Liaisons Ensure Continuity Of Care In Crisis

Many people in a mental health or substance use crisis seek help in a hospital emergency department (ED), where that crisis may be seen as a distinct episode with little continuity or communication about the person’s past or what happens after they leave. Because of this, Alliance Health’s care management team has a robust ED liaison system designed to ensure continuity of care, improve outcomes and possibly reduce repeat ED visits for the people we serve.

Six Alliance care coordinators currently serve as ED liaisons, coordinating and communicating between the EDs and other care coordinators and community-based services, including two Wake County school-based care coordinators who offer assistance to Wake County Public School system (WCPSS) students and their families.

Whether the member is discharged and connected to community supports or referred to an inpatient program, the goal is to establish continuity of care. “Our job is really a lot of communication, collaboration and brainstorming.” Said Adam Shields who serves as the ED liaison at Wake Med’s main ED in Raleigh, and backup for Ashley Marrow, who works with Rex and Duke Raleigh as well as the five other Wake Med EDs. Marrow also serves as backup for Shields.

Senitra Pryor works in Durham with Duke University and Duke Regional hospitals, including the inpatient psychiatry wards at each, and Melinda Short covers Cape Fear Valley Medical Center and its behavioral health center.

As part of Alliance’s School Based Team (SBT) partnership with WCPSS, school-based care coordinators Catherine Lilly and Christopher Toller monitor ED and crisis facility admissions to identify WCPSS students and link them to appropriate behavioral health and community resources to support them in their transition back to school after a crisis episode.

The ED liaisons have an app that allows them to see the facilities’ daily admissions and review the behavioral health cases. Then they partner and collaborate with the hospital social workers, providers and other community resources to get people diverted out of the ED if appropriate, or work on a discharge and continuity plan if someone has been admitted for observation. If the member has a care coordinator they are alerted, if not a care coordinator is assigned to ensure the member maintains connection to care after the crisis.

“We are making sure no one falls through the cracks and that care coordinators know when their members are there.” Short said. “A lot of times people in crisis don’t know their provider’s information or when their last date of service was, so we can make sure the social worker has the information they need at the time.”

For WCPSS students, the liaisons reach out to a child’s parent to see if they are interested in having additional support. If so, they get a signed consent and assign a school-based liaison who coordinates with the school, notifying them that a student is in the hospital. “The main goal is to support the student as they transition back to school after the hospitalization,” Lilly said. “This involves tailoring the child’s support to their specific circumstances,” she said.

The support goes beyond healthcare to addressing what are commonly called the social determinants of health, so the liaisons have a conversation with members about their needs. “Many people have a lack of resources including food insecurities or lack of transportation, so we try to ensure that they have that before they leave,” Pryor said.

The COVID-19 pandemic has multiplied some of the stressors that may push people into crisis, adding new pressures to school students. “There’s already the pressure and anxieties that come with that age and then on top of that you have virtual learning and feeling disconnected from peers,” Toller said. “The routine has changed so drastically, plus you have the pressures of parents and children all trying to work at home.”

Economic pressures may also increase the amount of stress in the household, multiplied for families who are facing homelessness. The liaisons can connect members and families with housing resources, which for Wake students includes the McKinney-Vento program, which addresses the needs of children and youth experiencing homelessness. Last summer the SBT liaisons were able to get Independent Living Initiative (ILI) funding for the family of a child with medical issues, which allowed them to move into a home. Another family of several Wake children were staying in a motel, but internet access issues made it difficult to register the kids for schools so Toller coordinated with a social worker to get the kids registered.

“I think of how hard it is for so many adults to adjust, and it’s something that no one could have prepared any young person for,” Toller said.

To learn more about crisis alternatives to the ED, visit the Alliance website.

Learn more about the Alliance School Based Team in its 2019-2020 annual report.

Alliance Telehealth Survey Finds High Satisfaction Among Members, Providers

The COVID-19 pandemic has dramatically changed the delivery of and access to healthcare across the US. Fear of exposure and evolving local and state restrictions caused cancellation or deferral of many in-person healthcare encounters. Because of this, as well as temporary flexibilities allowed by Centers for Medicare & Medicaid Services, many Alliance Health providers have expanded telemedicine visits to serve our members.

