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2023 Annual Report

Ready for a New Era of Integrated Care

Greetings from Alliance Health

I’m happy to be sharing this message on the eve, finally, of perhaps the most impactful transformation of North Carolina’s Medicaid system ever, the implementation of Behavioral Health and Intellectual/Developmental Disability Tailored Plans across our state. For years, Alliance has been a strong advocate for a model of care delivery that integrates not just the physical, behavioral and pharmacy care of our health plan participants, but also addresses the social and environmental factors that are critically impactful on their well-being. 

During 2023 our preparations for Tailored Plan operations continued, refining systems and processes and building our team to almost 1,100 committed professionals, including new leadership positions in areas such as health equity, hospital and facility relations, medical economics and strategic initiatives. We grew our comprehensive network of physical health providers to almost 1,200, including primary care practices, medical specialists, hospital systems, community health centers, laboratories and skilled nursing facilities. This growth ensured at
year’s end that 95% of our participants could retain their current physical health care providers under our Tailored Plan.
 We’ve also arranged for a statewide network of more than 2,000 retail pharmacies in all 100 counties to provide broad access to needed medicines.

In this report you’ll read about our innovative work to ease strain on local hospitals and the  entire behavioral healthcare system through the creation of community-based capacity restoration programs for people who have been charged with crimes but have been found by the court to be incapable to proceed to trial. These programs provide treatment for defendants charged with misdemeanor or nonviolent offenses who do not require hospital-level care and who can be safely treated within the community, preserving state psychiatric hospital resources for those with more complex needs.

We’ll talk about the solution we’re building to address the issue of youth with complex behavioral health needs, often including intellectual and developmental disabilities, ending up with extended stays in emergency departments, detention or DSS offices. This solution is a comprehensive system focused on early identification, trauma-informed assessments, intervention, community-based support to minimize out-of-home placements and crisis response capacity.

We’re also pleased to share a series of short documentaries highlighting our continued commitment to create options for safe, secure housing for the people we serve. They tell this compelling story from the perspectives of some of our partners in this work, clinicians, landlords and property managers, and most importantly, our members who have seen their lives changed for the better.

As 2023 turned to 2024 we were proud to welcome Harnett County to the Alliance family through a series of live and virtual town hall gatherings. We are grateful for the partnership of county government leaders in making this a smooth transition

Our work is enhanced 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 seven counties. We thank them all, along with our Consumer and Family Advisory Committee, and our partners and colleagues across the Alliance region.

Rob Robinson
Chief Executive Officer

We grew our comprehensive network of physical health providers to almost 

1,200

ensuring at year’s end that a full 

95%

of our
participants

could retain their current physical health care providers under our Tailored Plan.

Addressing Judicial Delays through Community-Based Capacity Restoration

People who are charged with crimes but deemed incapable to proceed (ITP) to trial because of serious mental illness, traumatic brain injury, intellectual and developmental disabilities or substance use disorder often sit in jails until a bed becomes available in one of the state’s three psychiatric hospitals. Alliance Health has partnered with the NC Department of Health and Human Services (NCDHHS) to pilot community-based capacity programs to provide treatment for defendants who can be safely treated within the community. This allows them to proceed more quickly through the court system.

When someone is considered ITP, all legal proceedings are put on hold until that person can get the mental health care they need. Community-based capacity restoration allows defendants who do not require hospital-level care to receive necessary services in a community setting so they can proceed to trial more quickly. This preserves state psychiatric hospital resources for individuals with more complex needs.

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This 2023 Frontline/WFAE News documentary Fractured examines how the country’s mental health crisis is playing out within the criminal justice system in North Carolina.

Alliance is the only Managed Care Organization (MCO) in North Carolina to provide community-based capacity restoration. The pilot projects in Mecklenburg, Cumberland and Wake counties address an increase in demand for capacity restoration services that has overwhelmed the state psychiatric hospitals (Cherry Hospital in Goldsboro, Central Regional Hospital in Butner, and Broughton Hospital in Morganton), which have been the only source of capacity restoration services in North Carolina.

According to NC DHHS, individuals considered ITP use nearly one quarter of the total state psychiatric beds. At Alliance, the demand for capacity evaluations has more than doubled in the last seven years. Because of long wait times for admission, some ITP defendants have had to stay in detention centers for longer than they would if convicted.

Alliance has contracted with Atrium Health in Mecklenburg County, Fellowship Health Resources in Wake County and CommuniCare in Cumberland County to provide community-based capacity restoration services. In Mecklenburg and Cumberland Counties, providers are accepting referrals. In Wake County, teams will begin accepting referrals later this year.

