Quarterly Report. Ken Jones, CEO. Renewing the Mind, Restoring the Spirit 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R

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Quarterly Report B o a r d o f D i r e c t o r s R o b B o y e tt e - C h a i r Bladen Emery White Billy Ray Pait Columbus James Prevatte Paul Russ Duplin Rebecca Judge Kay Hinson Edgecombe Addie

1 Quarterly Report B o a r d o f D i r e c t o r s R o b B o y e tt e - C h a i r Bladen Emery White Billy Ray Pait Columbus James Prevatte Paul Russ Duplin Rebecca Judge Kay Hinson Edgecombe Addie Carmon Greene James Shackleford Jerry Jones Lenoir Emily Moore Barry Dixon Nash Lisa Barnes Pearl Finch Robeson Jerry Stephens Tim Brooks Sampson J.W. Simmons Albert D. Kirby, Jr. Scotland Stephanie Monroe Carol McCall Wayne John Bell Nancy Moore Wilson Rob Boyette Executive Summary I am extremely pleased to inform you of the excellent work that Eastpointe has done on behalf of the citizens we serve during this time period. This report details data regarding our core functions. It shows that Eastpointe has frequently exceeded the State s standards, as well as increased services to our member/enrollees. While graphs quantify our accomplishments, it is important to note that it is the people of Eastpointe that achieve our successes. Included are our Board of Directors, administration, staff, and partners. In August, Wilson County Commissioner Rob Boyette assumed the role of Chairman of Eastpointe s Board of Directors. Mr. Boyette places member services as top priority. Boyette brings a wealth of business and organizational experience and talent to the table. The Eastpointe Board of Directors received training from the National Council for Behavioral Healthcare on the topic of Governing for Success: Positioning Eastpointe for Transformation. This is just one example of the steps that our Board of Directors is taking to ensure that Eastpointe is appropriately prepared to continue to serve our citizens in the future, as behavioral health care in North Carolina changes. Dr. Bryan Spader, Assistant Medical Director, became a Certified Brain Injury Specialist. He is comprehensively trained and nationally recognized to address incidence and epidemiology of brain injury. With Spader s new specialization, Eastpointe can address the traumatic brain injury needs of our communities with a strong foundation in the best practices in brain injury rehabilitation. The Carolinas Center for Medical Excellence (CCME) conducted it s External Quality Review Onsite of Eastpointe during this reporting period. Reviewers examined data files, and conducted interviews with staff. Eastpointe passed this very rigorous and comprehensive review, and was approved by CCME. The work of every staff member contributed to the information reviewed. Renewing the Mind, Restoring the Spirit 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R In the final month of this reporting period, The NC Council of Community Programs bestowed the Excellence Award for Prevention, Outreach, and Wellness to Eastpointe and one of our community partners, Kinston Teens. What a way to finish 2015! As we enter 2016, there are sure to be challenges and changes. But member/enrollees that need behavioral health services remains the steadfast focus of Eastpointe. The people of Eastpointe will work diligently every day to make sure that mission is achieved. Ken Jones, CEO

P A G E 2 Access to Care Total number of persons requesting Mental Health, Intellectual Developmental Disability and Substance Abuse Services (MH/IDD/SA) for the first quarter was 1,948.

During the second quarter 44%(752) of calls were triaged Emergent, 36%(626) Urgent, 20% (336) Routine.

STANDARD 97%:Emergent: 2 Hours,15 min 82%:Urgent: 48 Hours 75%: Routine: 14 Calendar Days During the first and second quarter, an average of ninety-nine percent (99%) of individuals determined to