To better understand the impact of these changes on services, Alliance conducted member and provider surveys to identify barriers, benefits, and gaps related to telehealth services. Overall, the satisfaction reported with telehealth services was near the level of reported satisfaction with In-person services.

“Our providers deserve a lot of credit for the amazing, almost overnight pivot that they made to provide telehealth,” said Sean Schreiber, Alliance Executive Vice President—Network and Community Health. “Our ability to support providers in their transition to telehealth has allowed us to maintain our members’ access to the services they need despite the difficulties imposed by the pandemic.”

The survey, conducted in June and July 2020, sampled Alliance providers via an online form, and members via telephone interviews by Alliance staff. Of the respondents, 64 providers reported providing and 202 members reported receiving telehealth services between March and July 2020. The number of members served via telehealth increased significantly during the COVID-19 pandemic. Of members that received telehealth eligible services between March and August, 62% received at least one telehealth service.

Of the member respondents that received telehealth services, 88% rated their service good or very good, which is only slightly below the 91% favorable rating for in-person services. Member satisfaction data was compared across demographic subgroups, including race, age, county, ethnicity, disability group, language, funding, service, provider, telehealth platform, provider training, and provider experience and were found to be proportional across all subgroups with at least 40 responses.

From the providers’ perspective, 78% believe their members are satisfied, 58% report improved show rates, and 66% report the same or increased member engagement as compared to in-person visits.

Some services appear to be better suited for telehealth than others. More than half of providers rated enhanced services (which include Multisystemic Therapy, Intensive In-Home, Family Centered Treatment, Community Support Team, Psychosocial Rehabilitation, Day Treatment, Substance Abuse Intensive Outpatient Program, Substance Abuse Comprehensive Outpatient Treatment, and Assertive Community Treatment Team) as more difficult to deliver via telehealth. Only 34% of providers rated outpatient services as harder to provide via telehealth than in person.

In addition to the ability to safely serve members during the pandemic, telehealth presents other benefits over in-person services. Members ad providers reported reduced transportation difficulties and travel expenses, which are known to be significant barriers to in-person appointments. Telehealth also provides flexibility and engagement advantages, reduces the need for childcare, and may allow providers some insight into a members’ home environment.

There are some disadvantages, however. One barrier may be lack of technology or the knowledge to use it. Providers may need to invest in upgraded equipment or broadband access, and some members may not have a computer, smart phone, or tablet with internet access. Despite this hurdle, 80% of providers reported that most members had no challenges with platform. Telehealth may not be suitable for all ages or diagnoses. Members’ home environments may not provide privacy from family members or present distractions from children in the household. And many members may have difficulties completing paperwork or co-payments electronically.

One survey limitation is that members without valid phone numbers in the system were excluded from the sample. In addition, there were low numbers of responses within subpopulations and claims lag may have meant several weeks passed between the members’ service and survey.

“This survey provides a starting point for continued examination of how telehealth may serve members going forward,” said Wes Knepper, Alliance Senior Director of Quality Management. Ideas for future inquiry include:

  • Leveraging stakeholder insight and digging deeper into claims data to identify populations whose needs are not being met.
  • Continuing to assess ongoing and long-term outcomes of the shift to telehealth for members and providers.
  • Developing strategy to support providers with transitioning to HIPAA compliant telehealth platforms
  • Assessing provider training needs, best practices, and training options.

The survey summary presentation may be found here.

Alliance Expands Partnerships to Care for Communities

Alliance Community Health and Well-Being (CHWB) staff have expanded efforts to improve well-being in our communities during the COVID-19 pandemic through strategic partnerships to reach people in areas of highest unmet social needs.

Factors such as income, employment, education, food security and housing are known to affect health and well-being, and all have been impacted by the COVID-19 pandemic. “When you’re out there in it you realize that the TV does not do it justice,” said Ann Oshel Alliance Senior Vice President—CHWB. “People are really struggling and suffering.”

To reach these people and let them know where to turn for help, Alliance has teamed up with providers and community organizations in new ways.

