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Message from the CEO - December 2018

Cardinal Innovations Healthcare — diciembre 05, 2018
This month marks the one-year anniversary of our member newsletter, Cardinal Innovations COMMUNITY – which also means it’s the one-year anniversary of my monthly message to you as CEO. We launched this newsletter for, and with, our members and families and I’m proud of how far we’ve come in one year. Of course, we are always looking for ways to do better - we are continuing to listen and learn, to make sure we’re talking about and doing things that are important to you.

On that note, I’d like to talk to you today about something that I’ve been hearing from a lot of members and families about. Last week, the NC Department of Health and Human Services (DHHS) hosted a webinar for Medicaid members and their families on Medicaid Transformation.  Along with several DHHS representatives, Kody Kinsley, Deputy Secretary for Behavioral Health & Intellectual and Developmental Disabilities at DHHS, and Dave Richard, Deputy Secretary for NC Medicaid, shared an overview of Tailored Plans and how they will be designed as a part of Medicaid Transformation.

DHHS is working hard to ensure that Tailored Plans serve the unique needs of each member.  Benefits for physical health, pharmacy, behavioral health and long-term services will be combined into a single plan, with a strong focus on consumer and family representation.  Cardinal Innovations believes strongly in this approach, and has been working hard to ensure that we are ready to begin operating as a Tailored Plan in July of 2021. 

As we all prepare for Medicaid Transformation, one key area where our plans differ from what the state shared last week has to do with care coordination. Many of you reading this message are familiar with Cardinal Innovations care coordinators, and understand what an important role they serve within your families. Our care coordinators are central to our community-based approach to care, and directly interact with thousands of members every single day. Our care coordinators are on the ground, in your lives and often in your homes, on a regular basis helping you navigate the system.

Before last week’s webinar, we understood that under Medicaid Transformation, Care Coordination would remain with the Managed Care Organizations, as explained in legislation passed by the NC General Assembly (“entities operating BH/IDD Tailored Plans shall operate care coordination functions”). On a slide presented to members and families last week, DHHS discussed Care Management and indicated that Managed Care Organizations like Cardinal would be required to contract with other agencies for Care Management. At this time, we are working with DHHS to understand the distinction between Care Coordination and Care Management, and to ensure that any plans for Care Management do not disrupt care for our members that receive care coordination.

While we believe there is an opportunity for Care Management for members who may not meet certain requirements for in-person, monthly care coordination, we feel strongly that our model of care coordination provides the most complete, personal, and member-focused care management available to people with intellectual and/or developmental disabilities, as well as those serious mental health needs. For many families, their Cardinal Innovations care coordinator has been a part of their family for years - this is something I have experienced first-hand sitting in living rooms and visiting with members along with our care coordinators throughout this last year.

After this webinar last week, the LME/MCO CEOs had their regular monthly call with DHHS leadership. As you can imagine, there was a lot of confusion and many questions following their presentation to members and families.  We don’t have firm answers at this time. What I can promise each of you is that we will continue to work closely with the Department to work towards developing a system of care in North Carolina that puts the interests of our members first. In addition, the Department has indicated that a policy paper on care management will be available in January, and that members and families, LME/MCOs, and other stakeholders will be a part of those discussions. We’re looking forward to being at the table.

In 2019 we will begin a series of care coordination focus groups to make sure we’re really listening to our members and families about what’s working and what’s not working. I cannot say it enough – your voices matter and we can’t do better without them. In addition to the focus groups, we are also working to ensure we are truly knowledgeable about all models of coordinating care. We will soon be launching a study to clearly define each step of a member’s health care journey, at which points a care coordinator interacts with the member, and most importantly, where the care coordinator is best placed to provide needed support.  I hope to provide an update on both of these important initiatives to you next summer.

I began this update talking about continuous improvement – that goes for everything we do here at Cardinal, including care coordination. I hope you’ll continue to tell us how we are doing and how we can improve in every aspect of what we do.

Best wishes and happy holidays,

Trey Sutten, CEO
Cardinal Innovations Healthcare

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