Of the member respondents that
received telehealth services, 88% rated
their service good or very good.
2020 is likely to go down as the most unique and challenging year in most of our lifetimes. We saw a global pandemic impact our neighbors and our communities in many ways, not the least of which was an expanded need for healthcare services and supports such as those managed by Alliance, coupled with significant obstacles in getting this help to those who could benefit from it.
I’m very proud of the determination and flexibility of our Alliance team in responding to the challenge by developing new and creative strategies to support both our members and our critical provider partners, while themselves transitioning seamlessly to a predominately work-from-home environment. You’ll read much more about these efforts in this report. In turn our providers – true frontline professionals – have done an exemplary job to ensure continuity of care to the North Carolinians they serve. We are grateful for them, and equally so for the support provided to us by our state partners and our General Assembly in the form of expanded funding and the policy flexibility necessary to adapt to this unprecedented public health crisis.
And the past year provided a critical opportunity to reaffirm our values of diversity and inclusivity and denounce all forms of racism. We have redoubled our commitment to identifying and implementing tangible solutions to anything in our organization that stands in the way of a fair, equitable and welcoming workplace, or anything that prohibits us from reflecting our values within our communities.
We also devoted significant time and attention to 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.
As always, our Alliance team of more than 500 exceptional professionals has focused daily on enhancing and managing innovative, evidenced-based services and supports that allow members of our health plan to live healthier, more satisfying lives. In particular, we sharpened our focus on developing expanded service options for DSS-involved children and youth experiencing behavioral health challenges. Read on to learn more about this.
Our work is bolstered by 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 from our four counties. We thank them all, along with our Consumer and Family Advisory Committee, and partners and colleagues across the Alliance region.
Chief Executive Officer
Working alongside NCDHHS and our strong and committed provider network with the guidance and flexibility our state partners have provided, Alliance stepped up with more than $10 million in additional support to help our members and our communities weather this storm.
Learn more about how Alliance supported our communities
during the COVID-19 pandemic.
Just as the social distancing requirements of the COVID-19 pandemic upended the way we work at Alliance, the public health emergency also created new, pressing needs in our communities. Our Community Health and Well-Being staff sprang into action to help address these new needs.
Of the member respondents that
received telehealth services, 88% rated
their service good or very good.
Alliance SVP, Community Health and Well-Being Ann Oshel: “It Took A Village” to provide fast and needed care to
our communities’ most vulnerable people at the beginning of the pandemic.
During calendar year
to help provide safe, stable
housing in our communities.
Alliance assisted over
individuals and family
Due to the pandemic, we relaxed our program criteria in order to prevent households from becoming homeless. Therefore, several applicants applied for financial assistance more than once due to extenuating circumstances surrounding their housing.
Durham County Virtual Resource Fair
Wake County Virtual Resource Fair
we pumped over
in early April to about 100 of our larger
outpatient providers and providers of
Alliance has been a strong and responsive partner in supporting the work of its provider network in the face of many COVID challenges.
Associate Director of Threshold, Inc.,
and chair of the Alliance Provider Advisory Council
We are dedicated to partnering within our communities and connecting people to supports that enhance recovery and well-being. By giving our communities the tools they need to succeed, including education and training, the development of care guidelines, and wayfinding through the system, we enable people to lead healthier, more satisfying lives.
The COVID-19 pandemic took this work in new directions in 2020 and impacted all the factors known to affect health and well-being such as income, employment, education, food security and housing, as well as our staff’s ability to interact with community members. Undeterred, our Community Health and Well-Being (CHWB) staff improvised to reach people in new ways and let them know where to turn for help.
Alliance CARES volunteers load up food boxes for McKinney-Vento families.
Community Education Specialist Debra Kinney delivers more than 42,000 Hope4NC fliers for distribution at a Cumberland County COVID-19 vaccination clinic.
Alliance is collaborating to build a recovery-focused system of supports that will provide a network of resources for community members and families experiencing emotional distress and disability-related needs so they can live their lives to the fullest, and in the communities of their choice. We have created a series of six Alliance training videos called “Changing Hearts and Minds” that shares basic tools needed to support the people we serve with the dignity and respect they deserve, to improve our communities by allowing them to experience all of their citizens’ different gifts, and to have inclusive neighborhoods that embrace the value of every member.
Alliance Chief Executive Officer Rob Robinson talks about building a recovery-focused system of supports.
