Mecklenburg moves to dump Cardinal Innovations, align with a new healthcare provider

Mecklenburg will soon sever its relationship with Cardinal Innovations Healthcare, more than 15 months after county leaders broached the idea, as they slammed the managed care organization for not delivering adequate mental and behavior health services.

But Mecklenburg won’t end up with its own county-centric organization.

County Manager Dena Diorio had requested that approach from state health leaders this year, saying that solution could better address the complicated needs of Mecklenburg’s large population.

Cardinal, seen by mental health advocates as failing to manage treatment across the 20 N.C. counties it serves, perpetuated a “vicious cycle” of failing to arrange “appropriate treatment” for foster children, Diorio claimed in her February letter to Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services. It followed a county commissioners’ vote last November to explore cutting ties with Cardinal.

Diorio, top county administrators and community providers have long accused Cardinal of denying or delaying access to care to some of Mecklenburg’s neediest residents, such as foster children and individuals with substance abuse problems and developmental disabilities.

A separate provider for just Mecklenburg, according to Diorio, could have bolstered treatment for all county residents — and echoed a model seen with MeckLINK Behavioral Healthcare from 2012 to 2014.

But now, Mecklenburg intends to realign with Alliance Health, the managed care organization already serving urban communities in Durham, Wake, Cumberland and Johnston counties.

It will take commissioners several months to start their arrangement with Alliance and end their relationship with Cardinal, though county commissioners took a crucial step toward that goal during their board meeting Tuesday night.

They unanimously voted on approving a “disengagement plan” from Cardinal and authorized county administrators to start the transition process to Alliance. County Commissioner Mark Jerrell abstained from the vote due to a conflict of interest.

A transition team will encompass a range of county agencies, plus Medic, Atrium Health, Novant Health, Cardinal and Alliance.

Commissioner Leigh Altman said the county’s decision is the result of “years and years and years of broken trust by Cardinal Innovations.” The vote was “desperately needed and long overdue,” she said.

“The suffering of our residents has been greatly increased and magnified,” Altman said. “That is something that we absolutely cannot tolerate.”

Yet since February 2020, Cardinal leaders have criticized Mecklenburg for not working together to fix ongoing issues.

Cardinal CEO Trey Sutten told the Observer on Tuesday he is disappointed by Mecklenburg’s decision, emphasizing the county’s frustration over foster care cases represent just a sliver of Cardinal’s services.

Sutten, who was not invited to speak during the board meeting, said recent interactions with county commissioners had signaled an improving relationship.

“The team here has worked extremely hard and in a very collaborative way with county staff to make sure that we continue to deliver on the right things...” Sutten said before the meeting. “We just don’t have a partner that we believe would have ever been satisfied.”

Problems with Cardinal Innovations

Cardinal was embroiled in scandal in 2017, when a state audit revealed “unreasonable spending” and lavish parties among executives who were later ousted. N.C. DHHS took the unusual step of taking over the organization after Cardinal’s board fired CEO Richard Topping and paid him and three other executives $3.8 million in severance.

In deliberations on Cardinal last year, Mecklenburg County commissioners said the organization forfeited the public’s trust and had ongoing transparency issues.

At least one-third of the counties in Cardinal’s service area have also tried to break away from Cardinal. including Union, Cabarrus, Forsyth and Orange.

Even after Cardinal developed a plan with the state to curb systemic problems and invested $30 million for child welfare across 20 counties last November, Mecklenburg leaders said they did not see “desired outcomes for improvement,” according to the county’s disengagement plan.

Cohen has said it’s critical for Cardinal to not only submit a plan but to follow through on it.

Mecklenburg’s document cites ongoing concerns with Cardinal, including “fragmented discharge planning” for people leaving emergency rooms or jails, treatment gaps for individuals during mental health emergencies and a “restricted” provider network for foster care children and adult wards.

But Sutten said Cardinal met or exceeded certain goals, including authorizing behavioral health service requests within a set timeframe and adding more providers.

Diorio has acknowledged that Cardinal, like other managed care organizations across the state, must contend with limited resources and limited funding from federal and state Medicaid tax dollars. Sutten said a “simple realignment” won’t address systemic public health problems beyond Cardinal or Mecklenburg’s control.

Earlier Tuesday, Cardinal and Vaya Health, another large managed care organization serving 22 counties in western North Carolina, announced their intent to consolidate — pending approval from the state.

Diorio said this was a “direct result” of Mecklenburg’s disengagement decision, which created financial stability concerns for Cardinal. It was compounded, Diorio said, by Forsyth County’s vote to disengage from Cardinal earlier this year.

Mecklenburg’s incoming provider

In their disengagement plan, Mecklenburg leaders touted Alliance’s “intentional community engagement at multiple levels within the counties that they serve.”

Alliance also has an “expansive” network of providers, with some already located in Mecklenburg.

“Mecklenburg County has always desired greater network capacity of service providers and greater levels of choice for county residents...” the county’s disengagement plan states. “Alliance utilizes its local networks of providers and community partners to effectively and efficiently serve individuals to promote healthier lives and improve the community.”

Alliance leaders addressed the board Tuesday.

The public will have 60 days to comment on Mecklenburg’s disengagement plan, Diorio said.

Separately, the county must publish a “Continuity of Services Plan.” Providers in good standing with Cardinal will be contracted with Alliance if they aren’t already, according to Mecklenburg.

This story was originally published June 1, 2021 at 3:40 PM.