In one initiative, funded through the CARES Act, outreach teams from Southlight Healthcare and Renew Counseling Center are canvassing in neighborhoods with high rates of COVID-19 infections. The canvassers visit businesses and homes in these areas and offer emotional support and information about accessing helping resources, including the Hope4NC helpline.

“We’re in some neighborhoods where they have a 60% positive rate,” Oshel said. “We know that just about everywhere we’re going somebody knows somebody or has been personally affected,” she said.

Food is a major area of increased need caused by the pandemic, so Alliance has partnered with NC Cooperative Extension Wake County Center and Wake County Public School System (WCPSS) as part of their food insecurity response. “It is huge what they’re doing, and it’s a terrific opportunity to make sure people know where to get help,” Oshel said.

Alliance staff have participated in food distribution events almost weekly, giving out packets that include information about Hope4NC, Alliance Health, and crisis services. At a recent drive-up food distribution at First United Methodist Church Cary, Oshel passed info to people in more than 400 cars that lined up for a Thanksgiving meal, groceries and gift cards. “They are in line for food, which is indicative of some kind of struggle, and everyone just wants to talk about how hard this has been,” she said.

In addition, people in each car scanned a QR code that led to a community outreach survey asking about specific needs each family may have. Those who indicate they are interested in mental health counseling and support are referred to Alliance for follow-up as part of Hope4NC outreach efforts.

Alliance staff will also be participating in upcoming events in partnership with WCPSS and the InterFaith Food Shuttle to deliver food to families currently housed in hotels, with mental health and Hope4NC information included in each box.

Another initiative Alliance has joined is the effort by WCPSS to address students who have not engaged in virtual learning. Alliance staff are analyzing school system data to see if we are already doing outreach into the neighborhoods with a high number of absentees and to help WCPSS determine what interventions and resources can help engage the missing students.

“It’s tens of thousands of kids” who have either never connected to the classroom or engaged only episodically, Oshel said. “The school system is concerned that there might be something more significant going on with the families, and they have asked us to provide some resources,” she said.

“It has evolved from the school system asking us to provide information and join them at events to asking us to work with together with them to make sure the families and students they are really concerned about have somebody to talk to,” Oshel said.

North Carolinians experiencing stress during this trying time can get free crisis counseling from Hope4NC by calling  1-855-587-346;3.

Alliance Launches Hope4NC #HealthyHoliday campaign

Hope4NC #HealthyHoliday social media message

One of the Hope4NC #HealthyHoliday social media messages.

Alliance’s Community Health and Well-Being department has launched the #HealthyHoliday campaign to promote mental health awareness and get the word out about Hope4NC.

To spread the word about Hope4NC, Alliance staff are being innovative to reach those who need hope and help during this holiday season. Throughout this holiday season interactive messaging, interviews, daily words of affirmation and videos will be posted on Alliance’s social media platforms: Facebook, Twitter and LinkedIn.

The Federal Emergency Management Agency originally created Hope4NC after the devastation of Hurricane Matthew to provide emotional support and referrals to community resources to help disaster survivors manage their stress. Hope4NC now offers a 24/7 helpline that provides free crisis counseling for North Carolinians who have been affected by COVID-19 physically, mentally or financially.

Anyone in North Carolina’s 100 counties can call 1-855-587-3463 to be connected to immediate crisis counseling services.

“Hope4NC provides a safe space for you to share your struggles, concerns, and needs by providing confidential crisis counseling and a variety of other resources to improve overall mental health,” said JaMonica Thompson, Alliance’s Hope4NC program manager. “Help us help you, stop the stigma, it’s OK to reach out.”

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New TBI Group Home Opens in Durham

Moretz Manor

Moretz Manor ribbon cutting

Top: Moretz Manor; bottom: Alliance Healthcare Network Program Manager Kate Peterson (right) helped cut the ribbon for the opening of Moretz Manor, a new group home for adults with traumatic brain injury.

Moretz Manor, a new group home in Durham serving adults with traumatic brain injury (TBI), celebrated its grand opening in October.