Empowering Families and Stabilizing Youth by Expanding Access to Care

Youth with complex behavioral health needs, including intellectual and developmental disabilities, often struggle to access proper treatment, leading to extended stays in emergency departments, detention or DSS offices. This creates stress for everyone involved. Alliance Health is building a solution: a comprehensive system focused on early identification, trauma-informed assessments, intervention, community-based support to minimize out-of-home placements, and crisis response capacity.

Intensive community-based support for high-risk youth and families

Program helps challenged teens achieve long-term independence

In 2022 Alliance partnered with Flourish Health to bring its intensive community-based model to our members. The specialized program for young adults (ages 13-21) and their caregivers facing significant mental health challenges uses evidence-based treatments to help young people achieve long-term independence. The program treats conditions like psychosis, mood disorders, anxiety disorders, behavioral disorders and serious emotional disturbance.

Each member is assigned a multidisciplinary care team, including a psychiatrist, therapist, “guide” teams for youth and families, a case manager and a crisis response team. Caregivers are actively involved in the process. Members have access to 24-hour crisis support by phone, with a qualified professional responding within an hour. A team of psychiatrists and other clinicians is also on call.

Services include medication management, therapy (individual, group and family), youth and family support, crisis response and case management. Members work with their team to develop personalized goals and an individualized service plan, reviewed regularly. The program offers a variety of therapy options and support services to meet individual needs. Participants can opt to use sensor watches that can be used to track activity, heart rate and sleep patterns. This information is used for monitoring purposes, but services are still provided if the watch is declined.

Hope for youth and families in crisis

The Hope Center youth BHUC opens

The Hope Center for Youth and Family Crisis, a new child behavioral health urgent care (BHUC) center in Fuquay-Varina, opened its doors in June 2023. Serving youth and families across the Alliance region, the BHUC provides 24/7 access to expert assessment, stabilization, and treatment planning for young people in crisis. Coming soon in spring 2024, the center will expand its services with a 16-bed facility-based crisis (FBC) program, offering walk-in care, same-day evaluations and medication management.

Hope Center Exterior
Hope Center interior

Helping youth in crisis find stability

Crisis Stabilization and Transitional Programs (CSTPs)

Crisis Stabilization and Transitional Programs (CSTPs) are short-term, in-facility programs designed to support youth in foster care or behavioral health systems who’ve experienced a placement disruption due to behavioral health issues. Alliance Health partners with providers and the counties we serve to increase both county-specific and regional inpatient CSTP capacity.

County-specific CSTP capacity initiatives include:

Click the arrows on the right and left to scroll through each county.

Mecklenburg
Mecklenburg: 22 beds
Cumberland
Cumberland: 6 beds
Durham
Durham: 4 beds
expected to open in early summer 2024
Wake
Wake: 4 beds
with 10 more set to open soon
different counties
25 beds in different counties open for regional use
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Escape for kids in limbo

Therapeutic relief

Therapeutic relief, run by Pinnacle Family Services, offers a lifeline to children in DSS custody by providing one-on-one outings from non-therapeutic settings like DSS offices. This program serves kids in Cumberland, Durham, Johnston, Mecklenburg, Orange and Wake counties.

Click the arrows on the right and left to scroll through each county.

Cumberland
Cumberland: 27 children served
since the program began in February 2023
Durham
Durham: 10 children served
since the program began in May 2023
Mecklenburg
Mecklenburg: 48 children served
since the program began in late 2022
Orange
Orange: 5 children served
since the program began in May 2023
Johnston and Wake
Programs in Johnston and Wake counties launched in 2024. Statistics will be available next year.
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Keeping families together

Child Assertive Community Treatment Team (Child ACTT)

Child Assertive Community Treatment Team provides intensive in-home or community-based support to prevent residential placement or hospitalization for youth in crisis. A dedicated clinical team is available 24/7, visiting families several times a week. Currently serving Durham and Orange counties, Child ACTT is now accepting referrals in Wake and Mecklenburg counties.

Averting crises and supporting families​

Mobile Outreach Response Engagement and Stabilization (MORES)

Mobile Outreach Response Engagement and Stabilization (MORES) dispatches specially trained responders within an hour to help youth and their families in crisis. These responders connect families to resources, reducing the need for hospitalization and out-of-home placements. MORES teams help keep children out of hospitals and restrictive residential settings and can reduce law enforcement involvement in children’s mental health crises. They also stay connected to the families for eight weeks to make sure they are engaged with a provider. MORES is available in all the counties we serve.

