2016 LME-MCO Community Behavioral Health Service Needs, Providers and Gaps Analysis Report for the NC Division of Health & Human Services April 2016

Transcription

1 2016 LME-MCO Community Behavioral Health Service Needs, Providers and Gaps Analysis Report for the NC Division of Health & Human Services April 2016 Conducted by ACT Associates, LLC April 2016 Page 1 of 46

2 Section One I. Executive Summary This is the Eastpointe LME-MCO 2016 Community Behavioral Health Service Needs, Providers and Gaps Analysis report. The report was written to respond to the requirements outlined in the NC Divisions of Medical Assistance (DMA) and Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) directive issued in November, The report summarizes a combination of consumer and provider data from SFY15 to determine access to service levels; consumer choice of State and Medicaid services offered throughout the network; consumer and family, board member, staff and community stakeholders input regarding needs and gaps throughout the service area; and outlines the demographic and geographic characteristics of the 12-county service area. In an attempt to ensure that needs and gaps are addressed across periods of time, the report also includes a progress report from the needs identified during last year s process, as well as strategies to address the gaps, needs, choice and access issues identified via the current year s process. In January 2013, after merging with the Beacon Center and Southeastern Regional LMEs, Eastpointe became the Local Management Entity (LME)-Managed Care Organization (MCO) for the 12-county area of Bladen, Columbus, Duplin, Edgecombe, Green, Lenoir, Nash, Robeson, Sampson, Scotland, Wayne, and Wilson Counties. As the MCO, Eastpointe became responsible for administering the Federal/State Medicaid funds for the behavioral healthcare benefit for Medicaid recipients, as well as administering the State funds for the uninsured population in the 12-county area who had behavioral health care issues and intellectual and developmental disabilities. During SFY15, the average monthly Medicaid population in the Eastpointe LME-MCO area was estimated to be 199,699 individuals. Using national estimates of prevalence for the three disability groups encompassing adults and children, it is estimated 46,662 Medicaid-covered adults and about 25,589 Medicaid-covered children/adolescents have one of these three disabilities. Eastpointe served a total of 39,072 Medicaid recipients during the fiscal year or about 54% of the 72,251 Medicaid recipients in their service area estimated to have one of the three disabilities. The following chart illustrates how many of the Medicaid population in the Eastpointe area have accessed services and compares it to the other LME-MCOs and State average. Eastpointe LME-MCO data appears to indicate they serve fewer Medicaid recipients in their service area when compared to the other LME-MCOs and to the State average. Data on their members may be skewed to a lower level due to the significant number of FQHCs and large physical health providers in their area that provide and bill for Medicaid members directly to DMA and who, therefore, are not captured in the Eastpointe data. Page 2 of 46

3 Percentage of MH/DD/SA Medicaid-Served SFY15 by LME/MCO 9.00% 8.00% 7.00% 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% 0.00% Alliance Cardinal CenterPoint Eastpointe Partners Sandhills Smoky Mountain Trillium % of members receving MM/DD/SA Services STATE AVERAGE During SFY15, the average monthly uninsured population in the Eastpointe LME-MCO area was estimated to be 129,588 individuals. Using national estimates of prevalence for the three disability groups encompassing adults and children, it is estimated 38,969 uninsured/indigent adults and about 13,506 uninsured/indigent children and adolescents have one of these three disabilities. Eastpointe served a total of 11,484 uninsured/indigent individuals during the fiscal year or about 21.8% of the 52,475 uninsured/indigent individuals in their service area estimated to have one of the three disabilities. The chart below illustrates how many of the uninsured/indigent population in the Eastpointe area have accessed services and compares it to the other LME-MCOs and State average. Services to the uninsured/indigent population are limited to the State dollars allocated by the North Carolina State Legislature and are designated to serve those in the most critical need, including the Adult Severe and Persistent Mentally Ill, Children with Severe Emotional Disability, those in crisis and military service members, veterans and their families. Eastpointe served more uninsured/indigent consumers than the State average for SFY15 when compared to the other LME-MCOs. Page 3 of 46

4 2.50% Percentage of Uninsured Receiving MH/DD/SA Services SFY15 by LME-MCO 2.00% 1.50% 1.00% 0.50% 0.00% Alliance Cardinal CenterPoint Eastpointe Partners Sandhills Smoky Mountain Trillium The calculations used to determine the prevalence for MH, I/DD and SUD conditions in the 12 counties of the Eastpointe LME-MCO can be found in Appendix A on page 44. The chart below lifts those numbers from the calculations and illustrates the number of people affected (Prevalence estimate), the number served (Penetration), the number of those affected who are covered by Medicaid insurance, those affected who are uninsured. The Gap represents the difference between the number of individuals, both adults and children, with MH, I/DD and SUD conditions in the 12-county area receiving services and the potential need. As the chart below illustrates, there are significant gaps in the disability groups served by Eastpointe in both Adult and Child/Adolescent age groups. Disability Populations Prevalence Penetration Gap Number of Persons Affected Medicaid Served Uninsured Served Total Served Number Needing Services Percent Underserved Adult MH 121,730 14,324 7,004 21,328 55,639 62% Adult I/DD 12,595 2, ,105 5,757 46% Adult SA 53,025 3,471 2,905 6,376 24,236 74% Total Adults 187,350 20,025 10,784 30,809 86,632 64% Prevalence Penetration Gap Disability Populations % of members receving MM/DD/SA Services STATE AVERAGE Number of Persons Affected Medicaid Served Uninsured Served Total Served Number Needing Services Percent Child MH 32,926 12, ,779 20,012 36% Child I/DD 28,481 1, ,709 17,310 90% Child SA (12-17) 3, ,774 85% Total Children 64,934 14, ,762 39,096 62% Page 4 of 46

5 II. Progress and achievements in addressing gaps identified in last year s gaps analysis report The following progress-to-date chart illustrates the areas the Eastpointe organization has been focusing on to increase the number of Medicaid and uninsured population it reaches throughout its service area and highlights those strategic plans and activities that it is focusing on to make a larger and more effective impact. Area Recommendations Actions Taken Responsible Party Summary of Issues and Strategies from SFY14 Summary of Issues and Strategies from SFY14 a. It is essential the new Alpha Management Information System (MIS) has all the data points which the LME-MCO needs to answer all DMA and DMHDDSAS contractual requirements, including this annual needs and gaps analysis process. b. It is imperative Eastpointe focus efforts in SFY15 on developing the crisis service portion of their network-- (including Facility-Based Crisis, Inpatient Services for both adults and adolescents/children, Multi-Systemic Therapy (MST) & Traumatic Braine Injury (TBI) services--so consumers have alternatives to hospital Emergency Departments. Eastpointe (EP) finished the conversion of its old Avatar system to Alpha on May 1, /31/15- EP was able to utilize the Alpha system for the latest needs and gaps Assessment in conjunction with the old Avatar system. EP will continue to refine this process. The Facility-Based Crisis (FBC) expansion in the southern part of the catchment area is moving forward and on target to open in early Eastpointe also pursued the Facility-Based Crisis expansion grant knowing that there was a gap in services. 12/17/15- The FBC expansion is continuing. EP has reworked the construction plan so the facility can remain open during the construction phase. There were costs overruns as a result of electrical issues discovered during the initial phases of the design plan. EP has gathered necessary resources to cover that cost overrun. Inpatient- EP was able to secure a three way contract for 2 beds with South East Regional Hospital; have entered into an MOA with Scotland General Hospital to open a gero-psych unit. MST- EP continues to promote MST as an alternative to hospital but providers continue to be reluctant due to the cost of certification and the low number of referrals. TBI- EP will offer more education to providers about TBI Identification and treatment alternatives. Additional specialty training for Veterans with TBI Alpha Implementation Team Network Operations, Training, Care Coordination Starting Timeframe Completion Date 5/1/15 05/1/15 4/1/15 6/30/16 Page 5 of 46

6 Area Recommendations Actions Taken Responsible Party Summary of Issues and Strategies from SFY14 Summary of Issues and Strategies from SFY14 c. Eastpointe should consider recruiting one Advanced Access site provider/county during SFY15. d. Eastpointe should develop a more current and realistic understanding of why its stakeholders perceive the level of need with each of the disability/ age groups the way they do and take steps to either address the stakeholder's perception or take steps to address those 4 areas where the community stakeholders identified the needs as the most critical. diagnoses. In addition to the FBC, this will also open up a level 4 behavioral outpatient walk-in unit. Eastpointe is in discussion with providers who are interested in partnering with them to explore funding for an FBC in the northern section of the catchment area. As of March 30, 2015, plans are still in place for level 4 behavioral walk-in clinic upon a consumer's completion of FBC. Further discussions regarding placement of the FBC and level 4 walk-in clinic in the northern section is pending Secretary's decision regarding Nash County and future merger plans. Develop strategies by which a community relations staff can educate and share information. Eastpointe will review the provider choice data base and begin to pull the provider data early spring The Provider Choice information on Eastpointe's website was provider-driven and with the use of the Alpha MIS system, the Provider Choice information is becoming Eastpointe-driven. This will allow Eastpointe to make routine changes and updates based on the reality of the network. Eastpointe is looking at placing billboards strategically throughout the community and on websites, as well as kiosks at different library sites. Eastpointe is reviewing innovative ways to make access easier and consumers aware of services. 12/17/15- Quality Management (QM) met with Community Relations staff and shared needs information. EP Community Relations is an active member of community collaborative and has multiple contacts in each of the counties to share needs and gaps data. Provider Choice Data Base specialty data has been loaded into the system and will be reviewed by providers for accuracy and implementation in early SFY16. Advertisement- EP has billboards in the area; now entering into phase one of the rollout. EP will be putting up 12 billboards Starting Timeframe Completion Date Network Operations 4/1/15 6/30/16 Community Relations, Information Technology (IT), Network Operations, Communications Committee 5/1/15 7/1/16 Page 6 of 46

