Facing county criticism, Cardinal says it will make changes: ‘Let’s work together’

Leaders from Cardinal Innovations Healthcare pleaded with Mecklenburg County commissioners Tuesday to work collaboratively in addressing systemic treatment gaps affecting some of the area’s neediest residents.

Trey Sutten, Cardinal’s chief executive officer, emphasized the managed care organization’s strong ties to Mecklenburg and attempted to partially shift blame to a complex state funding structure, which privatized some mental health services in 2015.

“Let’s work together rather than against one another. Let’s come up with a plan,” Sutten said, later telling the commissioners that “community problems” require “community solutions.”

Cardinal, which oversees behavioral-health treatment in 20 counties throughout North Carolina, came under scrutiny last month as Mecklenburg County commissioners contemplated severing ties with the managed care organization.

Assistant County Manager Anthony Trotman had detailed a pattern of denied, delayed and limited services to individuals with developmental disabilities, as well as mental health and substance abuse concerns.

Tuesday’s meeting marked the first opportunity for Cardinal executives, who were not invited to speak in mid-February, to publicly respond to Trotman’s allegations.

Dietrick Williams, Cardinal’s chief operations officer, refuted the county’s claim that youth who had experienced emergency placements — after being abandoned or neglected by their families — had been denied access to the organization’s provider network. Yet he said that “quite possibly” there were delays in arranging treatment.

“We acknowledge that we have opportunities with our network. We need to do a better job — we hear that,” Williams said, labeling the state’s social services system as broken. “We remain committed to closing treatment gaps, but we can’t do that alone.”

‘Wrapped in excuses’

Sutten said that Cardinal would collaborate with the state Department of Health and Human Services and enlist a third-party consultant to overhaul the organization’s shortcomings.

He also pledged to regularly update the county commissioners, some of whom chastised Cardinal on Tuesday for taking a defensive position. They also questioned whether the organization had fully overcome the problems from 2017 — when top leaders were ousted after “unreasonable spending” and inflated salaries.

“Cardinal has come to the table so many times wrapped in bureaucracy, in excuses,” Elaine Powell, the vice chair of the county commissioners, said. “It cannot be about maximizing return on dollars. ... It’s good to have a relationship with us, but it’s really important to have a conversation with providers.”

Sutten clarified that Cardinal’s priority is the “reach on dollars.”

Still, Sutten said, Cardinal has overspent its own funding allocation, coming from federal Medicaid and state dollars, by $68 million in the past two years. In 2019, about one-third of Cardinal’s allocation was overspent in Mecklenburg alone, Sutten said.

“We put our members first. This is our community,” Sutten said of the local investments.

Commissioner Trevor Fuller said that the North Carolina General Assembly is at fault — not Cardinal — for creating a “total mess” of behavioral-health care.

“Essentially, what you’re asking us to do is clean up the mess,” Fuller said to Sutten. “I remain unsatisfied that the answer to our complaints is essentially for us to get involved.”

Mobile Crisis Team

Lingering questions over funding changes to the Mobile Crisis Team, which provides rapid aid for people with mental or behavioral health emergencies, sparked contentious dialogue between the county commissioners and Cardinal.

The program, a contracted Cardinal provider, is intended to mitigate strain on hospitals and jails, where employees may lack adequate mental health training. But Mobile Crisis recently slashed its staff from eight to three full-time clinicians — causing more than 50 residents since December to wait hours for help, call 911 or go to the hospital.

Keshia Ginn, president of Mobile Crisis, previously told The Charlotte Observer that Cardinal has not fully reimbursed the team for all of its service calls.

Williams said Cardinal had introduced a new funding structure for Mobile Crisis — a fee-for-service model that reimburses the team for each individual helped, rather than providing lump sum payments in advance — last summer to boost transparency and accountability. There were no “funding cuts,” Williams said Tuesday.

“We have not stopped payment,” he said. “We’ll continue to make payments for services rendered.”

But as Cardinal touted its own separate hotline, Commissioner Susan Rodriguez-McDowell blasted the organization for “disavowing” Mobile Crisis.

“That’s what it sounds like to me,” she said. “Somehow saving money on this population, on this part of the puzzle — I’m not comfortable.”

This story was originally published March 10, 2020 at 6:52 PM.