MORES helped 167 children/youth in 2023

MORES received a 2023 Innovation Award from the i2i Center for Integrative Health for person-driven initiatives that bring together community stakeholders to promote the inclusion of individuals in their services, supports and local communities.

Meeting the needs of youth and families to boost success in school

School-Based Team partnership

Alliance’s School-Based Team (SBT) is an award-winning partnership with Wake County Public School System (WCPSS) to identify and connect qualifying WCPSS students to behavioral health services. The program provides system coordination when a child is experiencing a crisis or is in transition to and from crisis or residential placements such as psychiatric residential treatment facilities.

The SBT program received a 2023 Innovation Award from the i2i Center for Integrative Health for demonstrating commitment to innovation in the quality of services by improving treatment through measurable outcomes that result in success in the lives of the individuals served.

In 2023 the SBT launched a new pilot program in response to challenges in youth engagement and well-being created by the Covid-19 pandemic. The Student Engagement Team Pilot (SET) is an intentional, collaborative and holistic approach to help school staff and re-engage young people in positive youth development and educational systems. The pilot recognizes the role of school, community and family in a young person’s engagement and success and implements a community outreach campaign to increase access and reduce barriers. Read more about the SET pilot.

From its launch on July 1, 2023 to December 31, 2023, the SET pilot received

94

referrals

The Traditional Program connects students and their families referred through their school to behavioral health care providers who can assess and recommend appropriate treatment to improve their engagement. The program collaborates with WCPSS and community partners such as Easter Seals CARES to address any barriers to care engagement and help families stay connected to therapeutic interventions and support.

During the 2022-23 school year, the Traditional Program received

219

new
referrals

157

agreed to participate in the program

The Traditional I/DD (Long-Term Services) Program (I/DD-LTS) supports children with intellectual and developmental disabilities (I/DD) who are referred by the WCPSS special education department. Services include crisis intervention, immediate response and navigation of the I/DD eligibility process. The Lighthouse program is a trauma-informed intervention in the I/DD-LTS program that provides intensive support to students with complex needs.

During the 2022-23 school year, the Traditional I/DD Program received

77

new
referrals

63

agreed to participate in the program

The Crisis Program team works closely with local hospitals, crisis facilities and WCPSS to help students as they transition back to school. The team has an immediate alert process in which WCPSS provides rapid notification of “cases of concern.” This includes school-related threats and cases that involve a significant risk of violence or threat to safety. These alerts activate safety planning and support the identified student, family and school.

During the 2022-23 school year, the Crisis Program received

245

new
referrals

216

agreed to participate in the program

The Psychiatric Residential Treatment Facility (PRTF) Program helps coordinate prompt re-enrollment for students leaving PRTFs. During the 20212-23 school year, two SBT PTRF liaisons attended more than 200 Child and Family Team (CFT) meetings. These meetings help facilitate clear communication and collaboration between behavioral health providers and WCPSS to assist students.

During the 2022-23 school year

52

youths were referred to the PTRF Program

51

of whom consented to participate

The Diversion Program helps middle and high school youth who commit low-level, non-violent misdemeanor offenses at school avoid getting charges in the court system by participating in a rehabilitation program.

During the 2022-2023 school year

85

youths were referred to the Diversion Program

65

were eligible to participate

The SBT also includes a bilingual SBT liaison, who provides case monitoring and support across all SBT programs. The bilingual liaison provides Spanish language support, assistance with identifying necessary mental, physical and dental health resources, and community resource information for all clients.

Stable Housing, Better Health: Investing in Housing Solutions

Alliance understands that stable housing is a cornerstone of good health, especially for vulnerable populations. Without a safe and secure place to call home, health issues can worsen and healthcare costs can skyrocket. People experiencing homelessness often rely heavily on emergency rooms, struggle to manage chronic conditions and face higher rates of mental health and substance use challenges. At Alliance, we’re committed to addressing these housing needs. Through a diverse and expanding range of housing options, we empower our members to live, work and flourish in their own communities.

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It takes a collective effort to house our most vulnerable individuals and Alliance is pleased to showcase some of our inspiring success stories in a series of mini-documentaries outlining our work to support people experiencing homelessness.

Capital investments in our members’ health

Securing housing for our most vulnerable members

Lack of affordable housing is a major driver of homelessness and a tall hurdle for housing programs. To address this, Alliance has invested nearly $7.6 million since 2017 to build an inventory of housing available for our most vulnerable members. Alliance’s housing inventory currently includes the exclusive use of 92 units secured through partnerships with affordable housing organizations and developers.