At Alliance we recognize that housing is a healthcare intervention, and we have maintained a longstanding commitment to securing safe, decent, and affordable housing for our members in need. Our dedication to addressing housing needs has resulted in a broad and growing continuum of options to assist members in living, working, and playing in the communities of their choice.
Alliance has been amazing. They got me prepared and told me what I needed to do. They made things so much less stressful.
who is supportively housed through
our partnership with CASA.
The Alliance Transitions to Community Living Initiative (TCLI) completed 132 new moves in 2020. The initiative 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 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 2020 with services to find competitive employment and the support to keep their jobs.
Alliance supports and champions the NCDHHS vision of tailored care management, which affords access to resources that address the needs of people with complex and multiple concerns. Tailored Plans in North Carolina will provide comprehensive support to individuals while simultaneously adopting a population health approach to address physical, behavioral, and social needs at the community level. Alliance recognizes that care for complex populations is best provided within communities and closest to where these people live.
Director of Community Care Management
Life after a traumatic brain injury (TBI) often entails long-term or permanent physical or mental disability, which requires intensive rehabilitation and supports. For more than two years Alliance Health has been operating North Carolina’s TBI Waiver pilot project, which provides community-based services and support to people who have experienced a TBI as an adult.
Spending on TBI Waiver services increased by 13 times in the second year of the waiver over the previous year.
Moretz Manor, a new group home in Durham serving adults with traumatic brain injury.
The TBI Waiver implementation team continues to seek ways to boost community awareness of the waiver through outreach to primary care providers, hospital discharge staff, support groups, and other potential referral sources.
Enrollment in the waiver is active and available for people who qualify. To learn more, visit the Alliance website. NC DHHS seeks to begin expansion of the TBI Waiver into more areas of the state within the next year.
Learn more about Traumatic Brain Injury (TBI) and Alliance’s TBI Waiver Pilot.
A traumatic brain injury (TBI) sustained after he was thrown from a truck bed in 2014 changed Elliot Phillips’ life and filled it with struggles. Now, since enrolling in the NC TBI Waiver operated by Alliance Health in April 2020, Elliot has been on a journey toward healing with hope for the future. “It has made my life better in so many ways it’s hard to count,” Elliot said.
Alliance’s School Based Team (SBT) is a partnership with Wake County Public School System (WCPSS) to identify and connect qualifying WCPSS students to behavioral health services.
In the 2019-20 school year
Alliance’s School-Based Team served
The Traditional program, which connects referred students to assessment and treatment to improve engagement and success, served
The Traditional I/DD program, which connects students and families referred by the Special Education department to services, served
The Crisis program, which supports students referred from crisis facilities as they transition back to school, served
The Psychiatric Residential Treatment Facility (PRTF) program, which helps coordinate re-enrollment for students leaving PTRFs, served
The Alternative School program, which assists Longview School students transitioning in and out of crisis facilities, served
The Justice Liaison program, which helps divert teens who commit non-violent offenses at school from getting charges in the court system, served
The COVID-19 pandemic brought many challenges to students and their families. Isolation, family hardship, remote learning, and other unexpected changes have taken a social, emotional, and academic toll on children. The SBT staff’s support to students and their families became more essential than ever during this challenging time.
SBT Alternative School Liaison Chris Toller (far right), and Longview School Psychologist Tracy Cannady (far left) with “Activate Good” staff.
Longview School’s World Mental Health Day video.
Alliance resumed the renovation and start-up of our Child Crisis Center, a child facility-based crisis and urgent care center in Fuquay-Varina to serve youth and families across the four-county Alliance region. Work on the facility had been suspended in 2019 because of continued cuts to state single-stream funding, but we were able to move forward again in 2020 thanks to additional funding for behavioral health and crisis services and no new single-stream funding cuts. The 16-bed facility for children and teens ages 6-17 includes 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. No young person will be turned away while in crisis, regardless of insurer or ability to pay. Targeted completion date is late 2021.
The Tiered Care Coordination (TCC) pilot project, which is 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, continued for its second year in Cumberland County.