7 Area Recommendations Actions Taken Responsible Party Summary of Issues and Strategies from SFY14 Summary of Issues and Strategies from SFY14 e. Eastpointe needs to develop a strategy to increase the number of Medicaid consumers it serves during SFY15 f. Eastpointe needs to continue to maintain its efforts towards the Transition to Community Living (TCL) Initiative and to ensure that benchmarks for improvement are developed and measured for each case in the new MIS system in the catchment area over the next 6 months. August 4, 2015 EP launched its Facebook page. 1. Marketing efforts will increase knowledge about access. By June 30, 2016, Kiosks will be live and are going to be strategically placed in public health offices/agencies and libraries. Eastpointe's goal is to have a kiosk placed in each of the 12 counties. 2.There has been an increased effort in outreach with large health providers to make the doctor-to-doctor connection. 3. Eastpointe is promoting (b)(3) services for psychiatric consultation at provider meetings so they understand psychiatrists can be reimbursed as of July, In June 2015, Eastpointe initiated an Analytics Department to review data and trends throughout the 12-county area and set benchmarks within the first year. 5. EP has increased advertisement with brochures and pamphlets and Facebook. 6. EP recently added 13 sites that are primarily physical but will have mental health capability. 7. EP received a Transitions to Community Living Initiative - Critical Time Intervention (TCLI-CTI) Grant for members who do not meet ACTT criteria but still have great needs. This population is also primarily supported by Medicaid and will likely add more individuals to the Eastpointe Medicaid consumer base. Eastpointe will monitor the benchmarks for TCL by using the Quality of Life survey and Quality of Living tool. 12/17/15- Critical Time Intervention (CTI) is a time-limited intensive case management model designed to assist adults age 18 years and older with mental illness who are going through critical transitions, and who have functional impairments which preclude them from managing their transitional need adequately. CTI promotes a focus on recovery, psychiatric rehabilitation, and full community inclusion. EP completed Communication Committee, Network Operations, Clinical Staff, QM Starting Timeframe Completion Date 6/1/16 6/1/16 TCL Department 6/1/15 6/1/16 Page 7 of 46

8 Area Recommendations Actions Taken Responsible Party the Housing Plan and Housing Needs Assessment. EP released an RFP for Tenancy Supports Team and plans to implement March 1, 2016 to three vendors in the service area. EP completed the TCL audit in SFY16. Starting Timeframe Completion Date N.C. DHHS Initiatives- Integrated Physical and Behavioral Healthcare Initiative g. Eastpointe needs to rely upon the MCO's various data applications to identify the costs and outcomes for those persons identified as high risk by care coordination in order to determine the effectiveness of the process and develop provider incentives to co-locate behavioral health services in primary care clinics and Federally Qualified Health Centers (FQHCs) throughout the service area. 1. Eastpointe is promoting the use of injectables and analyzing data to identify the high utilizers. EP plans to host a meeting in SFY16 with the injectable providers to see how they can develop a follow-up and aftercare model for consumers enrolled in this program. 2. In April 2015, EP Systems Performance Group began reviewing admissions to all State hospitals; met with State Office personnel to analyze admission and discharge patterns in an attempt to understand flow through the State hospital system and consumer needs. 3. Eastpointe continues to monitor consumer issues regarding the Bringing the Kids Home Initiative. Medical Director, Clinical, Network, QM 1/1/15 6/31/15 N.C. DHHS Initiatives- Traumatic Brain Injury Initiative h. Eastpointe will be implementing a TBI screening from its call center during SFY15 and should ensure that data regarding the number screened, referred and followed up on is measured monthly. During SFY15, Eastpointe is conducting training for its provider community and the community on TBI. Additionally, one of the Eastpointe Psychiatrists is completing specialty training in treating TBI issues. Eastpointe will continue the TBI screening process while continuing to promote TBI education. There will be future TBI trainings scheduled during SFY16. Training, Clinical Staff 8/1/14 6/30/16 Prevalence & Penetration i. Eastpointe should review all six Eastpointe is reviewing the use of recently approved pre-screening measures for External Operations, Clinical 8/1/14 6/30/14 Page 8 of 46

9 Area Recommendations Actions Taken Responsible Party disability/age groups and develop strategies to accommodate the needs as they arise of those populations most significantly underserved. members on their registry of unmet needs. (B)(3) Waivers are used for some members on the registry which will free up State funds in the 2nd quarter (January 2016). Eastpointe plans to market the kiosks in each county and regularly analyze the data from consumers using the kiosks. EP has identified SUD as an underserved area, as well MH outpatient group adult. EP's Medical Director has conducted multiple trainings to increase awareness; sites established with integrated care to encourage referrals; Community Relations Department continues to work on antistigma campaigns. Staff Starting Timeframe Completion Date Demographics j. There are 50 FQHCs located throughout all 12 of the catchment counties. As behavioral health becomes more integrated into the healthcare system, it will be crucial for the MCO to identify sites that have working integrated care models and encourage their providers to co-locate or develop co-location projects with the FQHCs, health departments, and others throughout the MCO service area. It is equally important to understand who the FQHCs are serving and look for opportunities to work together to meet the needs of the MCO's service area. Demographics k. There were 157 deaths in 2013, including 46 prescription opioid deaths, and 1,696 emergency room admissions resulting from unintentional and In SFY15 Eastpointe began working with one FQHC that covers six Eastpointe counties concerning co-location. The FQHC wants to pilot a program in one county before they proceed to expand the program; EP gave them first quarter consumer population provider data; expect to initiate a joint project no later than June, Eastpointe will monitor opioid prescription activity by reviewing the prescriber data available via contract with Care Management Technologies (CMT). EP partnering with the Drug Enforcement Administration (DEA) to relocate individuals into treatment options rather Clinical Staff, Network Operations Provider Network, Medical Director 1/15/15 6/30/16 5/1/15 12/1/15 Page 9 of 46

10 Area Recommendations Actions Taken Responsible Party self-inflicted prescription drug overdoses in the combined 12 Eastpointe counties. than just prescribing options. Individuals have been displaced because providers were no longer available (since May/June 2015); EP promoting and assisting the DEA in efforts to place eligible consumers in appropriate treatment settings. 12/17/15- Several police departments within the catchment area administer Naloxone treatment to prevent overdose. In SFY16,EP completed an RFP process to award a contract to an Opioid Treatment provider in southern part of the area and recently added an Opioid provider in the northern area. Starting Timeframe Completion Date Workforce Capability Workforce Capability l. The MCO needs to make a significant effort to collect all professional license category data, including Certified Clinical Supervisor (CCS) Certified Substance Abuse Counselor (CSAC) and DEA numbers in order to adequately plan for its workforce needs. m. Further examination by Eastpointe is recommended to ensure FTEs of contracted psychiatrists are sufficient for the population and specialty areas are appropriately represented. It would be helpful for Eastpointe to collect information on actual numbers of available hours of psychiatrists to determine whether there are indeed enough psychiatrists to meet the needs of the population. It would be helpful in future years to track specialty psychiatry Eastpointe can now record all licenses in the Alpha MIS system; will be able to report this data in the 2015 Needs & Gaps Assessment. Eastpointe will check with other MCOs to see how they track this and if they utilize the Alpha MIS system to track by Board Certifications, by the second quarter. 12/17/15- EP has reached out to other MCOs and they monitor availability by meeting benchmarks of Urgent, Emergent, Routine. Eastpointe mirrors the state shortage of psychiatrists. External Operations, IT 5/1/15 1/30/16 Network Operations 5/1/15 6/30/16 Page 10 of 46

11 Workforce Capability Area Recommendations Actions Taken Responsible Party Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps information so that Eastpointe can determine whether the right mix of specialties exists to serve the members appropriately. n. It would benefit Eastpointe to consider using FQHCs and other organizations as a way to expand their telepsychiatry services to expand access to psychiatry for consumers. o. There is a gap in TBI services with Medicaid funding of % of the population not meeting access requirements. p. There is a gap in Inpatient Hospital- Adult services with State funding of 19.32% of the population not meeting access requirements. q. There is a gap in Inpatient Hospital- Adolescent services with Medicaid funding of 77.44% of the population not meeting access requirements. r. There is a gap in Inpatient Hospital- Adolescent services with State funding of 100% of the population not meeting access requirements. s. There is a gap in Inpatient Hospital- Child services with Medicaid funding of 84.47% of the population not meeting access requirements. In 2016, Eastpointe is planning to do a telephone survey of its telepsychiatry sites; having ongoing discussions with the FQHCs to form a stronger collaboration for integrated services, as well as psychiatric and telepsychiatric services. Develop a strategy to raise the issue with the alpha user group for TBI population identification as opposed to a service category. EP does not have a current marker in the ALPHA system to separate TBI from general services. Changes in the ALPHA system usually take up to a year to make. 12/07/15- South East Regional Hospital has received 2 beds under 3 way contract Eastpointe is willing to support any hospital willing to expand their adolescent bed services through the Certificate of Need (CON)process. Eastpointe is willing to support any hospital willing to expand their adolescent bed services through the Certificate of Need (CON)process. Eastpointe is willing to support any hospital willing to expand their child bed services through the Certificate of Need (CON)process. Network Operations and Clinical Staff Starting Timeframe Completion Date 10/1/15 1/1/16 N/A 10/15 7/16 Network Operations Network Operations Network Operations Network Operations ongoing ongoing ongoing ongoing Page 11 of 46

