Alliance Health Investing $25+ Million to Increase Access to Services

Recognizing that we and the communities we serve are Better Together through partnership, investment and service, Alliance Health has launched a multi-year initiative to invest more than $25 million in a range of targeted projects to build provider capacity and expand critical community-based health care services. The goal of this investment is to strengthen local access to mental health, intellectual and developmental disability (I/DD) and substance use disorder services by addressing service gaps and bolstering provider resources. The investments align with established NC Department of Health and Human Services (DHHS) priorities for responsive whole-person health that is driven by equity in access to health care.

Behavioral Health and Resilience:  supporting “upstream” services to build resiliency and enhance existing systems of care to expand access to mental health services and reduce stigma around them.

Alliance investment:

• Expansion of community living options, including a variety of wraparound services, rooted in recovery and promoting independence as an alternative for congregate care
• Expansion of specialized assertive community treatment team (ACTT) services to better support adult members living with serious mental illness
• Expansion of harm reduction efforts, including allocation of naloxone, fentanyl test strips and medication lock boxes, known to reduce deaths, promote engagement in treatment and reduce the spread of communicable disease
• Partnership with the NC Association of Pharmacists to support syringe services programs
• Expansion of office-based opioid treatment for the uninsured, including oral and injectable extended-release medications
• Increased appropriate and safe utilization of clozapine (an FDA-approved medication for treatment-resistant schizophrenia), support of a new youth clozapine clinic and expansion of the STEP clinic (schizophrenia treatment and evaluation program) in Wake County
• Support of NC MedAssist efforts to ensure access to needed medication and tobacco cessation treatment for the uninsured

Child and Family Well-Being:  investing in families and children’s healthy development by nurturing resilient families and communities.

Alliance investment:

• Startup funds for new child assertive community treatment (Child ACT) programs, using intensive wraparound services in a family setting, in Durham, Mecklenburg, Orange and Wake counties
• Professional parenting training for foster parents caring for children requiring higher levels of care

Strong and Inclusive Workforce: strengthening the workforce that supports health and wellness by ensuring that all people can be fully included members of their communities.

Alliance investment:

• Launching an independent clinically integrated network for historically underutilized providers to ensure that historically marginalized populations have access to providers who are more reflective of their own communities
• Funds to support expanded training for I/DD direct service providers (DSPs)
• Capacity building and technical assistance for care management agencies and advanced medical home plus (AMH+) practices
• Training for new community health workers to address linguistic capacity barriers
• Funding of a pilot project to evaluate the significance of pharmacist-led services in supporting improved member outcomes

“Alliance is committed to transforming health care by ensuring our members have equitable access to quality services and supports for those with the greatest needs,” said Alliance CEO Rob Robinson. “This $25+ million investment is driven by the shared mission of Alliance and our public system to improve the health and well-being of people with complex needs by reinvesting in our communities. This ability to reinvest is central to why LME/MCOs were created. We appreciate DHHS’ collaboration with Alliance as we developed this multi-year initiative.”

The components of this round of Alliance’s Better Together investment are:

Historically Underutilized Provider Clinically Integrated Network

Alliance believes that an important step in promoting and achieving health equity is ensuring that minority and underserved populations have access to providers that are more reflective of their community make-up. These historically underutilized providers (HUPs) have deep roots in their communities and a mission to serve them, but often lack the financing to secure critical technology and information management systems, initial network management/administration, and related staffing, hardware, legal and consulting services. We are supplying monetary support and technical assistance they need to become viable members of the Alliance provider network. Alliance will initially have 18 HUPs providing care management to Alliance members and an overall care management network of 42 provider-led entities after two rounds of certification.

Additional Capacity-Building Funding for Care Management Agencies (CMAs) and Advanced Medical Home Plus (AMH+) Practices

Alliance will invest in intensive technical assistance for our providers certified by the state as CMAs and AMH+ practices to build the capacity needed to successfully implement Tailored Care Management (TCM). TCM provides Alliance Medicaid members  with a single designated care manager supported by a care team to provide care management that addresses all their needs including physical health, behavioral health, I/DD, traumatic brain injury, pharmacy, long-term services and supports, and unmet health-related resource needs.