The program, which involves collaboration between Alliance MH/SUD care coordination staff, county social services, and juvenile justice staff, and providers CommuniCare and Youth Villages, offers high-fidelity wraparound services to youth coming back into the community from residential programs, including case management, clinical assessment, and follow-up to make sure youth and families get connected to the ongoing services and supports they need. A care coordinator shepherds families through confusing systems and services and a family navigator, who has lived experience with a family member or child with mental health challenges, can assist with treatment and non-treatment needs, including unmet needs like housing and food security. The goal is to help families learn how to navigate and advocate for themselves in the long term.
Alliance was the first MCO to implement TCC with a successful two-year pilot in Durham County during 2018-2019. An evaluation of the Durham pilot 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.
While thousands of youth involved in local departments of social services (DSS) or department of juvenile justice (DJJ) facilities are served successfully every day, a subset of youth with complex behavioral health needs, often including intellectual and developmental disability needs, face challenges in accessing needed treatment. This can result in long stays in the emergency departments, detention centers, or DSS offices. This can have a negative impact on their health and cause considerable stress and concern to them, their families, and agencies charged with supporting them.
At Alliance Health, we have focused our efforts on improving treatment and support for these individuals and their families. We have invested more than $13 million to date on an initiative to develop and implement a comprehensive service continuum to address the complex needs of this specialized population.
A full continuum should include early screening and identification of children and youth with social/emotional/behavioral needs, comprehensive trauma-informed assessments, early intervention and prevention, educational supports, fully integrated care management, a comprehensive array of community-based services and supports, residential treatment options, crisis response capacity, and the appropriate use of state facilities.
By their nature, crises can’t be predicted, which is why we have structured services and implemented approaches that can best meet the needs of people we serve who experience a behavioral health crisis. Our crisis continuum is designed to minimize delays, deliver the right care in the right place at the right time, and when possible, avoid the unnecessary use of emergency departments and jails.
The primary goal of our crisis services is to stabilize and improve symptoms of distress and to engage individuals in the most appropriate treatment to address the problem that led to the crisis. 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, our behavioral health urgent care centers (BHUCs) in Wake and Durham counties bridge the gap in access to care for individuals experiencing 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.
Number served by BHUCs
of individuals with Medicaid had an ED visit in the following 30 days after a BHUC visit.
left with a
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.
1,178 individuals were served by Facility Based Crisis/Detox Facilities.
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.
678 individuals were helped by a Mobile Crisis Team.
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.
823 individuals were served by the Wake County Enhanced Mobile Crisis. 32% of them were stabilized in the community.
Community Paramedic Services 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.
4,916 individuals were served by Community Paramedic Services.
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.
We have resumed the renovation and start-up of our Child Crisis Center, a child facility-based crisis and urgent care center in Fuquay-Varina to serve youth and families across the four-county Alliance region.
individuals were served by Alliance Crisis and Assessment Centers.
The COVID-19 pandemic contributed to a worsening of the opioid epidemic, resulting in a 22% increase in NC emergency department visits due to opioid overdose, and a rate of overdose deaths that the CDC reports to be the highest in US history. In addition to social isolation, loneliness, and job loss, people who use drugs have been affected by a more dangerous street drug supply. This supply is often contaminated with synthetic Fentanyl, which is 50 times more potent than heroin and is considered to be the primary driver of increased overdose deaths nationwide. These trends illustrate the importance of Alliance Health’s ongoing work to provide timely treatment access, support to address unmet social needs, and assistance with sustaining recovery, as well as supporting community harm reduction efforts.
Opioid Treatment By The Numbers
* Some programs have decreased capacity and availability due to the pandemic.
We have grown our network of medication-assisted treatment (MAT) providers to include seven opioid treatment programs (OTPs) where new patients go every day for their medication, and eight office-based opioid treatment (OBOT) providers where people get a prescription for their medication. This has resulted in a dramatic increase in the number served with this effective treatment.
We are also continuing efforts with other initiatives in our communities to grow the substance use disorder system of care, including:
|Grants / Miscellaneous||$159,287||0.03%|
|Grants / Miscellaneous||$134,926||0.02%|
*The difference between Administrative revenues and expenses resulted from 1) a required legislative
intergovernmental transfer and 2) the use of savings for reinvestment related to tailored plan implementation.
Moving forward from what you’ve read and heard here, we will continue our daily work to lead North Carolina in its transition to providing whole-person public sector care for its citizens.
We’ll do this, as always, shaped by our values: compassion for our members, respect for the diversity of our communities, integrity and accountability in our use of public funds, a major dose of collaboration, and our usual high level of innovation.