12 Area Recommendations Actions Taken Responsible Party Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps Gaps Illustrated by the Maps t. There is a gap in Inpatient Hospital- Child services with state funding of 100% of the population not meeting access requirements. u. There is a gap in Facility Based Crisis Services with Medicaid funding of 37.63% of the population not meeting access requirements. v. There is a gap in Facility Based Crisis Services with State funding of 68.52% of the population not meeting access requirements. w. There is a gap in Detoxification services with Medicaid funding of 12.70% of the population not meeting access requirements. x. There is gap in Detoxification services with State funding of 12.09% of the population not meeting access requirements. Eastpointe is willing to support any hospital willing to expand their child bed services through the Certificate of Need (CON)process. The Facility-Based Crisis expansion in the southern part of the catchment area is moving forward and on target to open in early EP pursued the Facility-Based Crisis expansion grant; this will also open up a level 4 behavioral outpatient walk-in unit. In discussion with providers interested in partnering with EP to explore funding for an FBC in the northern section of the catchment area; reviewing discharges from State hospitals for high utilizers; looking at ways to decrease the number of people going to hospital emergency departments. Eastpointe is meeting with providers to educate them. 12/17/15- EP is in the middle of expansion of FBC in southern region; northern region is currently pending secretary decision of Nash County. See above explanation In discussion with the Division; it was determined Eastpointe met the choice standard; no further strategies are needed. In discussion with the Division; it was determined Eastpointe met the choice standard; no further strategies are needed. Network Operations Starting Timeframe Completion Date ongoing Provider Network 7/1/15 3/30/16 Provider Network Provider Network 8/2015 Provider Network 8/2015 Priorities & Strategies y. In all disability/age categories, less than 40% of the stakeholders rated Eastpointe as meeting the needs. The In May 2015, Eastpointe developed a collaborative group to work with their communications director. This resulted in two different approaches: 1. Eastpointe communications is providing Provider Network 5/12/15 6/30/16 Page 12 of 46

13 Area Recommendations Actions Taken Responsible Party Priorities & Strategies Priorities & Strategies Priorities & Strategies stakeholders identified Children with I/DD, Adult SUDs and Child/Adolescent SUDs as those service categories where the needs were most significantly underserved. Long Term Supports was identified by both the Community Stakeholders and Eastpointe Staff as the service category with the greatest need. z. Crisis services were identified as an area of concern in the stakeholder surveys for each disability/age group which echoes this identified gap and brings a significant need to light. aa. In terms of areas of growth, 56 (31.3%) of the respondents indicated that lack of communication is an issue. In terms of describing how staff feel the working relationship between LME-MCO and its provider networks could be strengthened or improved, the biggest issue identified was the need for improved communication. bb. When respondents elaborated on the area regular provider education information to the Consumer and Family Advisory Committee (CFAC) to ensure they know about all services, and 2. EP now regularly forwards data to the Quality Improvement Committee about Needs & Gaps and encourages the collaborative members to participate more actively in tracking needs and gaps in their organizations. In December 2015, EP completed Requests for Proposal (RFPs) for Residential Adult MH and in process of RFP for Child MH Residential. Met with provider council about increasing Alternative Family Living (AFL) usage. EP utilizes only Fidelity Model ACTT Providers for Long Term Supports. Crisis Intervention Team (CIT) training has been increased. Ten trainings were held with over 130 participants (see chart on page 46). Eastpointe will focus on first responders and crisis responders in the 2015 Needs & Gaps Assessment. 12/17/15- See previous info regarding FBC expansion and Level 4 walk-ins. In SFY15, Eastpointe established a weekly call between network operations and claims, including other departments, medical records, Utilization Management (UM), etc. This has allowed the communication internally to flow much more regularly and in close to real time. Additionally, a monthly communication bulletin is sent to providers which includes more information that may impact them. Eastpointe shares data among the stakeholder group monthly. Eastpointe continues to have a quarterly process that involves information about staff and departments throughout the agency. In December, 2015 EP created a communication committee to address communication concerns. See communication information above related to bill boards, kiosks, pamphlets, etc. Funding for State services is limited due to the limitations those funds. Eastpointe Provider Network, Training Communications Committee, Provider Network, QM Starting Timeframe Completion Date 7/1/12 6/30/16 5/1/15 6/30/16 Provider Network 4/1/15 6/30/16 Page 13 of 46

14 Area Recommendations Actions Taken Responsible Party Priorities & Strategies Priorities & Strategies that they identified that the LME-MCO did not meet the need or could improve its services, respondents identified the need for providers to offer more services and/or supports to the members. Of the 37 staff respondents who identified this need, 12 specifically said that more substance abuse services were needed and that the majority of those were State funded services. cc. In terms of the respondents providing additional feedback related to how they view the LME-MCO system its challenges and future direction or any other issue related to a significant gap and/or need, respondents most frequently commented on the vast changes that have taken place in the past few years and about the various mergers (14). Eight respondents reported the need for greater services/supports and 5 additional respondents spoke of the future being uncertain. dd. In terms of identifying new innovative ideas or Evidence Based Practices that could be implemented by the LME-MCO that would strengthen the local system, respondents offered numerous attempt to increase the number of Medicaid services during the current fiscal year which should impact the savings the LME-MCO earns; will help dedicate savings to underserved populations in the service area. 12/17/15- RFP issued for opioid treatment. Tenancy Support Team and Network is open for expansion of outpatient treatment services. Eastpointe is utilizing the community relations staff, CFAC and Provider Council to share the most up-to-date information. 12/17/15- EP utilizes Community Relations, Communications; Chief Executive Officer (CEO) completes all staff releases. See comments above. Eastpointe sponsored various trainings during SFY15 for its provider network which includes a number of EBP practices. (See list in Appendix.) 12/17/15- EP received approval for alternative service definition for FACT (Forensic Assertive Community Treatment Teams-and alternative to In-Home Intensive (IIH); implementation has been delayed until 3rd Quarter 2016 due to Community Relations, Communications Provider Network, Clinical staff Starting Timeframe Completion Date 4/1/15 6/30/16 4/1/15 6/30/16 Page 14 of 46

15 Area Recommendations Actions Taken Responsible Party ideas. What emerged was to have more training on evidencebased practices. provider implementation issues. Starting Timeframe Completion Date III. Demographic Data Eastpointe serves a diverse and unique mix of people with varied cultural identities, socioeconomic backgrounds, and behavioral health needs. According to the N.C. Office of State Budget and Management there were 824,169 people living in the catchment area in July, This reflects a decrease of approximately 1,282 people from The median age of the counties is 39.7 years compared to the State median age of 38.3 years. The number of females (51.3%) is slightly greater than males (48.7%). Race A demographic analysis of the population by race based on 2015 Census projections for counties in the Eastpointe catchment area indicates that approximately 49.9% (411,838) identify as White, 34.1% (281,291) African-American, 10.2.% Hispanic/Latino (84,254), and 7.6% (62,498) Native American/Alaskan Native. Race and Ethnicity of Eastpointe Catchment 2015 White Alone Black or African- American American Indian and Alaskan Native Alone Asian- Pacific Islander Other Race Alone Two or More Races Hispanic/Latino 411, ,291 62,498 6,680 55,021 17,472 84,254 Significant findings regarding the racial make-up of the MCO s service area include: Based on the U.S. Census, 10.2% of the Eastpointe catchment is Hispanic/Latino. This percentage only represents individuals in the population who are legal residents. There is no accurate way to provide a count of undocumented or illegal residents. This does not reflect a percentage increase or decrease from the last assessment. Robeson County has the largest Native American population (51,663) in the catchment area with the majority being primarily members of the Lumbee Tribe. Scotland County has the second highest (4,095). Both counties reflect a slight increase in their numbers from last year. Page 15 of 46

16 White Alone Racial Analysis of Eastpointe MCO Consumers served during SFY15 Black or African- America American Indian and Alaskan Native Alone Native Hawaiian, Asian, and other Pacific Islander Alone Other Race Alone Two or More Races Hispanic/Latino 15,000 17,445 3, , ,737 When comparing the racial make-up of the 12-county area to the racial make-up of the consumers served by Eastpointe during SFY2015, the following observations are noted: Eastpointe served 2.1% of the Hispanic population living in the catchment area. This is similar to last year. Eastpointe served 3.6% of the White population living in the catchment area. This is a.2% increase from last year. Eastpointe served 6.2% of the African-American population living in the catchment area. This reflects a.3% increase from last year. Eastpointe served 5.1% of the American-Indian/Alaskan Native population living in the catchment area. This is a.1% increase from last year Comparison of Service Area and People Served by Race and Ethnicity Hispanic/Latino Two or More Races Other Race Alone Asian-Pacific Islander American Indian and Alaskan Black or African-American White Alone 0 100, , , , ,000 White Alone Black or African- American American Indian and Alaskan Native Alone Asian- Pacific Islander Other Race Alone Two or More Races Hispanic/ Latino Eastpointe Consumers Served 1,500 17,445 3, , ,737 Eastpointe Service Area 411, ,291 62,498 6,680 55,021 17,472 84,254 Page 16 of 46

17 Pregnant Women In SFY15 there were 11,674 pregnancies in the Eastpointe catchment. Eastpointe Member Call Center has a protocol in place regarding members who are substance abusers and pregnant, IV drug users or have HIV/AIDS. There is a priority preference for substance abuse admission; treatment is given for injecting drug users, substance using or HIV/AIDS pregnant women. This population receives priority referrals and is to be scheduled for an appointment as soon as possible, as well as a care coordination referral completed on behalf of the member. Eastpointe supports Robeson Healthcare Corp (Our House) in Pembroke, North Carolina, a drug rehab program focusing on pregnant women and children. The program provides substance abuse treatment and a halfway house or sober living home with residential long-term treatment for pregnant women and their children. In SFY15, 28 women were served and the average length of stay was 79 days. Veterans North Carolina ranks ninth in the country for the number of veterans who live in the state and sixth for the number of women veterans. There are approximately 60,930 active duty and non-active duty veterans in the 12-county catchment area. By far, the largest number are in Wayne County, assumed connected with Seymour Johnson Air Force Base. Over 16,000 are also located in Nash and Robeson Counties. Veteran Population County # Veterans as of 9/30/15 Bladen 3,031 Columbus 3,785 Duplin 3,489 Edgecombe 3,317 Greene 1,243 Lenoir 4,479 Nash 8,206 Robeson 8,092 Sampson 3,770 Scotland 2,740 Wayne 13,286 Wilson 5,492 Eastpointe Catchment 60,930 North Carolina 773,881 Eastpointe Member Call Center has been working with staff and members who are veterans and inquire for themselves or family members who are or were in active duty or reserve. For members who are veterans or currently in the military and inquire of community resources, Eastpointe has a list of resources (Member Call Center One Note) to assist them such as War Within, Veterans Crisis Line, etc. Page 17 of 46