2 P A G E 2 Access to Care Total number of persons requesting Mental Health, Intellectual Developmental Disability and Substance Abuse Services (MH/IDD/SA) for the first quarter was 1,948. During the first quarter, 43% (837) of calls were triaged Emergent, 35%(684) Urgent, 22% (427) Routine. In the second quarter there were a total of 1,714 requests for services. During the second quarter 44%(752) of calls were triaged Emergent, 36%(626) Urgent, 20% (336) Routine. Eastpointe continues to research ways to assist and encourage members to attend their appointments within triaged timeframes. STANDARD 97%:Emergent: 2 Hours,15 min 82%:Urgent: 48 Hours 75%: Routine: 14 Calendar Days During the first and second quarter, an average of ninety-nine percent (99%) of individuals determined to need Emergent services were scheduled within 2 hours 15 minutes of request exceeding the state standard of 97%, fan average of fifty-four percent (54%) of members deemed Urgent were scheduled within 48 hours falling below the State standard of 82% and an average of eighty-six (86%) received timely services within 14 calendar days exceeding the state standard of 75%. Eastpointe currently has a Quality Improvement Initiative to increase access to services for members determined to need Urgent Care. STANDARD 97%:Emergent: 2 Hours,15 min 82%:Urgent: 48 Hours 75%: Routine: 14 Calendar Days Totals represent Combined measures for Medicaid and Non-Medicaid Source:FY st and 2nd Quarter Call Center Access to Care Performance Report

# Complaints 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R 2 0 1 5 P A G E 3 Complaints 100 80 60 40 20 0 97 70 Total Complaints Received Complaints July-December 2015-16 35 29 62 41 33

3 # Complaints 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R P A G E 3 Complaints Total Complaints Received Complaints July-December Medicaid Non_Medicaid # of Complaints by or on Behalf of Consumer 64 # of Complaints not by or on Behalf of Consumer 1st Quarter 2nd Quarter Eastpointe processed a total of 97 complaints during July-September 2015 (1st Quarter). A total of 34 complaints resulted in an investigation, with 11 being substantiated, 20 not substantiated, and 3 that were partially substantiated. The top 3 categories for Primary nature of complaints were Quality of Care by Providers (36), LME-MCO Functions (26), and Authorization/Payment/Billing-Provider Only (12). All complaints were resolved within 30 days. During October-December 2015 (2nd Quarter), Eastpointe processed 70 complaints. A total of 20 complaints resulted in investigations, 4 were substantiated, 13 were not substantiated, and 3 were partially substantiated. The top 3 categories for Primary nature of complaints were Quality of Care by Providers (28), LME-MCO Functions (19), and Authorization/Payment/ Billing-Provider Only (12). Of the 70 complaints processed during the second quarter 69 were resolved within 30 days, with 1 being resolved within days. Source: FY st and 2nd Quarter Complaint Report

1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R 2 0 1 5 P A G E 4 Community Psychiatric Hospitalization During July-December 2015, there were 861 Mental Health (MH) admissions and 63

Sixty two members (7%) with a principal MH diagnosis and seven (11%) with Substance Abuse were readmitted within 30 days. Average length of stay for MH admissions was 6.1 days, while SA averaged 4.

4 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R P A G E 4 Community Psychiatric Hospitalization During July-December 2015, there were 861 Mental Health (MH) admissions and 63 Substance Abuse (SA) Medicaid funded admissions to Community Psychiatric Hospitals. Sixty two members (7%) with a principal MH diagnosis and seven (11%) with Substance Abuse were readmitted within 30 days. Average length of stay for MH admissions was 6.1 days, while SA averaged 4.8 days. During July-December 2015, there were 260 Mental Health (MH) State Funded admissions to Community Psychiatric Hospitals and 77 Substance Abuse (SA) admissions. Thirteen (13) re-admissions within 30 days occurred for individuals with a primary MH diagnosis and seven (7) with a primary SA diagnosis. Average length of stay for MH admissions was 5 days, while SA averaged at 4.2 days. Source: December Eastpointe-LME_MCO Monthly Monitoring Report for DMA-DMH