Nearing completion in Wake County is King’s Ridge, a development by our longtime partner CASA in which we have invested $1,000,000. The project is Wake County’s first supportive housing program and will feature trauma-informed design with on-site supportive services. It will provide permanent housing for up to 100 households, including 7 units for Alliance members, and will potentially reduce homelessness in Wake County by 10%. Alliance will also hold the contract for all supportive services at Kings Ridge. The development is expected to open in 2024.

KingsRidge1
Kings Ridge2

Other capital investments include:

TinyHomes1
TinyHomes2

A $350,000 investment to build seven tiny homes at the all-inclusive Tiny Homes Village at the Farm at Penny Lane in Pittsboro, NC. The 15-unit village is a demonstration project aimed at developing a new affordable housing option for people on a fixed income with serious mental illness and other health conditions. The village is part of a partnership between nonprofit Cross Disability Services, Inc., (XDS Inc.) and the UNC School of Social Work. The units were completed in October 2023 and are awaiting county services permits for occupancy, which is expected to begin in Fall 2024.

A $300,000 investment for six units in SECU The Rise on Clanton, Charlotte’s first adaptive reuse permanent supportive housing solution for our most vulnerable members in Mecklenburg County. The facility is an 88-unit former hotel that has been renovated into an affordable supportive housing facility by Roof Above, a Charlotte non-profit working to end chronic homelessness. Each unit has been turned into a studio apartment with a kitchen, and the facility offers onsite access to case managers, a full-time nurse, a learning lab and community space for supportive activities.

A $402,000 investment with Reinvestment Partners to fund the rehabilitation of three units in Durham for kids who have chronic asthma conditions and are frequent users of the emergency department. The interiors of the homes meet all green standards for minimization of potential asthma triggers.

Building a broad supportive housing continuum

Programs that reflect the unique needs of our communities

Providing a broad, inclusive range of equitable shelter and housing solutions is the key to building resilient communities. Each person takes a unique route depending on their situation and our goal is to provide support that fits each member’s individual needs.

Alliance’s continuum of housing solutions includes:

Community Transitional Recovery Program (CTRP)

CTRP provides short-term assessment and recovery supports to people with high and complex needs who are leaving institutions or other acute crisis settings. The program includes intensive supportive housing for 60-90 days to help people transition into independent community-based living. The program currently serves participants in Durham, with six two-bedroom apartments.

Durham Area Supportive Housing (DASH)

DASH is funded by the Department of Housing and Urban Development (HUD) and provides permanent supportive housing to chronically homeless individuals and families. With the average rent rate of $840, Alliance spent $171,343 in rent subsidies towards permanent supportive housing and support services. The use of community partnerships and low-income housing tax credit developments maximized the impact of the funds.

In 2023, the DASH Program served 

26

people

across 17 households, with half of those being 1-person households.

Independent Living Initiative (ILI)

ILI is a short-term financial assistance program for adults and children receiving services through Alliance. ILI assists members facing eviction or utility disconnection, or who need start-up funds such as security deposits for rent and utilities. ILI funds also support homeless individuals and families who had short term stays in local hotels.

In 2023, the ILI program provided $450,000 in assistance to more than 

375

individuals
and family households.

Bridge Housing

Bridge housing provides a temporary safe place to live along with case management, support and referral services for people who have been homeless. The goal is to help people move toward self-sufficiency and transition to permanent supportive housing in three to five months. Alliance currently has bridge housing programs in Wake, Cumberland, Mecklenburg and Orange counties

The Bridge Housing Program served 

77

members

in fiscal year 2023-24.

Durham Health and Housing Case Management Program

This partnership with Duke Health Systems and Resources for Human Development (RHD) connects chronically homeless people referred by Duke clinics with housing. It also helps provide the supportive services they need to maintain housing and manage their health conditions.

Wake Healthy at Home

This partnership with WakeMed and the Wake Continuum of Care connects chronically homeless people identified as frequent users of emergency department or crisis services with housing and supportive services. A HUD grant funds rental assistance while Alliance provides a range of supportive services to help recipients stay housed and healthy.

Helping people thrive in their communities

Transitions to Community Living (TCL)

The Transitions to Community Living (TCL) program empowers adults with serious mental illness (SMI) to thrive independently within their communities. TCL achieves this by connecting them with safe and affordable housing options, along with vital community supports. The program specifically targets individuals residing in or transitioning out of institutional settings, helping them avoid or leave these facilities in favor of less restrictive housing in their chosen communities. TCL also ensures access to critical mental health services, providing additional support through case management, peer support networks and community integration initiatives. This comprehensive approach fulfills North Carolina’s commitment under the Olmstead Settlement Agreement.

Alliance TCL completed 

163

new moves

in fiscal year 2023-24.

