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Cross-System Navigation in a Managed Care Environment

The goal of this initiative is to develop recommendations for the North Carolina Department of Health and Human Services (DHHS) about how individuals with I/DD and their families can best be supported to effectively navigate across various service systems (cross-system navigation) as DHHS moves toward implementation of Medicaid Transformation. Medicaid Transformation is NC's plan to transition the physical Medicaid program to managed care to improve overall service delivery and improve the integration of behavioral and I/DD healthcare and physical healthcare services.

Why is NCCDD funding this initiative?Goal2

  • Individuals with intellectual and other developmental disabilities (I/DD) and their families often need assistance to navigate the complex Medicaid/Medicare and State systems of long-term services and supports (LTSS).
  • As a result of the transition to the North Carolina Innovations Waiver starting in 2005, case management and targeted case management functions (which supported individuals with and without Medicaid waiver services) were largely substituted with less robust care coordination and community guide services.
  • With the evolution from a Local Management Entity (LME) system to a Local Management Entity/Managed Care Organization (LME/MCO) system, families and individuals have described taking on greater care coordination and community and service definition exploration without the informed expertise previously provided by case managers leading to confusion, reduced efficacy and unnecessary service interruption or costly outcomes.
  • The structure of care coordination is inconsistent across the state, which has further complicated the ability of individuals with I/DD and their families to help each other navigate such a complex landscape, as what works in one region may not work the same in another.
  • Through Medicaid Transformation, North Carolina is joining the trend of state systems implementing capitated managed care as a strategy for lowering mental health care costs and improving efficiencies. Complicating this, however, is the enhanced supports that individuals with intellectual and other developmental disabilities (I/DD) who are dually diagnosed with behavioral health challenges need to navigate these changing systems.

What are the major goals and objectives?

  • Continue to convene the Cross-System Navigation Advisory Workgroup in collaboration with NC Department of Health and Human Services, advocacy and service provider organizations - disseminating its discussions and findings with wider policy and health service audiences in ways that will facilitate research uptake in decision-making processes and practices.
  • Assess the options available to Individuals with I/DD who are on Medicaid (both the state plan and the Innovations Waiver) and provide recommendations to meet needs of individuals with I/DD being served as well as individuals with I/DD on the Registry of Unmet Needs waiting for waiver services and for individuals with I/DD on Medicaid as well as individuals with I/DD who have private insurance or no insurance (i.e., are not in the Medicaid System).
  • By October 2019, produce a Workforce White Paper that will make relevant workforce development recommendations to DHHS, state policymakers, LME/MCO leadership and provider leadership.
  • By June 30, 2020, produce a Grant Recommendation Report detailing the workgroup findings regarding navigation support needs for individuals with I/DD and also outlining policy and practice change recommendations.

What has been achieved to date?

In the initiatives first year:

  • Cross-System Navigation Advisory Group Development: i2i has secured 22 members to the Advisory Workgroup. i2i is continuously ensuring that the Managed Care Cross-System Navigation Advisory Workgroup consists of a wide variety of members chosen for their subject matter expertise, organizational affiliations, and lived experience to achieve successful systems change.
  • Four Cross-System Advisory Group meetings:
    • September 26th in Raleigh, NC
    • December 4th in Pinehurst, NC
    • March 27th in Greenville, NC
    • June 19th in Asheville, NC
  • Website Development: i2i has developed a website specifically for this initiative: CrossSystemNavigation.org. It provides information about the initiative and will be updated to include initiatives progress, resources, and Advisory Group member information in the future.
  • Provided Feedback the Care Management Policy Paper released by NC DHHS. Submitted feedback included:
    • What questions and concerns the group have about the design or implementation of the Care Management model proposed
    • Recommendations for changes to the care management model proposed for the BH/IDD TP
    • What topic areas will need to be covered to educate the system to move in this direction (beneficiaries, providers, LMEMCOs, stakeholders in other systems)
  • Developed and held “Medicaid Transformation 101 Webinar” to provide basic information about Medicaid Transformation to people with I/DD and their family members.
    • Over 1,200 people attended or watched the recordings
    • “Thank you for breaking down a very complex topic into much more manageable terms and graphics” – Participant Feedback
    • 91% of participants indicated they were “satisfied” or “very satisfied” after attending the webinar.
    • 98.5% of attendees reported increased understanding of Medicaid Transformation after attending the webinar.
  • Collected Feedback for MCAC BH I/DD Tailored Plan Design Subcommittee about “Transitions of Care”
    • 448 people participated
    • 40% self-identified as consumers, family members, or advocates
    • Generated 48 pages of questions, recommendations and feedback for DHHS
  • Provided feedback on “A Guide for People with Disabilities and Older Adults Who Use NC Medicaid” to NC DHHS
    • Only outside group to review and provide feedback to DHHS
    • Recommendations provided included:
      • Provide a glossary of terms
      • How to disseminate to reach the most people
      • Areas to simply
      • Person-centered/ strength-oriented language
      • 5 pages of feedback

What long-term changes are expected as a result of this initiative?

  • The initiative will continue to support Medicaid Transformation in ways that will have meaningful and sustainable benefits for people with I/DD and their families. With the help of our Advisory Group, we will continue to influence the evolving plan, and we will disseminate information regarding system navigation widely.

Who is the contractor?

i2i logo LG copy

The contractor is i2i Center for Integrative Health.

Who can I contact for questions?

Project Director: Kelly Friedlander, MSW, MPA. Kelly@i2icenter.org

NCCDD: David Ingram, Systems Change Manager. David.Ingram@dhhs.nc.gov


Additional Resources

Click HERE to review a one-pager on the Cross-System Navigation in a Managed Care Environment initiative

For additional information on i2i and i2i’s work on this initiative, visit www.CrossSystemNavigation.org  

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North Carolina Council on Developmental Disabilities
3125 Poplarwood Court
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Raleigh, NC 27604
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