Alliance Health funded Moretz Manor’s start up and is working closely with Lutheran Services Carolinas on the facility’s development. The home will offer a specialized residential program to people receiving services through the North Carolina TBI Waiver. The program will also be open to adult Innovations Waiver members who sustained a TBI. Lutheran will also be accepting workers compensation and other forms of payment.

The home, located in a quiet Durham neighborhood, has six single-occupancy bedrooms and two full bathrooms, one of which is wheelchair accessible. The home also features a large living room, dining room and kitchen, an outdoor patio, and internet, cable and all amenities.

“Moretz Manor is a welcome addition to the spectrum of community-based care available to adult participants in the TBI Waiver and Innovations Waiver program,” said Cristina Phillips, Alliance Provider TBI/IDD Long Term Supports Supervisor. “The home provides an alternative to a skilled nursing facility or institutional setting.”

The home provides 24-hour supervision, with trained staff assisting residents with activities of daily living, educational and recreational opportunities and skill building. Staff include a program manager and a nurse, and participants will receive psychological and medical services, including speech therapy, occupational therapy, and physical therapy.

About North Carolina’s TBI Waiver program

The TBI Waiver provides an array of home and community-based services, through a three-year Medicaid waiver pilot, in Alliance’s four-county region. The waiver is designed to provide an alternative to nursing facility care or specialty rehabilitation hospital care for eligible individuals with a traumatic brain injury.

TBI Waiver services may be available to residents of Durham, Wake, Cumberland and Johnston counties who experienced a severe TBI which occurred on or after the age of 22, resulted in effects that are likely to continue for a very long time, resulted in significant challenges in completing daily activities, and caused the person to need more than one type of rehabilitative service and supports. Individuals must apply for and be eligible for Medicaid to receive TBI Waiver Services. Alliance staff can assist with the application process. To get started, call the Alliance Health Access and Information Center at 800-510-9132 and ask to speak to a TBI access specialist. Learn more at the Alliance Health TBI Waiver page.

LME/MCOs Preserve Behavioral Healthcare Access During COVID-19

The following op-ed piece was authored by all seven North Carolina LME/MCOs and is being submitted to various publications across the state.

Like nothing before it, COVID-19 threatened access to behavioral healthcare. It led many people to put off or cancel necessary care. It created grave challenges for many healthcare professionals who provide that care to individuals who receive mental health, intellectual/developmental disability (IDD), and substance use disorder (SUD) services. The negative health impacts of this pandemic will extend far beyond the immediate effects of the virus, particularly for those who are either uninsured or on Medicaid and have social and environmental factors impacting their overall health.

Aggressive action was needed to sustain our state’s behavioral health and IDD system so that these individuals have uninterrupted access to care throughout the COVID emergency and beyond. Thanks to the support of the North Carolina General Assembly, Governor Cooper, and the NC Department of Health and Human Services, North Carolina’s Local Management Entity/Managed Care Organizations (LME/MCOs) have been able to meet this challenge by sustaining and adapting the availability of local services and supports across our state.

North Carolina’s seven LME/MCOs are responsible for managing Medicaid and other public behavioral health and IDD funds for millions of North Carolinians in all 100 counties who are uninsured or covered by Medicaid. Working closely with our behavioral health providers, the LME/MCOs have invested more than $150 million over the last six months to help our members, families, and communities weather the pandemic and prepare for challenges in the months and years ahead.

LME/MCOs made significant investments to ensure the availability of local services and supports. We sustained our front-line providers, the healthcare professionals who ensure members receive crucial treatments and care. We made financial stability payments that helped keep their doors open, quickly jump-start telehealth services, and serve individuals virtually.

People can and do recover from mental illness and SUDs–provided they can access the proper treatment. That is why telehealth service delivery has become essential during the pandemic. LME/MCOs utilized funding to purchase mobile phones and data plans for members who did not otherwise have these resources but needed to continue receiving services. By maintaining access to services through telehealth, we can help avoid emergency department visits and unnecessary hospital admissions, thereby relieving pressure on the state’s hospitals and healthcare system. And, we know that positive outcomes for individuals with IDD hinge on promoting stability and helping them stay in their homes and communities of their choice.