Alliance’s 

1,120

TCL members

living in supportive housing represent almost one-third of North Carolina’s TCL members currently in housing.

Building meaningful lives

Employment and community inclusion

Leaving institutional care can be daunting. New challenges like transportation, employment, and daily living tasks suddenly require navigation. To bridge this gap, we’ve partnered with Promise Resource Network. Their peer support program provides community inclusion interventions across various life domains.

This program tackles obstacles that prevent individuals with mental illness from fully integrating into their communities. It empowers them to participate actively and equally, expanding their opportunities for a fulfilling life.

We’re also adapting this community inclusion process for young people transitioning out of foster care or other residential programs. This program equips them with the necessary skills to navigate adulthood smoothly.

Alliance Health’s community integration efforts include referral for Individual Placement and Support – Supported Employment (IPS-SE) to help people with severe mental illness work at jobs of their choosing. We partner with Alliance of Disability Advocates North Carolina (ADANC) to provide community inclusion services, which supports TCL members in fully integrating into their communities, fostering a sense of belonging and social connection. ADANC also provides peer extender work, which uses peer support specialists to enhance our ability to engage in education and in-reach with TCL eligible members living in adult care homes.

Food is medicine

Nutritional support for TCL members

Alongside housing, food is also a health care intervention; a healthy diet may reduce disease symptoms and improve quality of life. To nutritionally support eligible TCL members, Alliance has partnered with digital health and nutrition company NourishedRx to provide nutritious home-delivered food and associated nutritional support services. The goal is to improve tenancy and independent living, improve participants’ nutrition security, support health equity, and improve self-reported health outcomes.

Supporting Our Communities with Accessible Crisis Care

Strong behavioral health crisis response saves lives. Connecting people to the right care when they need it can reduce suicides, opioid deaths, incarceration and unnecessary hospitalization and promotes better recovery and outcomes. Often, a mental health or substance use crisis can be prevented with a timely clinical intervention. However, it can sometimes take weeks to get an appointment with a provider.

Our primary goal for clinical crisis intervention is to quickly de-escalate distress symptoms and connect people to the treatment they need. To make evidence-based treatment more accessible and reduce treatment delays, we are always expanding our crisis care services.

Crisis care in your community

Behavioral health urgent care

Behavioral health urgent care (BHUC) is a community-based option to stabilize people experiencing behavioral health crises. It provides rapid assessment of a person’s situation, medical screening and care, and referrals for follow-up services. BHUC is proven to reduce unnecessary trips to the emergency room, hospitalizations and incarcerations.

Our crisis continuum includes a BHUC in Durham, operated by Carolina Outreach; one in Wake County, operated by Monarch; one at the Steve Smith Family Wellness Center in Charlotte, operated by Daymark Recovery Services; and a youth BHUC at the Hope Center in Fuquay-Varina. There are also BHUCs at the Cumberland Recovery Response Center in Fayetteville and the Durham Recovery Response Center, both operated by RI International.

Alliances Durham and Wake BHUCs served 

2,077

people
in 2023.

79% of the people who came to BHUC saw a physician/prescriber on the same day and 62% left with a prescription. 9% of people with Medicaid had an ED visit in the following 30 days after a BHUC visit.

Data for the other BHUCs is included in the data for crisis and assessment centers later in this section.

Help when you need it

Crisis and assessment centers

Alliance’s crisis and assessment centers offer an alternative to inpatient hospitals in Cumberland, Durham, Orange and Wake counties. Licensed clinicians assess treatment needs and connect people to the right care.

In 2023 Alliance selected new providers (RI International and WakeMed) for the WakeBrook center in Wake County, which reopened in Spring 2024. WakeMed will provide inpatient care and treatment in the 28-bed WakeMed Mental Health & Well-Being Hospital – WakeBrook, located at 111 Sunnybrook Road in Raleigh. RI International will offer crisis and assessment services at the Wake Recovery Response Center, 107 Sunnybrook Rd., with plans to restart the remaining two services, alcohol and drug detoxification unit and facility-based crisis services, soon.

Alliance crisis and assessment centers served 

7,390

people
in 2023.

26% of individuals with Medicaid had an ED visit in the following 30 days after a crisis and assessment center visit.

Crisis support, faster recovery​

Facility-based crisis and detox

Facility-based crisis and detox services help people in an average of 5-7 days build the skills they need to work through crisis, begin recovery and return to their community with continued treatment services. This reduces reliance on emergency rooms and psychiatric hospitals.

