One week after state officials notified Western Highlands Network of plans to end its Medicaid waiver contract July 31, WHN board members report that the future of the Asheville-based organization will come in one of two ways: merge with another local management entity, or pilot an integrated health-care program.
“The state wants us to figure out what we’re going to do,” Western Highlands interim CEO Charlie Schoenheit said at the board’s April 12 meeting. “We’ve got a couple of weeks to come up with our plan. We don’t have a lot of time to mess around.”
The first option means merging with one of 11 local management entities in the state, while trying to keep as many of the existing staff as possible. These organizations are available 24/7, helping people find information about how to receive services in their county for mental health, developmental disabilities or substance abuse. Schoenheit noted that Western Highlands has already “received letters of interest from across the state.”
The closest management entity to Western Highlands is Smoky Mountains LME, which serves individuals in Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga and Wilkes Counties.
Board member Mandy Stone said that, should Western Highlands take this route, it would not be the first time a merger has happened in the state. However, it would be the first time that one occurred after a contract termination. “I think that’s what caused anxiety for providers and consumers, [who want] to know whether they were going to have local input in how we go forward,” Stone explained.
The second option involves creating a pilot program centered on an integrated care model, in which behavioral health care and medical health care are managed comprehensively as a way to look at the whole person and reduce costs in the long-term, Stone said.
Board chair Charles Vines said in the next two to three weeks, the board will sit down with state officials and attorneys to sort out legal options for pursuing the pilot program. State officials “are willing to allow us to have input, lots of input, and we’re going to work to make the best decision we can,” Vines says.
The pilot program matches the state’s long-range “Partnership for a Healthy North Carolina” plan, which “calls for the creation of several statewide Comprehensive Care Entities that will provide the framework to deliver high quality, patient-centered care to Medicaid recipients.” Presented earlier this year, the plan awaits approval from the North Carolina General Assembly.
Stone says, “We’re the perfect community to pilot an integrated model. … It’s in our [federally qualified health center] at Minnie Jones, it’s a part of our hospital system, it’s a part of MAHEC and how they train docs.”
Both options came out of an April 11 meeting: Six of the seven county managers who serve on the Western Highlands board traveled to Raleigh and met with Alonda Wos, secretary of N.C. Department of Health and Human Services; Carol Streckel, director of N.C. Division of Medical Assistance; and DHHS staff to discuss the termination of the Medicaid waiver.
Western Highlands board members mentioned that the state apologized for how the notification was handled, but voiced frustration nonetheless. “We were here Friday morning [April 8] in a meeting. Now, you tell me that [state officials] decided at 3 p.m. [that day] to do this? No. They knew good and damn well what was going on and they had to know, or should have known, that we were here. They should have had somebody here and said, ‘Hey folks, we need to talk about this,’” board member Steve Wyatt told Xpress after the meeting.
Board members maintained that they’ll determine Western Highland’s fate based not only on what it means for the network’s more than 300 providers but for how it affects the more than 10,000 consumers the network serves at any given time.
“Our main objective is to make sure that, whatever process we end up with at the end of the day, we make sure everything is as seamless as possible to the clients and the providers at the end. The clients are the most important thing that’s on our mind right now [and] how we’re going to continue to take care of them. And hopefully the transition will not affect them whatsoever,” Vines said.
Until then, Schoenheit noted, “it’s business as usual. We are going to continue to do authorizations. We’re going to continue to take in new consumers through our access department. All these functions are still going to continue while we figure out what we’re going to do and while we’re making the transition.”
— Caitlin Byrd can be reached at 251-1333, ext. 140, or at firstname.lastname@example.org.