Expansion of Community Living Options

Alliance has built an array of community living options offering a variety of onsite wraparound services. These supportive housing programs are rooted in recovery and promoting independence that provide education and skill building and offer an alternative to congregate care. Our investment initiative will expand capacity for specific programs, including:

• Bridge Housing

  A three-to-nine-month program focused on serving people with serious mental illness or with co-occurring substance use conditions. Preference will be given to people who are experiencing homelessness or housing insecurity and have not been stable enough to engage in services and housing search. This funding will expand bridge housing in Wake, Durham and Mecklenburg counties.

• Enhanced Bridge Housing

  A nine to 12-month program focused on serving people with severe mental illness who are discharged from inpatient settings and have more intensive needs than the traditional bridge housing program would serve. Onsite staff is provided seven days a week for 12-14 hours per day and use remote sensors for overnight monitoring.

• Supervised Living

  A 12 to 18-month program focused on serving people with severe mental illness who have extensive crisis and inpatient utilization and have been unsuccessful in lower levels of care. This program will provide 24/7 staff and the ability for medication management and will expand the Varsity Crest supervised living model in Durham County using single room occupancy units allowing for a more intensive supervision and monitoring of members.

Strong Minds Community Health Workers Training Program to Address Linguistic Capacity Barriers

Alliance funding will provide training for 24 new community health workers (CHWs) through the Strong Minds CHW program, a curriculum designed to address health workforce shortages and mitigate access challenges regarding mental health services in settings where there are linguistic capacity barriers. The overall objective of this request is to help address significant linguistic capacity barriers across our region.

Expansion of Child Assertive Community Treatment (Child ACT)

This investment will finance startup costs for Child ACT programs in Durham, Mecklenburg, Orange and Wake counties. Evidence demonstrates that children who are experiencing behavioral health problems often have better outcomes when they can receive care in a family setting. Using intensive wraparound services to manage the care of children in a family setting frequently yields greater treatment success than a congregate care setting. Child ACT serves children in their homes, kinship placements or may begin during transition from a more restrictive residential setting.

Implementation of a Professional Parenting Certification Program

Across the nation and in North Carolina, there is a foster care crisis. Finding placements for children and youth with more complex needs is extremely challenging. Frequently, these children/youth are placed in institutional settings that are not appropriate for the level of care needed. This funding will increase professional parenting capacity to provide care and support in a home environment to children/youth with serious emotional and mental

health needs. Children/youth are matched with a foster care parent who is a paid professional that is employed by a foster care agency.

Specialized Assertive Community Treatment Team (ACTT) Expansion

Alliance will use these funds to develop and implement two ACT teams that will receive intensive permanent supportive housing training and ongoing technical assistance to better support individuals who are part of the Transitions to Community Living (TCL) population. TCL provides eligible adults living with serious mental illnesses the opportunity to choose where they live, work and play in North Carolina. This initiative promotes recovery through providing long-term housing, community-based services, supported employment and community integration.

Expansion of Harm Reduction Efforts

Harm reduction efforts are known to reduce deaths, promote engagement in treatment, reduce the spread of communicable diseases such as HIV and hepatitis and prevent medical complications such as endocarditis. Alliance funding will support harm reduction efforts through one-time purchases of naloxone, naloxone vending machines, fentanyl test strips, drug testing equipment and supplies, medication lock boxes, medication disposal kits and other allowable harm reduction expenditures.

Partnership with NC Association of Pharmacists (NCAP) to Support Syringe Services Programs

Alliance will establish partnerships between syringe service programs (SSPs) and local pharmacies in Alliance counties to support harm reduction efforts by allowing syringe disposal, access to tobacco cessation treatment, medication access, vaccinations and

potentially other health services that are available through pharmacies. Funds will enable SSP/pharmacy partnerships in Alliance counties and additional targeted support in Mecklenburg and Wake counties.

Expansion of Office-Based Opioid Treatment for the Uninsured

Alliance will purchase medication for opioid use disorder for people who are uninsured. These individuals face significant barriers to receiving care, particularly those who are seeking office-based opioid treatment (OBOT) services. These funds will be used to purchase oral (buprenorphine/naloxone) and injectable extended-release medication (e.g., Sublocade) for treatment of opioid use disorder.