18 Traumatic Brain Injury Traumatic brain injury (TBI) is a major cause of death and disability in the United States, contributing to about 30% of all injury deaths according to the Centers for Disease Control and Prevention. Every day, 138 people in the United States die from injuries that include TBI. Those who survive a TBI can face effects lasting a few days to disabilities which may last the rest of their lives. Effects of TBI can include impaired thinking or memory, movement, sensation (e.g., vision or hearing), or emotional functioning (e.g., personality changes, depression). These issues not only affect individuals but can have lasting effects on families and communities. Eastpointe served 17 people with traumatic brain injuries in SFY2015. There were no veterans among those served. Causes of the injuries included motor vehicle crashes, assault and bicycle or motorcycle accidents. Four of the 17 served with Traumatic Brain Injuries were female and the average age of those served was 45. Sexual Aggression Sexual aggression is domestic and sexual violence, as well as other behaviors which could cause someone to feel harassed, intimidated or afraid. This includes, but may not be limited to, sexual assault, domestic violence, intimate partner violence, stalking and harassment. Statistics reflected below have been extracted from information entered into the NC Sex Offender and Public Protection Registry database by North Carolina Sheriff s Offices. The North Carolina State Bureau of Investigation serves as the collection and entry point for this information. These statistics provide approximate numbers. The accuracy of these statistics may be impacted by certain limitations, such as delays or errors in processing information or delay or errors in the system s operation. Not all offenders are included in this report because of different registration requirements. Offenders whose status is listed as pending are not included in this report. Persons Convicted of a Sex Offense or Offense against a Minor Living in County as of 12/31/15 County Total Offenders Bladen 71 Columbus 101 Duplin 88 Edgecombe 172 Greene 33 Lenoir 104 Nash 142 Robeson 279 Sampson 118 Scotland 104 Wayne 199 Wilson 143 Eastpointe Catchment 1,554 North Carolina Total 14,416 Source: N.C. Department of Public Safety. Accessed 3/2/16. Page 18 of 46

19 Eastpointe has a Memorandum of Agreement (MOA) in place with the TEDI BEAR Children's Advocacy Center. The purpose is to facilitate cooperation in addressing allegations of sexual abuse, physical abuse and severe neglect of children and adolescents younger than 18 years old. Eastpointe Member Call Center also works with the local Southern Regional Area Health Education Center (AHEC), Fayetteville, NC, to assist with child abuse medical evaluations associated with pediatric sexual assaults. Jails and Prisons There are nine correctional facilities located in the Eastpointe Catchment Counties. As of June 30, 2015 there were 3,707 people incarcerated and 11,110 persons in the Community Corrections population. The Community Corrections System offers viable alternatives and meaningful supervision to offenders on probation, parole or post-release supervision. Eastpointe Member Call Center also has been working to capture information received from correctional facilities by providing resources and follow-up appointments to ensure there is continuity of care from the prison system back into the community. Eastpointe also completes a care coordination referral so they are able to notify them that the member is being released. Health Trends Significant to the 12 County Area Medical disorders may lead to mental disorders, mental conditions may place a person at risk for medical disorders and mental and medical disorders may share common risk factors. According to the Robert Wood Johnson Foundation s Synthesis Project, epidemiological studies have been important in examining these pathways. For instance, medical conditions that are accompanied by a high symptom burden, such as migraine headaches or back pain, can lead to depression. At the same time, major depression is a risk factor for developing medical conditions, such as cardiovascular disease, that are characterized by pain or inflammation. In the National Comorbidity Survey Replication, a nationally representative epidemiological survey, more than 68 percent of adults with a mental disorder (diagnosed with a structured clinical interview) reported having at least one general medical disorder and 29 percent of those with a medical disorder had a co-morbid mental health condition. The annual County Health Rankings measure vital health factors, including high school graduation rates, obesity, smoking, unemployment, access to healthy foods, the quality of air and water, income, and teen births in nearly every county in America. The annual rankings provide a revealing snapshot of how health is influenced by where people live, learn, work and play. The County Health Rankings program is a collaboration of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. Nine of the 12 Eastpointe Counties are among the lower 50 of North Carolina s 100 counties. Four of the 12 are in the bottom ten. Columbus County is ranked 100 th out of Health Outcome Ranking County Rank in the N.C. 100 Counties Wilson 41 Duplin 42 Greene 49 Wayne 54 Nash 58 Page 19 of 46

20 Overdose Deaths Sampson 70 Edgecombe 87 Bladen 88 Lenoir 90 Robeson 95 Scotland 98 Columbus 100 Source: 2015 County Health Rankings. Accessed 3/4/15. According to the Centers for Disease Control and Prevention, drug overdoses now surpass automobile accidents as the leading cause of injury-related death for Americans between the ages of 25 and 64. A seriously under-recognized and misunderstood public health issue is unintentional prescription drug poisoning, which is commonly referred to as overdose. In 2011, 1,140 North Carolina residents died as a result of unintentional poisonings; approximately 80% of those deaths were related to prescription drugs-- predominantly painkillers. Since 1999, the number of deaths (279) from unintentional poisonings has increased more than 300% in North Carolina. Narcotic painkillers such as methadone, oxycodone, and hydrocodone are the cause of the majority of unintentional poisoning deaths in North Carolina. The overdose deaths for the 12 Eastpointe catchment counties for 2013 and 2014 are noted below. Sampson and Robeson Counties had the highest number of deaths in County R Opioid Deaths 2013 Overdose Deaths Comparison Rx Med- Drug R Heroin Heroin Methadone Opioid Poisoning Poisoning Poisoning Poisoning Poisoning Deaths Deaths Deaths Deaths Deaths 2013 Rx Med- Drug Deaths 2014 Methadone Poisoning Deaths 2013 Total Deaths 2013 Bladen Columbus Duplin Edgecombe Greene Lenoir Nash Robeson Sampson Scotland Wayne Wilson Total Deaths 2014 Catchment Total North Carolina ,215 1, ,182 2,414 Source: N.C. DHHS, Injury Epidemiology and Surveillance Unit, Injury and Violence Prevention Branch, Chronic Disease and Injury Section, Division of Public Health. Received 11/3/15. Page 20 of 46

21 IV. Input from consumers and family members A survey was created specifically for Eastpointe LME-MCO consumers and families. This survey was available in hard copy and posted online on November 18, 2015 through January 5, Surveys were advertised on the Eastpointe LME-MCO website and through an distribution to consumers and families. Advertisements were published in 14 local newspapers running daily, weekly or twice per day. Six hundred twenty three consumers and families completed the Eastpointe LME-MCO Survey. The following chart represents the counties for consumers and families who took the survey (n=648). Respondents Completing Consumer & Family Survey Eastpointe LME-MCO % of Responses Number of Responses 12 Counties for Each County Bladen % Columbus % Duplin % Edgecombe % Greene % Lenoir % Nash % Robeson % Sampson % Scotland % Wayne % Wilson % *Other % *Other includes respondents living outside the Eastpointe LME-MCO catchment area. Some respondents reported more than one county. The following chart shows the percentages of respondents who reported either they or a family member had a primary diagnosis of mental illness, intellectual-developmental disability or substance use disorder at the time of this survey. Eastpointe LME/MCO SFY2015 Consumer and Family Survey Primary Diagnosis of Respondents or Respondents Family Members Substance Use Disorder 12.5% n=73 (n=585) Mental Illness 36.9% n=216 Intellectual- Developmental Disability 50.6% n=296 Page 21 of 46

22 V. Input from stakeholders A survey was developed specifically for Eastpointe LME-MCO stakeholders. The survey was made available through hard copy and online on November 18, 2015 through January 16, Surveys were advertised on the Eastpointe website and through an distribution to the Eastpointe stakeholders. Stakeholder advertisements were published in 14 local newspapers running daily, weekly or twice a day. There were 394 surveys completed for Eastpointe LME-MCO. Of those completing the surveys, 221 respondents were Eastpointe employees, 149 represented stakeholders, such as contract providers, hospital staff, social services, law enforcement, schools, and other healthcare providers, etc., and 15 were Eastpointe Board Members. The following graph shows percentages representing respondent-reported relationships to Eastpointe LME-MCO. Eastpointe LME/MCO SFY2015 Stakeholder/Staff/Board Member Survey Respondents' Relationship to Eastpointe (n=394) Board Member 3.8% *Other 2.3% Stakeholder 37.8% Staff Member 56.1% *Other includes respondents' relationship to Eastpointe LME-MCO that was neither board member, stakeholder nor staff member. The following chart indicates counties where respondents reported they had offices within the Eastpointe 12-county catchment area. Eastpointe LME-MCO 12 Counties Number of Responses % of Responses for Each County Bladen % Columbus % Duplin % Edgecombe % Greene % Lenoir % Nash % Robeson % Page 22 of 46