We are grateful to North Carolina policymakers for supporting our efforts to maintain access to behavioral health and IDD services for North Carolinians during the COVID-19 pandemic and helping us protect our members, their families, and providers. Because of this support, we have promptly responded to the unique needs of our communities during this crisis. Moreover, we commend our providers for adapting under extraordinary circumstances to serve members and we recognize them for their outstanding courage and dedication to others. The LME/MCOs are committed to continuing to work together with policymakers and providers to successfully serve our members and their families through the pandemic and beyond.

North Carolina’s LME/MCOs:

  • Alliance Health
  • Cardinal Innovations Healthcare
  • Eastpointe
  • Partners Health Management
  • Sandhills Center
  • Trillium Health Resources
  • Vaya Health
Text message on phone

Alliance Health Initiates Digital Communications to Improve Member Health

Alliance Health has launched a digital communications effort to better engage members with their healthcare needs. The pilot program, which began in July, is a population health strategy focused on improving health literacy and providing education and outreach to the people Alliance serves.

“As Alliance prepares to operate a tailored plan as part of North Carolina Medicaid Transformation, this is one of many technologies we are implementing to empower our members to manage their health,” said Alliance Chief Medical Officer Dr. Mehul Mankad.

Members may receive text messages related to resources that can help them stop using tobacco or maintain a healthy weight, remember to take their medication as directed, and follow up with their primary care physician about recommended healthcare screenings or lab work, such as blood glucose tests. The messages will encourage members to call their doctor with any questions.

Members can choose to opt in or out of receiving future text messages at any time during the outreach campaigns, and they may also receive automated calls to update their contact information.

The initiative, which uses an engagement platform developed by HealthCrowd, is part of Alliance’s diverse approach to educating and engaging members through multiple touchpoints and communication formats. Alliance’s vision for engagement of members and individuals who support them includes:

  • Being an active participant, based on one’s cultural values and beliefs.
  • Sharing in decision making, valued and respected as an equal partner
  • Understanding one’s healthcare needs and options and expressing individual preferences
  • Informed choice about accessing services and supports.

“Providing opportunities for education and outreach through digital communication channels will become increasingly important as we focus on an integrated care model to help engage members as they make informed decisions about their healthcare needs,” said Doug Wright, Alliance’s Director of Community and Member Engagement.

Alliance Community Health & Strategy Manager Lori Caviness, who has been instrumental in developing the initiative, called early feedback and indicators such as opt-in rates are “preliminarily positive.” She said the program will be under evaluation as implementation progresses and optimized as appropriate.

Update on Alliance Health’s COVID-19 Response Initiatives

Alliance Health recognizes the ongoing stress that the COVID-19 pandemic has created for our members and their families, our providers, and our communities across our four-county service area (Durham, Wake, Cumberland, and Johnston). Social isolation, loss of routine, and amplified stress associated with in-person school closures, employment uncertainty, and financial concerns present significant risks for individuals already experiencing behavioral health conditions and these circumstances have increased incidents of depression, anxiety, and substance use disorders (SUDs) in our state and across the country.

During this challenging time, it is more critical than ever to sustain and strengthen a behavioral healthcare system to ensure that it is robust and accessible. We know that people can and do recover from mental illness and SUDs provided they can access the proper treatment. Additionally, promoting stability for individuals with intellectual/developmental disabilities (IDD) and others in their homes and communities of their choice is integral to positive health outcomes and living a full life. Thanks to recent funding made available to Alliance Health by the North Carolina General Assembly, the Governor, and the NC Department of Health and Human Services, Alliance has been able to make significant investments to ensure the availability of local services and supports in our communities.

Considering the increased costs to deliver services during the pandemic, Alliance has committed to both ongoing and new rate increases for certain providers through the remainder of the year. These rate increases are designed to stabilize front-line providers by helping offset their extra costs and time related to obtaining and using personal protective equipment (PPE), high-risk pay for staff working in residential facilities, overtime expenses, and higher pay rates to retain and recruit direct care professional and clinicians. These initiatives, coupled with previous financial stability payments made by Alliance during the initial days of the COVID emergency, have enabled our dedicated provider network to continue to serve members in their care and remain accessible for those newly in need of behavioral health services.

