MM Curator summary
The consolidation of North Carolina behavioral health providers continues in advance of the tailored plan launch next year.
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Two of North Carolina’s largest managed care organizations recently announced they will consolidate in preparation for the state’s transformation to Medicaid managed care.
Vaya Health and Cardinal Innovations have already begun transition efforts, with Vaya assuming responsibility for coordinating services and supports for Cardinal Innovations members once consolidated. Together, the organizations will work toward a seamless transition focused on integrated, compassionate care for individuals with mental illness, substance use disorders and/or intellectual and developmental disabilities.
Vaya Health currently manages services for individuals in 22 counties in Western North Carolina. If approved by the N.C. Department of Health and Human Services and county representatives, the consolidation will expand Vaya’s operations to encompass benefits for the individuals and counties served by Cardinal Innovations. The proposed consolidation marks the fourth such endeavor for Vaya, having successfully led previous mergers with New River Behavioral Healthcare in 2007, Foothills Area MH/DD/SA Authority in 2008 and Western Highlands Network in 2013.
Vaya’s experience with transitioning members through consolidation efforts will be especially beneficial as the state’s public health care system is undergoing a significant shift. The first phase of N.C. Medicaid Transformation will launch on July 1, 2021, with five commercial health plans poised to manage integrated health benefits for the majority of Medicaid enrollees.
As part of the second phase of transformation to BH and I/DD Tailored Plans, which are expected to launch in July 2022, Vaya and Cardinal Innovations have been preparing to evolve their operations to offer fully integrated care for people with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability or a traumatic brain injury.
According to a press release, the consolidation of the two organizations will enable a stronger health plan to serve individuals who receive care through North Carolina’s public health care system. It will also bring needed stability to members in counties served by Cardinal Innovations.
“We believe that when we work together to meet the needs of our communities, we all benefit,” said Brian Ingraham, Vaya Health President & CEO. “Our number one priority throughout this transition will be to support members, providers and counties and avoid any disruption in care. We remain committed to offering a successful public service option as a Tailored Plan. It is a privilege to have the opportunity to strengthen the public model, support our county partners and serve even more North Carolinians on their journey toward health and wellness.”
“The passion and commitment of Vaya staff in serving our members and communities is beyond compare,” said Rick French, Vaya Health Board Chair. “The Board of Directors is pleased to expand that work to ensure Cardinal Innovations health plan members continue to receive quality services and supports.”
“We believe in our mission to improve the health and wellness of our members and their families,” said Trey Sutten, Cardinal Innovations CEO. “It has become increasingly clear that in order to deliver on that mission, we need to consolidate with a strong organization that has a history of meeting member and community needs and can stabilize the disruption caused by Medicaid Transformation and county realignments. I have known Brian and the Vaya team for years, and know that our members, providers and communities are in the best possible hands.”
Leadership for the two organizations will be working closely with DHHS as well as local and state government representatives to ensure a successful transition. The boards for each organization will establish a joint steering committee to guide the development of a transition plan that puts member, provider and county needs at the forefront of planning efforts.
Vaya leadership will be visiting with each county to hear their concerns and learn about the unique needs of each community. Consolidation of the two entities under Vaya Health leadership is expected to be completed by June 30, 2022.