23 Sampson % Scotland % Wayne % Wilson % *Other % The *other category represents counties where respondents had offices outside the Eastpointe 12 counties (n=335). Section Two - Access and Choice Standards I. Outpatient Services. Medicaid and State-Funded outpatient services access and choice standard: All eligible individuals must have a choice of two different outpatient service provider agencies within 30 miles or 30 minutes of their residences for urban counties or 45 miles/45 minutes for rural counties. Information provided below was derived from the Eastpointe claims data from SFY15. Categories Reside in urban counties Reside in rural counties Total (standard = 100%) Medicaid # of enrollees with choice of two providers within 30/45 miles* # of Medicaid Enrollees % State-Funded # of consumers with choice of two providers within 30/45 miles* # of Consumers 9,188 9, % 3,269 3, % 19,203 19, % 6,293 6, % 28,391 28, % 9,562 9, % % Adults (age 18+) 16,194 16, % 9,021 9, % Children (age 17 and younger) 12,197 12, % % Total (standard = 100%) 28,391 28, % 9,562 9, % * 30/45 miles is the abbreviated term used in this document for individuals having choice within 30 miles or 30 minutes (45 miles or 45 minutes in rural counties) of their residences. All standards for both Medicaid and State-Funded Outpatient Services have been met and, therefore, no exceptions or written justifications are necessary. B. What outpatient service gaps were identified by consumers and family members? Outpatient service gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 2,861 consumers and families that responded (out of 45,571 (6.2%)consumers served by Eastpointe in SFY15) about gaps in outpatient services. Out of the 2,891 respondents, 1,256 (43.9%) responded with I Don t Know when asked what service gaps existed in the current outpatient service system in your community. There were no outpatient service gaps identified by consumers and families in the % range. Page 23 of 46

24 C. What outpatient service gaps were identified by other stakeholders? Outpatient service gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 1,491 stakeholders that responded about gaps in outpatient services. Out of the 1,491 respondents, 406 (27.2%) responded with 'I Don't Know' when asked what service gaps existed in the current outpatient service system in your community. There were no outpatient service gaps in the % range. Psychological testing was the only outpatient service gap between the 51-75% range. D. What specific geographic, cultural or demographic groups experience outpatient services gaps that need to be addressed? Describe gaps and how the information was gathered. Medicaid and State access requirements for outpatient services was 100%. Consumers and families reported needs for more community-based socialization/recreation activities, needs assistance with transportation and childcare. Transportation was reported frequently as a challenge for respondents in their geographic region in rural areas. Stakeholders reported gaps including lack of community education, lack of access to services and collaboration. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. E. Goals, strategies and timelines for addressing outpatient services gaps identified in I.A., I.B., I.C. and I.D. Briefly identify the service gap, goal and target date for reducing or eliminating the gap, and strategies planned or in progress to achieve the goal. Eastpointe had no services gaps identified in the Medicaid or State-Funded Outpatient Services. II. Location-Based Services. a. Medicaid choice standard: All eligible individuals must have a choice of two different provider agencies for each location-based service in the chart below within 30 miles/30 minutes for urban counties or 45 miles/45 minutes for rural counties. b. State-Funded location-based services standard: All eligible individuals must have access to at least one provider agency for each location-based service in the chart below within 30 minutes/30 miles for urban counties or 45 minutes/45 miles for rural counties. Service Medicaid # and % of enrollees with choice of two providers within 30/45 miles of their residences Total # of Medicaid Enrollees State-Funded # and % of consumers with at least one provider within 30/45 miles of their residences Total # of Consumers # % # % Psychosocial Rehabilitation 16, % 16,194 6, % 6,543 Child and Adolescent Day Treatment 13, % 13, % 462 SA Comprehensive Outpatient Treatment Program 28, % 28,391 2, % 2,710 SA Intensive Outpatient Program 28, % 28,391 2, % 2,710 Opioid Treatment 13, % 16,194 2, % 2,694 Page 24 of 46

25 Day Supports 28, % 28,391 1, % 1,009 Adult Developmental Vocational Program 1, % 1,009 Medicaid If not at 100%, have exceptions been requested but not yet finalized?. If no, briefly explain and give dates each will be requested: Eastpointe is requesting an exception for Opioid Treatment in SFY16. yes State-Funded If not at 100%, have written justifications and plans to meet needs been submitted? yes If no, briefly explain and give dates each will be submitted: B. What location-based services gaps were identified by consumers and family members? Location-Based services gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 3,513 consumers and families that responded out of 45,571 (7.7%) consumers served by Eastpointe in SFY15 about gaps in location-based services. Out of the 3,513 respondents, 1,990, over half (56.6%), responded with 'I Don't Know' when asked what service gaps existed in the current location-based service system in your community. There were no location-based services gaps in the % range. C. What location-based services gaps were identified by other stakeholders? Location-Based services gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 2,012 stakeholders that responded about gaps in locationbased services. Out of the 2,012 respondents, 806 (40.1%) responded with 'I Don't Know' when asked what service gaps existed in the current location-based service system in your community. There were no location-based service gaps in the % range. D. What specific geographic, cultural or demographic groups experience gaps in the location-based services above that need to be addressed? Describe gaps and how the information was gathered. Opioid treatment for Medicaid access requirements was not met and day supports for State-Funded access requirements for location-based services was not met. Consumers and families reported transportation needs are not being met, as well as childcare and jobs. These needs that are not being met make it difficult for respondents to get the services they need. Transportation was reported frequently as a challenge for respondents in their geographic region in rural areas. Stakeholders reported gaps included lack of staff responsiveness; person-centeredness; communication and poverty as a result of their geographic location. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. E. Goals, strategies and timelines for addressing location-based services gaps identified in II.A, II.B., II.C. and II.D. Wilson County Strategy Application has been received and is in process for an Opioid Treatment provider in the Wilson area. Eastpointe LME-MCO anticipates completion of the credentialing process by the end of March Upon completion of the credentialing process the provider who is already a non-medicaid provider will have orientation as far as Medicaid billing, etc., and will begin operations by the end of April Page 25 of 46

26 Scotland County Strategy Eastpointe LME-MCO has recently credentialed an Opioid Treatment provider in the Robeson County area and will discussing with them possible expanded services to members in this area by July In the Scotland area, if expansion of the Robeson provider who is currently within the Eastpointe network is not possible, EP will meet with approved providers of this service in bordering counties by September If there is interest among multiple providers, EP will conduct an RFP/RFI and release by November If no competing interests, then EP will begin contract negotiations with the interested provider. III. Community/Mobile Services. a. Medicaid community/mobile services access and choice standard: All eligible individuals must have a choice of two provider agencies within the LME-MCO catchment area for each community/mobile service in the chart below. b. State-Funded community/mobile services access and choice standard: All eligible individuals must have access to at least one provider agency within the LME-MCO catchment area for each community mobile service in the chart below. Service Medicaid # and % of enrollees with choice of two provider agencies within the LME- MCO catchment area Total # of Medicaid Enrollees State-Funded # and % of consumers with access to at least one provider agency within the LME-MCO catchment area # % # % Total # of Consumers Assertive Community Treatment Team 16, % 16,194 6, % 6,543 Community Support Team 16, % 16,194 8, % 8,512 Intensive In-Home 13, % 13, % 462 Mobile Crisis 28, % 28,391 9, % 9,562 Multi-systemic Therapy 13, % 13, % 462 Traumatic Brain Injury Services (non-residential) Home-based I/DD Services 28, % 28,391 1, % 1,009 (b)(3) MH/I/DD Supported Employment Services 28, % 28,391 (b)(3) Waiver Community Guide 2, % 28,391 (b)(3) Waiver Individual Support (Personal Care) 28, % 28,391 (b)(3) Waiver Peer Support 28, % 28,391 (b)(3) Waiver Respite 28, % 28,391 I/DD Supported Employment Services (Innovations) 28, % 28,391 I/DD Supported Employment Services (State-Funded) 1, % 1,009 MH/SA Supported Employment Services (IPS-SE) (State-Funded) 8, % 8,512 Developmental Therapies (State- Funded) 1, % 1,009 Page 26 of 46

27 All standards for both Medicaid and State-Funded Community/Mobile Services have been met and, therefore, no exceptions or written justifications are necessary. B. What community/mobile services gaps were identified by consumers and family members? Community/Mobile services gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 7,479 consumers and families that responded about gaps in community/mobile services. Out of the 7,479 respondents, 4,332 (57.9%) responded with 'I Don't Know' when asked what service gaps existed in the current community/mobile service system in your community. There were no community/mobile services gaps in the % range. C. What community/mobile services gaps were identified by other stakeholders? Community/Mobile services gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 3,922 stakeholders that responded about gaps in community/mobile services. Out of the 3,922 respondents, 1,781 (45.4%) responded with 'I Don't Know' when asked what service gaps existed in the current community/mobile service system in your community. There were no community/mobile services gaps in the % range. D. What specific geographic, cultural or demographic groups experience gaps in the community/mobile services above that need to be addressed? Describe gaps and how the information was gathered. Medicaid and State-Funded access requirements for community/mobile services was 100%. Although the access requirements were met, consumers, families and stakeholders reported there were gaps due to the geographic location. Lack of childcare, jobs, community education and transportation are issues because of how rural most of the area is. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. E. Goals, strategies and timelines for addressing community/mobile services gaps identified in III.A., III.B., III.C. and III.D. Eastpointe had no gaps identified in the Medicaid or State-Funded Community/Mobile Services. IV. Crisis Services. Medicaid and State-Funded crisis services and choice standard: All eligible individuals must have access to at least one provider agency within the LME-MCO catchment area for each crisis service in the chart below. Number Facilities in LME-MCO Number Facilities in LME-MCO Catchment Service Catchment Area with Medicaid Contract Area with Contract for State-Funded Services Facility-Based Crisis 8 3 Respite Detoxification (non-hospital) 9 5 All standards for both Medicaid and State-Funded Crisis Services have been met and, therefore, no exceptions or written justifications are necessary. Page 27 of 46