Work continued in 2023 on the new facility-based crisis and detox center in Mecklenburg County. The planned Mecklenburg Recovery Response Center will feature a 24/7 walk-in behavioral health urgent care and a 16-bed facility-based crisis center and will serve walk-ins as well as people brought in under involuntary commitment orders. It will also offer 23-hour observation, detoxification and short-term crisis stabilization services. RI International will operate the facility, which is planned to open in late 2025.

Alliance served

2,617

people

at facility-based crisis/detox facilities in 2023.

Crisis care at home

Mobile crisis teams

Mobile crisis teams support people experiencing behavioral health crises in their homes or other community settings. The goal is to stabilize the situation and link people to appropriate treatment and community services, helping them avoid trips to emergency departments and crisis facilities.

Mobile crisis teams helped 

1,495

people
in 2023.

Teaming up for care

Enhanced mobile crisis

Enhanced Mobile Crisis, an innovative pilot partnership between Alliance, Wake County and a community provider, integrates mobile crisis clinicians into the Wake EMS system to provide on-scene assessment, referrals and follow-up support. This helps keep people in their homes and communities whenever possible, reducing the need for hospitalization.

The Wake County Enhanced Mobile Crisis Pilot served 

329

people
in 2023.

3% of whom were stabilized in the community.

Helping people get the right care

Community paramedic services

In Wake, Cumberland and Johnston counties, our community paramedics help people experiencing mental health or substance use crises. These specially trained paramedics can connect people to appropriate care outside the emergency room, when no other medical emergency exists.

Community Paramedic Services served 

3,480

people
in 2023.

Creating a Culture of Patient-Centered Whole-Person Care

Alliance provides essential services to members with intellectual or developmental disabilities (I/DD) and traumatic brain injury (TBI). Our modern, interdisciplinary care teams help people with disabilities get the supportive care they need to live full lives in their communities and reach their goals.

Portrait of african american multigenerational family looking at camera while sitting on sofa couch at home. Family and lifestyle concept.

Promoting independence for people with I/DD

The NC Innovations Waiver

The NC Innovations Waiver, managed by Alliance in six counties, empowers individuals with intellectual or developmental disabilities (I/DD) to live in their communities rather than institutions. The waiver helps people with I/DD live the life they choose with services and supports tailored to their individual needs.

Alliance served

3,551

people

through the Innovations waiver in 2023.

325

new
people

received waiver services through a combination of new slots opened in 2022 and 2023 and slots that were re-filled when others left the waiver.

Alliance member Wiley Johnson, who receives NC Innovations Waiver services for supports that are self-directed through the “Employer of Record” program, is gaining recognition in the arts community for his colorful abstract artwork. The supports Wiley receives through the Innovations Waiver have allowed him to live on his own and create his art. He also enjoys listening to music, gaming, playing his guitar and hanging out with his cat, Melinda. When asked how it felt to live in the community after leaving a care facility Wiley said, “I felt like I could live my life again.” Learn more about Wiley and the difference community living self-directed services have made in his life.

Supporting children with complex needs (CWCN)

CWCN program consultant

Our care management team supports many children diagnosed with both I/DD and a mental health disorder. A dedicated consultant develops strategies to address challenging behaviors and supports training for community providers on positive behavior support, trauma, intellectual disability and autism, and attends treatment team and school-based meetings. She also advocates for unmet needs and helps secure programs, services, and funding.

CWCN accomplishments for 2023 include:

Eight providers, including all NC START teams, completed training in the Skills System method of emotional regulation.

For the first time, two CWCN waiver slots were approved by the NC DHHS Division of Health Benefits.

Ten Alliance care managers completed the National Association for the Dually Diagnosed dual diagnosis specialist certification.

Six children received emergency waiver slots.

An average of three children each month were referred to NC START, a statewide community crisis prevention and intervention program.

Four residential providers were identified to increase bed availability to move CWCN out of local hospitals.

Helping people thrive in the community

The Olmstead team

Alliance’s Olmstead team supports individuals at risk of entering or currently residing in institutions like state hospitals. They facilitate community-based housing and comprehensive support services, allowing members to live fulfilling lives.

In 2023 the Olmstead team worked with more than 250 members in a variety of capacities, including:

Transitioning nine members into the community through B3DI, a Medicaid-funded deinstitutionalization program that helps members in intermediate care facilities for individuals with intellectual disabilities (ICF/IID)

Serving 16 members through Money Follows the Person (MPF), a federal demonstration project run by the states that helps members in facility settings move back into the community using a variety of Medicaid waivers.

