Advancing NC Whole Health

 

What we are doing

Advancing NC Whole Health is a new partnership to leverage strengths and expertise in response to Medicaid reform. The coalition will unite the efforts of high-performing MCOs—Vaya Health and Trillium Health Resources—to address significant, statewide health policy issues that impact North Carolinians across the state. Advancing NC Whole Health is in alignment with the Medicaid Reform plan proposed by the NC Department of Health and Human Services.

Why we are joining together

Through the formation of the coalition, we seek to have a stronger voice in advancing the role of the public behavioral healthcare system in Medicaid Transformation, helping ensure continued stability and continuity of care for the people they serve. The combined provider network of the MCOs will enhance access to a diverse range of services and supports to people in both urban and rural areas of the state. It also has the potential to provide more seamless access to services to all of the entities that ultimately are part of North Carolina’s evolved Medicaid landscape.

Our leadership identified this coalition as the most effective way to demonstrate to NC DHHS, the General Assembly and potential commercial healthcare partners that MCOs can successfully implement Medicaid Transformation in a way that advances high-quality care, improves population health, engages and supports providers and establishes a sustainable program with predictable costs (a four-prong approach known as the Quadruple Aim).

Who we are

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Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with substance use, mental illness and intellectual/developmental disabilities in 26 counties in eastern North Carolina. Trillium’s mission is to transform the lives of people in need by providing them with ready access to quality care. We take a person-centered approach to health and wellbeing, coordinating care across multiple systems to achieve improved health outcomes, quality of care and efficient use of resources. Trillium is investing in innovation to meet the unique needs of the individuals and communities we serve, and remains focused on delivering the right services, in the right amount, at the right time. For more information, visit www.TrilliumHealthResources.org.


Based in Asheville, N.C., Vaya Health manages public funds for mental health, substance use disorder and intellectual or developmental disability services in 23 western North Carolina counties: Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey. Access to care and crisis assistance are available 24/7 at 1-800-849-6127. Learn more at www.vayahealth.com.

FAQs

What is the purpose of the coalition?

Coming together as a coalition will enhance our ability to respond to the challenges and opportunities of Medicaid reform, demonstrating to NC DHHS, the General Assembly, and potential commercial healthcare partners that MCOs are able to:

  • Work together successfully, leveraging their strengths, experience and expertise, and utilize best practices to increase efficiencies
  • Implement Medicaid Transformation in a way that advances high-quality care, improves population health, engages and supports providers, and establishes a sustainable program with predictable costs
  • Support both Standard and Tailored Plan concepts to offer a proven, North Carolina-based solution that meets statewide and regional needs for MH/DD/SUD and other complex care populations.

Each of these MCOs will continue to operate in the North Carolina counties they serve just as they have been – they will keep their same names, leadership, Board structure and staffing – in addition to working together as part of a coalition to leverage their resources, experience and expertise on a statewide level.


No, this is not a merger or a mandated consolidation. It is a proactive, cooperative effort initiated by high-performing MCOs to unite their efforts to address significant, statewide health policy issues that impact all members across the state, such as emergency department boarding, the opioid crisis, and the IDD wait list. The coalition is in full alignment with the Medicaid Reform plan proposed by the NC Department of Health and Human Services.

As a coalition our MCOs will have a stronger voice in preserving the role of the public behavioral healthcare system in Medicaid Transformation, helping ensure continued stability and continuity of care for the people we serve. The potential to create a combined statewide provider network that will result from the coalition will enhance access to a diverse range of services and supports for people in both urban and rural areas of the state. We’ll be able to leverage the strength of our combined provider networks to better promote the use of evidenced-based practices to ensure high-quality consumer care.

As the coalition evolves, we understand the importance of exploring ways to streamline processes and create system efficiencies to reduce the administrative burden on providers. In addition, the coalition supports the opportunity to create a local, regional and statewide provider network which can provide the opportunity for network members to expand their reach across the state and into integrated care.

There could be opportunity for other MCOs to partner once the coalition has a clear understanding of its business relationships with Prepaid Health Plans (PHPs) or Provider Led Entities (PLEs). At that point we’ll assess gaps and identify strengths of other potential partners for the Tailored and Special Plans. If gaps exist, we’ll explore partnerships with other entities, including MCOs, to fill those gaps.

News: Agreement with AmeriHealth Caritas 

Partnership with AmeriHealth Caritas, to Deliver Integrated Behavioral Health and Pharmacy Services To North Carolina Medicaid Beneficiaries.