28 B. What crisis services gaps were identified by consumers and family members? Crisis services gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. Of 45,571 consumers served by Eastpointe in SFY15, there was a total of 1,417 (3.1%) consumers and families that responded about gaps in crisis services. Out of the 1,417 respondents, 869 (61.3%) responded with 'I Don't Know' when asked what service gaps existed in the current crisis service system in your community. There were no crisis services gaps identified in the % range. C. What crisis services gaps were identified by other stakeholders? Crisis services gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 870 stakeholders that responded about gaps in crisis services. Out of the 870 respondents, 302 (34.7%) responded 'I Don't Know' when asked what service gaps existed in the current crisis service system in your community. There were no crisis services gaps in the % range. D. What specific geographic, cultural or demographic groups experience gaps in the crisis services above that need to be addressed? Describe gaps and how the information was gathered. Medicaid and State-Funded access requirements have been met for crisis services. Although requirements have been met, consumers, families and stakeholders still reported there were geographic gaps which included lack of responsiveness, transportation, communication and medical services. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. E. Goals, strategies and timelines for addressing crisis services gaps identified in IV.A., IV.B., IV.C. and IV.D.. Consumers and Families and Stakeholders did not identify any significant needs or gaps in the crisis services offered by Eastpointe. V. Inpatient Services. Medicaid and State-Funded services access and choice standard: All eligible individuals must have access to at least one inpatient provider agency listed in the chart below within the LME-MCO catchment area. Service Number Facilities in LME-MCO Catchment Area with Medicaid Contract Number Facilities in LME-MCO Catchment Area with Contract for State-Funded Services Inpatient Hospital Adult a. Acute care hospitals with adult inpatient psychiatric beds 12 1 b. Other hospitals with adult inpatient psychiatric beds 3 2 c. Acute care hospitals with adult inpatient substance use beds 3 0 d. Other hospitals with adult inpatient substance use beds 3 2 Inpatient Hospital Adolescent a. Acute care hospitals with adolescent inpatient psychiatric beds 1 0 b. Other hospitals with adolescent inpatient psychiatric beds 1 1 c. Acute care hospitals with adolescent inpatient substance use beds 0 0 d. Other hospitals with adolescent inpatient substance use beds 2 2 Page 28 of 46

29 Inpatient Hospital Child a. Acute care hospitals with child inpatient psychiatric beds 1 0 b. Other hospitals with child inpatient psychiatric beds 3 3 Medicaid Eastpointe's CEO wrote a letter to the hospitals located within their catchment area they had contractual agreements with for Adult Inpatient Psychiatric services. The purpose of this was to gauge interest in providing this level of service to adolescent members. Completed March 31, A letter was sent to hospitals that Eastpointe LME-MCO contracted with in counties contiguous to their catchment area for Adolescent Inpatient Psychiatric services. The purpose of this letter was to gauge interest in opening an adolescent unit for beds within their catchment area. Completed March 31, The Hospital Association was contacted via a letter requesting assistance with communicating Eastpointe's interest in recruitment of a provider of Inpatient Psychiatric services for adolescent members within their catchment area. Completed March 31, State-Funded Eastpointe's CEO wrote a letter to the hospitals located within their catchment area they had contractual agreements with for Adult Inpatient Psychiatric services. The purpose of this was to gauge interest in providing this level of service to adolescent and child members. This was completed March 31, A letter was sent to hospitals that Eastpointe LME-MCO contracted with in counties contiguous to their catchment area for Adolescent Inpatient Psychiatric services. The purpose of this letter was to gauge interest in opening an adolescent unit for beds as well as a child unit for beds, within their catchment area. Completed March 31, The Hospital Association was contacted via a letter requesting assistance with communicating Eastpointe's interest in recruitment of a provider of Inpatient Psychiatric services for adolescent and child members within their catchment area. Completed March 31, B. What inpatient services gaps were identified by consumers and family members? Inpatient services gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 1,400 consumers and families that responded (out of 45,571 (3%)consumers served by Eastpointe in SFY15) about gaps in inpatient services. Out of the 1,400 respondents, 822 (58.7%) responded with 'I Don't Know' when asked what service gaps existed in the current inpatient service system in your community. There were no inpatient services gaps in the % range. C. What inpatient services gaps were identified by other stakeholders? Inpatient services gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 864 stakeholders that responded about gaps in inpatient services. Out of the 864 respondents, 303 (35.1%) responded with 'I Don't Know' when asked what service gaps existed in the current inpatient service system in your community. There were no inpatient services gaps in the % range. D. What specific geographic, cultural or demographic groups experience gaps in the inpatient services above that need to be addressed? Describe gaps and how the information was gathered. Neither Medicaid nor State -Funded access requirements have been met for all of the inpatient services. Consumers, families and stakeholders reported there were geographic gaps which included transportation, safe housing for respondents and their children, medical services, lack of funding, and lack of responsiveness. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. Page 29 of 46

30 E. Goals, strategies and timelines for addressing inpatient services gaps identified in V.A., V.B., V.C. and V.D. Medicaid Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or in progress Adolescent Inpatient Psychiatric services Letters were written to hospitals located within Eastpointe's catchment area that they have contractual agreements with for Adult Inpatient Psychiatric services to gauge their interest of them providing this level of service to adolescent members. A letter was sent to hospitals that Eastpointe contracts out with in counties contiguous to their catchment area for Adolescent Inpatient Psychiatric services to gauge interest in opening an adolescent unit for beds with their catchment area. The Hospital Association was contacted via a letter requesting assistance with communicating Eastpointe's interest in recruitment of a provider of Inpatient Psychiatric services for adolescent members within their catchment area. Completed March 31, Completed State-Funded Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or in progress Adolescent Inpatient Psychiatric Services Letters were written to hospitals located within Eastpointe's catchment area that they have contractual agreements with for Adult Inpatient Psychiatric services to gauge their interest of them providing this level of service to adolescent members. A letter was sent to hospitals that Eastpointe contracts out with in counties contiguous to their catchment area for Adolescent Inpatient Psychiatric services to gauge interest in opening an adolescent unit for beds with their catchment area. The Hospital Association was contacted via a letter requesting assistance with communicating Eastpointe's interest in recruitment of a provider of Inpatient Psychiatric services for adolescent members within their Completed Page 30 of 46

31 Child Inpatient Psychiatric Services catchment area. Completed March 31, Letters were written to hospitals located within Eastpointe's catchment area that they have contractual agreements with for Adult Inpatient Psychiatric services to gauge their interest of them providing this level of service to child members. A letter was sent to hospitals that Eastpointe contracts out with in counties contiguous to their catchment area for Adolescent Inpatient Psychiatric services to gauge interest in opening an child unit for beds with their catchment area. The Hospital Association was contacted via a letter requesting assistance with communicating Eastpointe's interest in recruitment of a provider of Inpatient Psychiatric services for child members within their catchment area. Completed March 31, Completed VI. Specialized Services. Medicaid and State-Funded specialized services access and choice standard: It is the expectation that all contracted providers serve consumers from all counties within the Eastpointe catchment area. Service Parent Agency Name Medicaid State CAROLINA OUTREACH LLC CORINE'S CARE MANAGEMENT, INC. East Carolina Health NEW DIMENSION GROUP, LLC Partial Hospitalization NOVA IC, INC MH Group Homes Psychiatric Residential Treatment Facility ONECARE, INC SOUTHEASTERN BEHAVIORAL HEALTHCARE SERVICES, LLC UNC Hospital Chapel Hill VIDANT EDGECOMBE HOSPITAL BETTER DAYS AHEAD, INC EASTER SEALS UCP- NORTH CAROLINA AND VIRGINIA, INC HOWELL & HOWELL GROUP HOME, LLC LOVING CARE SUPERVISED LIVING GROUP LTD MONARCH NEW DESTINATIONS INC SOMEONE DOES CARE Supreme Love 2 Alexander Youth Network Barium Springs Home for Children Page 31 of 46

32 Cornerstone Treatment Facility Program, Inc. Eliada Homes, Inc. Grandfather Home for Children, Inc. Michael Walker NOVA, Inc PREMIER HEALTHCARE SERVICES, INC. Strategic Behavioral Health The Children's Home, Inc. Thompson Child & Family Focus Yahweh Center Children's Village YOUTH FOCUS, INC CHILDREN'S HOME SOCIETY OF NORTH CAROLINA EASTER SEALS UCP- NORTH CAROLINA AND VIRGINIA, INC FAMILY SERVICES OF AMERICA Residential Treatment KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA,INC Level 1 LUTHERAN FAMILY SERVICES OMNI VISIONS, INC THE BAIR FOUNDATION TOUCHSTONE RESIDENTIAL SERVICES ACI SUPPORT SPECIALISTS,INC Alexander Youth Network Barium Springs Home for Children CHILDREN'S HOME SOCIETY OF NORTH CAROLINA COASTAL BEHAVIOR HEALTH SERVICES, INC. EASTER SEALS UCP- NORTH CAROLINA AND VIRGINIA, INC ELIADA HOMES, INC FAITH IN FAMILIES, INC FAMILY PRESERVATION SERVICES OF NC INC GRANDFATHER HOME FOR CHILDREN KIDSPEACE NATIONAL CENTERS OF NORTH AMERICA,INC LIFE OPPORTUNITIES THERAPEUTIC HOME SERVICES LUTHERAN FAMILY SERVICES Residential Treatment NATIONAL MENTOR HEALTHCARE Level 2 Family Type OMNI VISIONS, INC SAFE HAVEN CHILDRENS SERVICES LLC SANDHILLS ALTERNATIVE ACADEMY LLC STEPHENS OUTREACH CENTER SUNLIGHT BEHAVIOR CENTER INC THE BAIR FOUNDATION THE BRUSON GROUP, INC THE METHODIST HOME FOR CHILDREN,INC Thompson Child & Family Focus TOUCHSTONE RESIDENTIAL SERVICES UNITY HOME CARE INC VOCA CORPORATION OF NC DBA NEW HORIZONS YOUTH FOCUS, INC Barium Springs Home for Children Residential Treatment STEPHENS OUTREACH CENTER Level 2 Group Type THE BRUSON GROUP, INC YOUTH ENRICHMENT GROUP HOME, INC Residential Treatment A SPECIAL TOUCH, INC Page 32 of 46