In addition to boosting rates to providers, Alliance is making investments in several key areas to enhance access to much-needed services for our members in their home communities. These investments include:

  • Developing an array of specialized services to help ensure that individuals who have received inpatient or crisis services are able to link directly with community-based treatment once they are discharged from a facility or residential program. For example, Alliance has partnered with a local community-based behavioral health provider to implement a Peer Bridging Program. This program enables individuals that are receiving detoxification services from a local crisis provider to meet and engage with a person with similar life experience. These peers provide the individuals with ongoing support and links to other needed services upon discharge.
  • Renovating and starting up a new child crisis center in Wake County to serve youth and families across our four-county region. This facility for children and teens ages 6-17 will include behavioral health urgent care services to address emergency department overcrowding, walk-in access to same-day clinical assessments, psychiatric evaluations, necessary medications, and 24/7 access to assessment, stabilization, and treatment planning.
  • Expanding options for individuals with IDD to live in their home communities. Alliance is designing and funding individualized residential and support services for people who were previously living in an institutional setting.
  • Creating new independent living options for individuals with serious mental illness including a specialized professionally-supported transitional living program that helps adults acquire independent living skills and make the adjustment from receiving treatment in a state hospital to living in the setting of their choice.
  • Local residential service options for individuals with traumatic brain injury.

Making sure that our healthcare system can meet community behavioral health and IDD service needs is crucial now and in the months and years ahead as we deal with the immediate and longer-term impacts of COVID-19. Alliance is committed to continuing to work together with our providers to adapt and innovate in order to effectively serve our members and their families throughout the pandemic and beyond.

Alliance Brand A

Check Out the October Alliance Health InTouch Newsletter

The latest edition of the Alliance InTouch newsletter is now available! Stay “in touch” with what is going on at Alliance and the important work we do to deliver the best care to the people we serve.

Read the Alliance InTouch newsletter.

Alliance Launches New Bridge Housing Program

Alliance Health’s Community Health and Well-Being team recently launched a new bridge housing program in Durham to help people we serve who are living in homelessness transition to permanent supportive housing.

The initiative provides housing, case management, support and referral services for people exiting homelessness to help them move toward self-sufficiency. Alliance aims to help people transition to permanent supportive housing in three to five months.

The new program, which began in August, is similar to one that Alliance operated in partnership with Resources for Human Development at Harrington Place in Raleigh, where most participants were able to move into permanent housing within 90 days. That program was forced to close when the building was sold to a developer who terminated the lease.

“One of the things that we like about bridge housing is the basic concept of giving people a safe and temporary place to live while they get the services and support they need to move toward permanent housing,” said Ann Oshel, Alliance Senior Vice President, Community Health and Well-Being. “It’s better and easier than trying to do that while someone is living under an overpass.”

The bridge housing is located at the Carolina Duke Inn, where Alliance has a master lease on 8 units in one of the buildings. Through a capital investment project, the rooms have been reconfigured into single-room occupancy dwellings with kitchenettes.

The initiative is in partnership with Durham community development organization Reinvestment Partners, which provides onsite management, and Southlight Healthcare, which provides peer support.

Individuals are referred to the program and supported by Assertive Community Treatment (ACT) or Community Support Team (CST) providers or Alliance’s Transitions to Community Living Initiative (TCLI) team, which provide primary supports to participants. The program is available to people in the Alliance service area of Cumberland, Durham, Johnston and Wake counties.

“We are in the process of developing an array of community living options, and bridge housing is an important step in this array,” Oshel said. “This type of program, which matches case management and peer support to help people to find benefits and employment and to navigate a housing search is really one of the best housing interventions we can offer to help people leave homelessness.”

Oshel said that struggles in the hotel industry as a result of the COVID-19 pandemic provided the opportunity for the initiative. “I’m convinced we would not have had this opportunity had it not been for COVID, so it’s a little bit of a silver lining.”

The current lease at Carolina Duke is for two years, during which time Oshel hopes to find a permanent location to continue and improve the program, as well as a funding model that would support the option in all communities served by Alliance.