5 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R Authorizations Utilization Management (UM) received a total of 14,003 authorizations during the first (7,180) and second (6,823) quarters. During both quarters, UM received a total of 10,844 standard authorization requests of which 10,804 were processed within 14 days. A total of 3,159 expedited and inpatient authorization requests were received with 3,092 being processed within three(3) days. Eastpointe exceeded the state standard of 95% for all standards, achieving 99.6% for processing authorizations within 14 days, 97.8% of expedited and inpatient authorization requests processed in 3 days, and 99.2% of total authorization requests processed in required timeframes. 8,000 6,000 4,000 2,000 0 Total Authorization Requests Received-Medicaid July-September 7,180 6,823 Total Received 1st Qtr 2nd Qtr 5,632 5,212 Standard Auth. Request Decisions 1,507 1,585 # Expedited and Inpatient Requests P A G E 5 There were a total of 1,359 Medicaid funded requests denied during the 1st quarter (654) and 2nd quarter (705). Utilization Management (UM) received a total of 2,822 authorizations during the first (1,414) and second (1,408) quarters. UM received a total of 2,452 standard authorization requests of which 2,440 were processed within 14 days. A total of 370 expedited and inpatient authorization requests were received with 363 being processed within three(3) days. Eastpointe exceeded the state standard of 95% for all standards, processing 99.5% of authorizations within 14 days, 98.3% of expedited and inpatient authorization requests processed in 3 days, and 99.3% of total authorization requests processed in required timeframes. 2,000 Authorization Requests-IPRS July-December ,414 1,408 1,234 1, There were a total of 334 State funded requests denied 0 Total Received 1st Qtr Standard Auth. Request Decisions 2nd Qtr # Expedited and Inpatient Requests during the 1st quarter (186) and 2nd quarter (148). Source: January EP-LME_MCO Monthly Monitoring Report for DMA-DMH

1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R 2 0 1 5 Penetration Rate Penetration Rate captures the percentage of Medicaid enrollees under the 1915 B/C waiver who received at least one

6 1 S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R Penetration Rate Penetration Rate captures the percentage of Medicaid enrollees under the 1915 B/C waiver who received at least one Medicaid-funded Mental Health, Intellectual/ Developmental Disabilities, or Substance Abuse (MH/I/DD/SA) service during the measurement period in each of the six age-disability groups and for all agesdisabilities combined. During July-September 2015; 18,396 members received at least one service. Robeson County served 3,452 individuals, Wayne 2,932 and Wilson 1,901. Total number of Medicaid enrollees in Eastpointe's catchment area was 204,874. Percent that Received at Least One MH/IDD/SA Service - Medicaid July - Sept % 8.41% 9.26% 8.38% 9.07% 10.94% 7.57% 8.38% 6.38% 9.47% 11.10% 10.18% 8.98% P A G E 6 Members that received at least one Medicaid funded service increased by 104. Total number of Medicaid enrollees increased by 5,935 from the previous quarter. Eastpointe served 5,080 uninsured persons who received at least one State -funded mental health, intellectual/developmental disabilities, or substance abuse (MH/I/DD/SA) service during the measurement period in each of the six age-disability groups and for all ages and disabilities. The uninsured population totaled 138,447. Percent that Recieved at Least One MH/IDD/SA Service- Uninsured July -September % 3.13% 2.58% 4.23% 1.24% 4.84% 3.26% 2.60% 2.30% 3.37% 5.77% Source: DMH/DD/SAS LME-MCO Quarterly Performance Measures July September % 3.67% The number of Uninsured persons that received at least one MH/I/DD/ SA service increased by 248 from the previous quarter.

Our Mission Administrative Offices: 514 E. Main St. P.O. Box 896

families, providers, and communities to achieve valued outcomes in

Network Operations Call Center 1-888-977-2160 Customer

Services: 1-800-913-6109 Direct Access to Services (TTY):

7 Our Mission Administrative Offices: 514 E. Main St. P.O. Box 896 Beulaville, NC Eastpointe works together with individuals, families, providers, and communities to achieve valued outcomes in our behavioral healthcare system. Network Operations Call Center Customer Service/Provider Assistance: Direct Access to Services: Direct Access to Services (TTY): Veterans Crisis Line: S T A N D 2 N D Q U A R T E R : J U L Y - D E C E M B E R

QUALITY IMPROVEMENT PLAN AND PROGRAM DESCRIPTION FY

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