33 Level 3 ALL GOD'S CHILDREN OF BURLINGTON, LLC ELIADA HOMES, INC ENVISIONS OF LIFE, LLC Forever Young Grandfather Home for Children, Inc. KEEP HOPE ALIVE HUMAN SERVICES LLC NEW HORIZON GROUP HOME, LLC PEARL'S ANGEL CARE INC PRIDE IN NORTH CAROLINA INC STEPHENS OUTREACH CENTER SUNLIGHT BEHAVIOR CENTER INC WECARE RESIDENTIAL FACILITY YOUTH ENRICHMENT GROUP HOME, INC ELIADA HOMES, INC Residential Treatment Forever Young Level 4 Grandfather Home for Children, Inc. YOUTH ENRICHMENT GROUP HOME, INC Child MH Out-of-Home Respite NATIONAL MENTOR HEALTHCARE OMNI VISIONS, INC SOUTHEASTERN RECOVERY ALTERNATIVES SA Non-Medical Community SOUTHLIGHT HEALTHCARE Residential Treatment TRI COUNTY COMMUNITY HEALTH COUNCIL,INC SA Medically-Monitored Community Residential Treatment UNC Hospital Chapel Hill SA Halfway Houses TRI COUNTY COMMUNITY HEALTH COUNCIL,INC A CARING HEART CASE MANAGEMENT, INC. A SMALL MIRACLE, INC AMBLECARE, INC AMBLESIDE, INC AUTISM SOCIETY OF NORTH CAROLINA BETTER CONNECTIONS, INC. BETTER DAYS AHEAD, INC CAROBELL, INC COASTAL RESIDENTIAL SERVICES, INC I/DD Group Homes and AFLs EASTER SEALS UCP- NORTH CAROLINA AND VIRGINIA, INC HERBERT REID HOME, INC KYSEEM'S UNITY GROUP HOME, LLC LE CHRIS ADULT DAY CARE OF ROCKY MOUNT MONARCH RHA HEALTH SERVICES, INC. RHA HOWELL CARE CENTERS, INC RHA NORTH CAROLINA MR,INC SAGUARO GROUP SOPHIA B PIERCE AND ASSOCIATES, INC BAILEY'S RESPITE CARE CNC/ACCESS, INC. EDUCARE COMMUNITY LIVING CORP.-NC I/DD Out-of-Home Respite HOMECARE MANAGEMENT CORPORATION RHA HEALTH SERVICES, INC. RIVERBEND SERVICES INC SAGUARO GROUP Page 33 of 46

34 I/DD Facility-Based Respite Intermediate Care Facility-I/DD SKILL CREATIONS, INC BAILEY'S RESPITE CARE BETTER CONNECTIONS, INC. BETTER DAYS AHEAD, INC LUCILLE'S BEHAVIORAL, INC RHA HEALTH SERVICES, INC. SAGUARO GROUP TT & T SERVICES, INC. Autism Services, Inc. Cape Fear Group Homes, Inc. Carobell, Inc. Carter Clinic, P.A. Community Innovations, Inc. EduCare Community Living Corporation-North Carolina GHA Autism Supports Greater Image Healthcare, Corp. HORIZONS RESIDENTIAL CARE CENTER HOWELL SUPPORT SERVICES, LLC. Howell's Child Care Center, Inc. LIFE, INC Midstate Health Systems, Inc. Monarch NOVA IC, Inc. Pitt Co GH Board for MR, Autistic Persons, Inc. ResCare of North Carolina-EduCare Community Living RHA HOWELL CARE CENTERS, INC RHA NORTH CAROLINA MR,INC Rouse's Group Home, Inc. Skill Creations, Inc. Sophia B. Pierce & Associates, Inc. VOCA Corporation of North Carolina B. What specialized services gaps were identified by consumers, family members and other stakeholders? Specialized services gaps identified by consumers and family members were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 6,483 consumers and families that responded (6483 represents a total of 14% of the 45,571 total consumers served by Eastpointe during SFY15) about gaps in specialized services. Out of the 6,483 respondents, 4,057 (62.6%) responded with I Don t Know when asked what service gaps existed in the current specialized service system in your community. There were no specialized services gaps in the % range. C. What specialized services gaps were identified by consumers, family members and other stakeholders? Specialized services gaps identified by stakeholders were rated on a scale of 0-25%, 26-50%, 51-75% and %. The percentage represents the number of respondents who reported 'Yes', there were gaps in the following services. There was a total of 3,661 stakeholders that responded about gaps in specialized services. Out of the 3,661 respondents, 1,694 (46.3%) responded with I Don t Know when asked what service gaps existed in the current specialized service system in your community. There were no specialized services gaps in the % range. Page 34 of 46

35 D. What specific geographic, cultural or demographic groups experience gaps in the specialized services above that need to be addressed? Describe gaps and how the information was gathered. Several specialized services did not meet the access requirements for either Medicaid or State-Funded. Consumers and families reported there are no services in the community; lack of transportation and jobs are geographic barriers for respondents. Stakeholders reported service gaps including limited providers, lack of responsiveness, lack of referrals and collaboration. Information was gathered by surveys throughout the Eastpointe LME-MCO 12-county catchment area. E. Goals, strategies and timelines for addressing specialized services gaps identified in VI.A., VI.B., VI.C. and VI.D. Medicaid Service Gap Goal and Target Date Strategies to achieve goal, noting if planned or in progress Non-Medical Community Residential Treatment Eastpointe will operationalize a Non-Medical Community Residential Treatment Provider in the Eastpointe Catchment Area by November 1, 2016 Eastpointe will prepare and release RFP for this service (by 5/30/16). Eastpointe will review the RFP submissions and select vendor by 7/1/16. The selected vendor will obtains site/license etc., by 9/30/16. Site approval/contract approval by MCO by 10/15/16. VII. State-Funded Services Items A. For State-Funded services, describe any geographic discrepancies in services included in the LME-MCO s local Benefit Plan. That is, are residents of some counties excluded from coverage under the LME-MCO benefit plan, or have stricter eligibility requirements? Include which services, why this occurred, and whether there is a plan in place to ensure equal access based on need across all geographic areas. All services are available to all geographic areas of the Eastpointe LME-MCO. No residents are excluded from coverage under the benefit plan or have stricter eligibility requirements. B. For State-Funded services, describe any services that were closed to new admissions or not offered during the year. Include which services, why this occurred, the period of time, and how the LME-MCO ensured priority populations continued to access appropriate levels of care. During SFY15, no services were closed to new admissions or not offered during the year. Section Three: Geoaccess Maps. Maps are provided for services listed below where less than 90% of consumers have the required access and/or choice meeting the NC DHHS standards for location-based and community/mobile services. I. Location-Based Services Medicaid Opioid Treatment is the only Location-Based Service where less than 90% of Eastpointe consumers have the required access and choice. See map on page 43 in Appendix A. Page 35 of 46

36 II. Community/Mobile Services Eastpointe had no gaps identified in the Medicaid or State-Funded Community Mobile Services. Section Four: Departmental Initiatives. Eastpointe provided a list of progress, strategies, goals and target dates for each of the seven required State initiatives below. Initiative Service Gap Goal Recovery- Oriented Systems of Care 1. Not enough Recovery- Oriented Activities provided by Network Providers. 2. Need for additional area rallies for recovery across the 12 county catchment area. Increase provider training in Recovery-Oriented Systems of Care. Expand area rallies for recovery across the catchment area. Target Date Jan 1, 2017 Jan 1, 2017 Strategy Collaborate internally and with external agencies to link people to services and supports that help sustain long-term recovery, including resources such as: recovery centers in the community recovery activities and websites peer support mutual help groups faith-based supports housing transportation education and vocational training medical care, including HIV services financial and budget counseling legal and advocacy services alcohol, drug and gambling services prevention for children and adolescents parenting and family services Conduct recovery rallies in each county served. Progress to Date ASAM Certification Training using the NC DMH/DD/SAS ASAM elearning modules from The Change Companies has been provided. A total of 55 Eastpointe staff registered; 48 providers registered with 33 completing. A chart is provided on page 44 outlining the progress of those registering. ASAM Criteria: Module 1 Introduction to ASAM Criteria. 2.0 hours completed 3/2/15. ASAM Criteria Module 2: From Assessment to Service Planning and Level of Care 6.0 hours completed 2/25/2015. ASAM Criteria Module 3: Multidimensional Assessment 6.0 hours completed 1/29/15. ASAM Criteria Module 3: Multidimensional Assessment 6.0 hours Completed 1/29/15. Quality of Care physician-led case reviews, team approach to address risks and deficiencies in care models are held weekly and are ongoing. First Annual Rally for Recovery held Sep 26, 2015 at First United Methodist Church in Wilson, NC; over 300 attendees from Nash, Edgecombe, Robeson and Wilson counties. Page 36 of 46

37 Crisis Solutions 1. Facility- Based Crisis Services are not located in close proximity to all members throughout the 12-county region. To have Facility- Based Crisis fully expanded by targeting the northern portion of the catchment area for expansion of one FBC. The only other FBC is in Lumberton, NC. Jun 30, 2016 Work with Emergency Medical Services (EMS) within the 12 counties to provide training on behavioral health (i.e., CIT and onsite Eastpointe and Emergency Medical Emergency preceptor training). Inpatient- were able to secure a three-way contract for 2 beds with South East Regional Hospital. Entered into an MOA with Scotland General Hospital to open a gero-psych unit. MST- continue to promote MST as an alternative to hospital but providers continue to be reluctant due to the cost of certification and the low number of referrals. TBI- Educate providers more about TBI Identification and treatment alternatives. Additional specialty training for Veterans with TBI. Discussion with Lenoir County EMS to provide education and onsite (preceptor training). The FBC Crisis expansion is continuing. Eastpointe has reworked the construction plan for 207 W. 29 th Street, Lumberton, NC, so the facility can remain open during the construction phase. Eastpointe has gathered necessary resources to cover cost overruns as a result of electrical issues discovered during the initial phases of the design plan. Page 37 of 46