Launching a new in-reach program (starting in October) to  engage and educate adults who have a serious mental illness or a serious and persistent mental illness about community-based mental health services and supported housing options such as tenancy support services and rental assistance. The team reached more than 65 people and successfully transitioned seven to community living by the end of the year.

Helping rebuild lives after traumatic brain injury

NC TBI Waiver

Life after a TBI often entails long-term or permanent physical or cognitive disability, which requires intensive rehabilitation and supports. For more than five 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 on or after their 18th birthday. TBI Waiver services have helped members living with TBI in the community for many years and helped some members move back into their community for the first time since their injury.

In 2022 Alliance worked with DHHS partners to expand TBI Waiver services to include members in Orange and Mecklenburg counties. CMS approved the expansion and TBI Waiver services now available in those counties.  To be placed on Alliance’s TBI Waiver registry of interest, members who live in Wake, Durham, Cumberland, Johnston Orange and Mecklenburg counties may call Alliance Member and Recipient Services at 800-510-9132.

The NC TBI Waiver was renewed for another five years on April 1, 2023. As part of the renewal process, new services such as supported living and remote supports were added to the TBI Waiver.

During calendar year 2023, 67 survivors of traumatic brain injury were served by the NC TBI waiver and the population continues to expand. To support the growing population, Alliance created a dedicated position to assist members with establishing eligibility and enrolling in the TBI Waiver.

Fighting the Substance Use Crisis

For more than nine years Alliance Health Alliance Health has championed a multi-pronged approach to address the substance use crisis that is devastating families and communities across the state, and our efforts continue to increase. We continue to expand our efforts toward prevention, harm reduction and treatment access, while tackling stigma, inequities and barriers to care.

Increasing access to substance use treatment

Expanding our network of opioid treatment programs

We have continued to increase our capacity to provide evidence-based substance use disorder (SUD) treatment. As most people receiving medications for opioid use disorder (MOUD) must get their medicine every day from opioid treatment programs (OTPs), making OTPs accessible is a necessity. We are now contracting with 100% of the licensed opioid treatment programs in each of our counties and for treatment of Medicaid recipients and uninsured people.

2019
2020
2021
2022
2023

The number of uninsured people treated at OTPs far surpassed the Medicaid recipients beginning in 2022 as a result of funding through the 21st Century Cures Act State Targeted Response and State Opioid Response grant.

Partnering for recovery

Working with counties to leverage national opioid settlement funds

We are collaborating with all our counties on the use of funds from the national opioid settlements. Two counties, Wake and Mecklenburg have contracted with us to manage funds for treatment access expansion. In Mecklenburg County we are also helping to expand recovery support services and start up early intervention programs.

Making treatment affordable

Covering medication and lab costs for uninsured people

We continue to address financial barriers for people who receive office-based opioid treatment (OBOT). OBOT allows physicians to provide addiction treatment services in primary care settings. It is commonly the setting for treatment with Suboxone (buprenorphine and naloxone), in which patients obtain and fill a prescription rather than receiving their medication daily in a clinic as with methadone. The medication and necessary lab tests can be too expensive for most uninsured people, so we removed this barrier by paying for them.

Fighting opioid addiction behind bars

Detention-based opioid treatment

Five of our seven counties are launching or have launched detention-based opioid treatment. Across the criminal justice system, MOUD has been found to reduce overdose risk, the spread of infectious diseases and recidivism. Our goal is to offer MOUD and peer support to people who have opioid use disorder and are incarcerated and help them connect and transition to community-based treatment after their release.

Harm reduction

Fighting overdoses by expanding access to naloxone

In 2023, Alliance invested $300,000 to distribute naloxone, a life-saving medication that reverses opioid overdose. We provided 6,828 boxes to 50 partners, including opioid treatment providers, crisis facilities and BHUCs, two police departments, four detention facilities and many organizations that provide outreach to homeless and LGBTQ populations.

Supporting people in recovery

Fostering stability through housing

Reliable, supportive housing provides a foundation for long-term recovery success by addressing the social determinants of health that can contribute to substance use. Our recovery housing partnerships give members in recovery safe, stable places to empower them in their recover and help them become self-sufficient.

We have partnered with Oxford House, a housing option for people in recovery. The program provides funding to help uninsured individuals pay for their initial rent and application fee and provides peer support for their transition into the home.

We also contract with NC Recovery Support Services (NCRSS) in Wake County to provide a 45-day transitional housing program for people with opioid use disorder. Participants receive a combination of treatment and housing supports in a group home setting before transitioning to permanent housing.

From September 30, 2023, to March 30, 2024, the NCRSS transitional housing program served

69

people.

