteville Metropolitan Housing Authority – they create access to permanent housing and we create access to support services for somebody to be successful.”

Safe and affordable housing, along with the supports necessary to thrive there, is perhaps the most basic and powerful social driver of health. Alliance has long been committed to “Housing First, Housing Plus,” the principle of supportive housing as a platform for improving quality of life and a foundation for recovery.

“It’s really hard to address the other social drivers of health if you can’t find housing for somebody. It really begins and ends there. And the minute you stabilize them in their own place, you can address all those other unmet social needs,” Oshel said.

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Alliance Surpasses CIT Training Milestone in Durham

November 22, 2019, marked Alliance Health’s 45th Crisis Intervention Team (CIT) training in Durham, bringing the number of Durham first responders we have trained to 1075.

CIT training teaches police and other first responders how to recognize and respond appropriately to individuals in behavioral health crisis so that they may de-escalate dangerous situations and refer individuals, when appropriate, to treatment instead of emergency departments or jail. Along with Mental Health First Aid (MHFA) training for first responders and other community members, CIT is a foundation for Alliance’s longstanding commitment to improving safety and health in our communities.

Special thanks to Alliance Criminal Justice Specialist, Laylon Williams, who leads all Durham CIT trainings, as well as our partners NAMI Durham, Durham County Government, City of Durham Government, Durham County Emergency Medical Services, Durham Police Department, Durham County Sheriff’s Office, Duke University, Durham Technical Community College, North Carolina Central University Police Department, NAMI, and North Carolina Department of Public Safety.

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Implementation of Managed Care Suspended

NC DHHS shared its plan yesterday to suspend implementation of Medicaid managed care due to the continuing state budget impasse. Alliance has been informed by DHHS that the Tailored Plan Request for Application (the procurement process for the Tailored Plan) remains on schedule for release in February 2020. Access the DHHS statement.

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Alliance Announces New Clinical Leadership

(Morrisville, NC) – Alliance Health has named Mehul Mankad MD as its new Chief Medical Officer effective in October.

Currently Dr. Mankad is Chief of Psychiatry at the Durham VA Medical Center and an Assistant Professor at the Duke University Department of Psychiatry. He received his medical degree from Northwestern University and served his psychiatric residency at Duke University Medical Center. Dr. Mankad is a Distinguished Fellow of the American Psychiatric Association and the immediate past president of the North Carolina Psychiatric Association.

In his new role at Alliance Dr. Mankad will lead a clinical team of physicians, nurses and a pharmacist, reflecting the organization’s focus on its future as the manager of not just behavioral healthcare, but also physical healthcare and pharmacy services for the people it serves. He will also have oversight of Alliance’s utilization management and care coordination functions, and brings from the VA Medical Center an empathy for veterans and a keen understanding of their unique behavioral healthcare needs. The Alliance service area has one of the highest concentrations of veterans of any North Carolina behavioral health managed care organization.

“For years I’ve watched Alliance serve as a model for local management entities in our state, delivering on its promise to serve the public with quality staff and a commitment to excellence,” said Dr. Mankad. “At a time when Medicaid transformation is in full swing in North Carolina, Alliance has an opportunity to define healthcare delivery to the most vulnerable segment of our state’s population. I’m excited to join the Alliance team.”

“Alliance is pleased to take advantage of Dr. Mankad’s unique blend of experience and expertise,” said Alliance CEO Rob Robinson. “He has been a clinical leader since medical school, and under his leadership Alliance will only enhance its reputation for clinical excellence as we evolve to become operators of a Tailored Plan.”

Health and Housing Partnership Saves Lives and Money

The Health and Housing Case Management Program, a partnership between Alliance Health, Resources for Human Development (RHD) and Duke University, has reduced hospitalizations of “heavy users” by 40%. Click here to read all about it.