38 2. Lack of an alternative crisis solution to Emergency Departments for members in crisis. Have an MOA between EMS and a local provider related to crisis response sites outside of the ED. Pursue funding for FBC expansion in other counties in our catchment area. Jan 1, 2017 Coordinate the linkage between EMS and the local providers to promote development of ED alternative sites for crisis response. Currently meeting with the following EMS Departments: Edgecombe - Meets twice a year, once in fall, once in spring unless otherwise specified, usually at Edgecombe County Administrative Building Auditorium. Spring meeting to be announced. Nash - Meets quarterly at Nash UNC Hospital, Surgical Pavilion Conference Center Auditorium, 10a-12p. Meeting dates are Feb 26, 2016, May 27, 2016, Aug 26, 2016 and Nov 18, Wilson - Meets quarterly on second Wed from 10a-12p. Greene - Greene County doesn't meet very often; no set date and time. Wayne - Meets quarterly at the Wayne EMS Building in Goldsboro; no date at this time. Lenoir - Quarterly dates determined each quarter. Last meeting with Lenoir EMS was on 3/4/2016 at Eastpointe LME-MCO Lumberton Site-Lenoir EMS toured Eastpointe s Member Call Center. Duplin - Fourth Thu each month at the Duplin EMS Building in Kenansville. Sampson - Meets 3rd Tues in January, April, July and October. Columbus -Meets quarterly or 4 times a year at Sheriff s Department, Hospital, Brunswick Electric, Federal Paper Company and Atlantic Publishing in Tabor City. Robeson - Meets quarterly; next meeting will be held in March (Official date undetermined), at Robeson County Emergency Services building: 38 Legend Drive Lumberton. Scotland - Meets quarterly from 9a-1p. Bladen - Meets twice per year; next meeting is in May (official date undetermined) at Bladen County Health Department in Elizabethtown. Page 38 of 46

39 Advancing Technology Need to increase access and engagement of members through technology. 1. To complement and expand member and provider resources and create cost effective methods of access to safe mental health resources and evidence-based information. 2. To prevent, identify and assist in every entry point of a crisis regardless of mental illness, intellectual disability, or substance use. 3. To educate our members and providers on the uses of the various types of innovative technology within the crisis services continuum. Jun 1, 2016 Jun 1, 2016 Jun 1, 2016 MH, SU, and I/DD educational Kiosks will be strategically placed in public health offices, agencies and libraries; they will go live by the second quarter of Eastpointe's plan is to have a kiosk placed in each of the 12 counties. Kiosks will provide easier access to services with screening capabilities for members. Overhaul and development of Eastpointe website. Incorporation of Facebook. After publishing the overhauled website and Facebook, other social media (i.e., Twitter, LinkedIn, Instagram, etc.) avenues will be implemented. Eastpointe has partnered with Screening for Mental Health, Inc. to provide the MindKare Kiosk Program. This will be an educational and awareness-raising tool to help normalize mental health care and reduce stigma. In December, EP discovered the MindKare Program which included an expansion of services for members. EP expects to have at least four kiosks out in the first cities that were approached by June of Kiosks will be located in Barton College in Wilson, NC, Library in Lumberton, NC, Library in Rocky Mt., NC, Library in Tar Heel, NC. The screening program is embedded within the company or initiative-branded machine and the screenings are quickly conducted through self-administration. The company is working directly with Eastpointe to build tailored, mental health screening kiosks. The following will be included: Voice over IP; Cloud Solution; and technical support and assistance. Screening Tools include Hands Depression Screening, Audit Alcohol Screening, Mood Disorder questionnaire; Eating Disorders Screening; The Carroll-Davidson Gad Scale; SPRINT-4 (Post-Traumatic Stress Disorder) and Brief Screen for Adolescent Depression (BSAD). Eastpointe has implemented six billboards to assist with educating and promoting access to behavioral healthcare; projected to have been viewed 353,021 times to date. The updated website and Facebook page will be launched by May 1, Ongoing Page 39 of 46

40 Employment 1. Need to expand network to include availability of providers across the geographic regions. Increase Supported Employment enrollments and in particular the at risk population by 3%. Jun 30, 2017 Increase education to members, families and providers regarding Supported Employment Services. Review, track, and trend utilization of Supported Employment Services in conjunction with the Quality Management Department. The Transition to Community Living Initiative Department is offering Supported Employment to all 332 members being in-reached. Data is being tracked and trended on a monthly basis. For , EP had approximately 450 individuals receiving Supported Employment Services. 2. Need increased marketing to encourage and empower consumers in Supported Employment Services. Increase collaboration with external programs that assist individuals with competitive employment opportunities. Jun 20, 2017 Reach out to Vocational Rehabilitative Programs across the catchment area to discuss strategies and resources available to assist individuals. Explore the Clubhouse Model; explore volunteer opportunities and internships to assist with obtaining work experience. Outreach to Vocational Rehabilitation, Club House Model and Internships are in process. Housing Need to identify additional housing resources with proximity to medical/ behavioral and community resources Expand the Shelter Plus Care Program from the current four counties to all twelve counties across the Eastpointe catchment area. Jan 1, 2017 Complete an action plan to address identified needs as they relate to community housing. Additional resources utilized by the Eastpointe Housing Specialists are: SocialServe; NC Housing Search Assisted with application for two additional SPC grants; one grant will serve an additional 17 families and individuals in four counties of the Southeast Region; the other grant will expand the smallest grant in the Twin- County/ Wilson-Greene Region to serve an additional ten families and individuals. Anticipate announcement in Spring/Summer Eastpointe s Housing Department actively cultivates partnerships with community stakeholders and seeks out opportunities that will benefit our members throughout the catchment area. Eastpointe is involved in collaborative efforts throughout the 12-county catchment area, including regular monthly meetings with the local regional Committees. Page 40 of 46

41 Children s Services 1. Need to increase Intensive Alternative Family Treatment (IAFT) homes in the catchment area. 2. Not enough awareness of bullying and its impact on a person's mental health well-being in catchment area. Increase number of IAFT homes by five Expand the Bullying Initiative and the American Academy of Child and Adolescent Psychiatry ( AACAP) Advocacy Grant across the catchment area. Jun 30, 2017 Jun 30, 2017 External and Clinical Operations will work with contracted provider to increase the number of IAFT homes within the catchment area. Eastpointe will collaborate with external entities to expand its Youth Summit model to more counties in the catchment and collect measurable data on initiative impact. The aim is to expand the already successful model of youth education and support regarding bullying within school from the Eastpointe catchment area to other regions of the state by training and education. EP continues to work with Rapid Resource to increase our inventory of homes for this service. Currently, five children use this service and have increased our inventory locally by two sites. Attending physicians and residents with the University of North Carolina Chapel Hill Department of Child and Adolescent Psychiatry attended a Youth Summit in Greene County. In July 2015, the Eastpointe Medical Director and Bullying Initiative Lead from Community Relations conducted an all- state training with attending physicians and residents from all 4 medical school programs. Anti-bullying summits held: Greene County, Sep 20, 2014; Duplin County, Mar 14, 2015; Edgecombe County, Nov 23, 2015; Robeson County, Feb 6, EP is seeking grant funds for advocacy activities designed to improve care for the mental health needs of children, adolescents, and families within a state or community; discussed in Executive Team for possible funding. Antibullying has been coordinated in two counties; plan is to train in other counties. The Medical Director with the Community Relations Department has scheduled Anti-Bullying Summits across Eastpointe's catchment area. Page 41 of 46

42 Integration of Physical and Behavioral Health Care 3. Engagement time in step-down services after Psychiatric Residential Treatment Facility (PRTF) discharge is not sufficient to decrease re-admission rate to higher level of care. Need to utilize various data applications to identify the costs and outcomes for those persons identified as high risk by care coordination in order to determine the effectiveness of the process and develop provider incentives to co-locate behavioral health services in primary care clinics and Federally Qualified Health Clinics (FQHCs) throughout the service area. Decrease re-admission rates to PRTF and high levels of care by 10%. Ensure a smooth transition for members stepping down from PRTF, ensure treatment planning occurs with family and guardians. UM reviews every member for step down services prior to discharge when contacted for review. To provide resources to medical providers regarding how to investigate evidence-based tools and techniques in integrated care. Jun 20, 2017 Jun 30, 2016 UM will review services prior to member discharge and approve the most appropriate step-down. Care coordination works with PRTF, family and Child and Family Team to offer available step-down services and providers. Clinical and QM participation with the Governor's Mental Health and Substance Use Task Force Meeting. Review, track, and trend data related to hospitalizations Collaborate with external physical health entities on integration of care. Continued collaboration with the NC Center of Excellence for Integrated Care and the 3 CCNC Networks. Continued attendance at the Crisis Collaborative and Crisis Solutions Coalition & Behavioral Health Urgent Care Workgroup. UM approves all step-down services prior to discharge when requested. Care coordination is involved with discharge planning meetings and offers service choices to guardians. Readmission rates are being monitored and reviewed by Quality Management Department. Clinical staff in partnership with QM have been reviewing repeat hospitalizations and developing strategies to address this problem. It was determined that re-admits may be skewed. EP is also working with EMS regarding potential for applying for a grant to defer ED admits through EMS. Eastpointe is also in the process of adding 13 physical health clinics that will co-locate with behavioral health. Eastpointe's Medical Director is working individually with medical doctors in the area to share information related to behavioral health services. Page 42 of 46

43 Geoaccess Map Appendix A Eastpointe Note: The reference population for this map is all Eastpointe Adult consumers eligible for Medicaid funding. Page 43 of 46