Together We Thrive: Building Strong Community Partnerships

We collaborate with organizations, law enforcement and community members to create lasting change in our communities. Through education, training, and system navigation support, we empower individuals to achieve healthier, fulfilling lives.

Nourishing the communities we serve

Community capacity grants

Alliance Health awarded nearly $200,000 in community capacity grants in 2023 to community-based organizations operating food and nutrition programs across Cumberland, Durham, Johnston, Mecklenburg, Orange, and Wake counties. The goal of these one-time grants is to help increase capacity and infrastructure for community food security throughout the Alliance Health region. Organizations may use the funds for food supplies, food distribution, food storage, food education such as cooking and gardening classes, program staffing and/or other administrative costs.  The following organizations received grants:

  • Ada Jenkins Families and Career Development Center, Inc. (Mecklenburg County)
  • Alliance Medical Ministry (Wake County)
  • Angels and Sparrows Soup Kitchen, Inc. (Mecklenburg County)
  • Inter-Faith Council for Social Service (Orange County)
  • Inter-Faith Food Shuttle (Durham, Johnston, Orange, and Wake Counties)
  • Meals on Wheels Orange County, NC (Orange County)
  • Pineville Neighbors Place (Mecklenburg County)
  • PORCH Chapel Hill-Carrboro (Orange County)
  • PORCH Durham (Durham County)
  • Table Ministries, Inc. (Orange County)
  • Women’s Center of Wake County (Wake County)

Helping law enforcement navigate behavioral health crises

Crisis Intervention Training

Alliance equips first responders with the skills they need to safely de-escalate situations involving people experiencing a mental health crisis.  Our 40-hour Crisis Intervention Team (CIT) training helps officers recognize crisis signs, respond calmly, and connect individuals with treatment instead of emergency rooms or incarceration.  We also offer a specialized 16-hour Veterans CIT (VCIT) program to address the unique needs of military veterans in crisis.

In 2023 Alliance staff trained

302

first
responders

and others in CIT, plus eight in VCIT.

Durham Criminal Justice Specialist Laylon Williams (left) and Wake Criminal Justice Specialist Roosevelt Richard (right) have been facilitating CIT (Crisis Intervention Team) training at Alliance for 10 years and are among the most experienced CIT specialists in the state.

Helping others in crisis

Mental Health First Aid training

Mental health crises are more common than heart attacks. Alliance equips our community with the skills to act through Mental Health First Aid (MHFA) classes. This training provides a 5-step action plan to support someone in crisis and connect them to care. We also offer Youth MHFA specifically for those interacting with young people.

In 2023 Alliance held 49 MHFA classes, training 

650

people,

and 17 Youth MHFA classes, training

278

people.

Supporting families in child welfare

Child and Family Team trainings

We offer regular Child and Family Team (CFT) trainings for community members, families and agencies. CFTs are meetings that bring together members of families involved in the child welfare system and their community supports to create a care plan for the child. The plan builds on the family’s strengths, desires and dreams and addresses the needs identified during the child protective services assessment. The two-day experiential trainings provide an overview of CFT meetings from the family’s perspective.

Building a healthier community

Free monthly community trainings

We also offer free monthly trainings to help community members understand and manage their own health and well-being, including:

  • Free virtual community health and wellness trainings on topics such as conflict and crisis management and verbal de-escalation, trauma and managing diabetes.
  • Medicaid Essentials Training in English and Spanish, which provides key information about the steps to determine and confirm eligibility and resources to help North Carolinians navigate the Medicaid expansion process.

Financials

Medicaid$840,591,98975.49%
Federal State$123,903,62311.13%
Local$27,096,4372.43%
Grants / Miscellaneous$172,2600.02%
Administrative$116,111,66610.43%
Others$5,667,1450.51%
$1,113,543,120
Medicaid$766,391,89972.78%
Federal State$124,280,65611.80%
Local$26,253,8422.49%
Grants / Miscellaneous$172,2600.02%
Administrative$135,856,68012.90%
Others$00.00%
$1,052,955,337

*The difference between Administrative revenues and expenses resulted from 1) a required legislative intergovernmental transfer 2) the use of savings for reinvestment related to tailored plan implementation.

**Other income is interest earned on the investment of idle funds in accordance with GS 159-30.

Alliance met or exceeded all requirements of Senate Bill 208 governing the performance of LME-MCOs

  • Financial reports submitted in accordance with our Medicaid contract
  • Ratio of current assets to current liabilities at 1.94 for FY23, exceeding the 1.0 requirement every month
  • 99% of claims paid in a timely manner, providing training and technical support to providers to ensure submission of error-free claims
  • Successful sending and receiving of HIPAA-required data files