Support to NC MedAssist

NC MedAssist seeks to ensure that no eligible person in North Carolina must choose between purchasing food or necessary medication, improving the person’s health and lowering uncompensated health care costs for all.

• Expand Access to Medication for the Uninsured in Mecklenburg County

  Alliance will provide funds to purchase medication for the uninsured who receive care at a behavioral health urgent care center (BHUC). These funds will enable uninsured people who go to the BHUC for services to receive medication for behavioral health conditions in a timely manner and at no cost.

• Expand Access and Upgrade Equipment

  In addition to funding for medication, Alliance will support mobile free pharmacy events and support ongoing operational requirements through the purchase of a truck, medication dispensing robot and telemedicine devices for telepharmacy.

• Expand Access to Tobacco Cessation Treatment

  Alliance will provide funds to purchase medication to assist with tobacco cessation for the uninsured. In addition to the health benefits for recipients who use tobacco products, availability of tobacco cessation treatment is important for providers as they transition to new requirements for tobacco-free campuses.

Pilot Project with the NC Association of Pharmacies

Alliance will fund a pilot project with NC Association of Pharmacies (NCAP) to evaluate the significance of pharmacist-led services in supporting improved outcomes for Tailored Plan members. Pharmacists in North Carolina have the authority to provide hormonal contraceptives, tobacco cessation, HIV prevention, prenatal vitamins, glucagon and the administration of self-administered injectable drugs as well as long acting injectables. With these new provisions, coupled with pharmacist delivery of education, screening, adherence monitoring, packaging and evaluation of medication-related problems, pharmacists are in a unique position to impact patient care regarding mental illness.

Support for Increased Utilization of Clozapine

Alliance will provide funds to the North Carolina Clozapine Network (NCCN) and to purchase remote patient monitoring devices for use by Alliance providers. NCCN is a clozapine expert group whose primary mission is to increase appropriate and safe clozapine utilization across North Carolina. Scientific studies have consistently demonstrated the superior functional outcomes, symptom control, tolerability and acceptability, reduction in hospitalization and use of crisis services, reduction of suicidality and violence and lower mortality rate in people with a schizophrenia diagnosis who take clozapine.

Youth Clozapine Clinic and Wake STEP Clinic Expansion

Alliance will provide funds to the North Carolina Clozapine Network to support a new youth clozapine clinic and for expansion of the STEP clinic in Wake County.

Expanded Training for Intellectual and Developmental Disabilities (I/DD) Direct Service Providers

Alliance will fund training for direct service providers (DSPs) who work for participating network providers in response to the critical need for workforce retention and increased support for DSPs across our region.

• DSP I/DD-MI Dual Diagnosis Workforce Development Project

  A training series for DSPs employed by Alliance providers designed to enhance network capacity to serve people with co-occurring I/DD and mental illness through a comprehensive training program that enhances skills, awareness of best practice competencies, and preparation for DSP certification.

• Skills Systems Program for Residential Providers Including Innovations, B3DI, TBI, and ICF Services

  It is a frequent challenge to identify appropriate residential placement and day treatment programs due to children exhibiting multiple aggressive and destructive behaviors. Untreated trauma and challenges learning emotion regulation, particularly for children with autism, are main drivers for these behaviors. The Skills Systems training series will be offered to each of the targeted residential providers, who will then be able to train their own staff, access online resources, and schedule monthly consults to discuss successes and barriers and to receive technical assistance.

• Training for Direct Support Professionals through the National Center for START Services

  • Direct Support Professional (DSP) course

    A live, six-session course that provides DSPs the knowledge, skills and resources needed to provide people with an intellectual development disability or mental health service (I/DD-MH) positive, person-centered, strengths and wellness-based supports and services.

  • Mobile Crisis Responder Course for DSPs

    A live, six-session course that offers the expert training and support needed to develop expertise in providing effective crisis support to people with an intellectual development disability and mental illness. Topics address best practices in crisis assessment, response strategies, and disposition recommendations.

  • Care Coordinator Course for Care Managers

    A live, six-session course that provides care coordinators with expert training where the course facilitator will demonstrate how the information reviewed during sessions can be applied in the day-to-day support of people with an intellectual development disability and mental illness.