The risk-based contract marks meaningful expansion for both companies in a state that is growing its Medicaid rolls to include additional vulnerable populations.
Medicaid MCO Alliance Health will partner with value-based care provider Cityblock to deliver “comprehensive, integrated medical and behavioral health care to members with serious mental illness and/or substance use disorder” (SMI/SUD) North Carolina’s Medicaid program.
The partnership began July 1, 2024, and will deliver community-based care to regional members of Alliance Health's Behavioral Health and Intellectual/Development Disability (BH I/DD) Tailored Plan.
The partnership grows both Alliance Health and Cityblock’s presence in North Carolina Alliance Health serves 137,000 Medicaid members in North Carolina’s Cumberland, Durham, Harnett, Johnston, Mecklenburg, Orange and Wake counties. Cityblock serves more than 100,000 Medicaid and Medicare-Medicaid dually eligible beneficiaries in seven states.
Dr. Kam Matthews, Chief Health Officer of Cityblock, tells HealthLeaders: “The partnership with Alliance Health marks a meaningful expansion for us in a state that is making immense progress in its Medicaid expansion efforts. This partnership will not only enhance access to quality healthcare for the most vulnerable members of North Carolina’s Medicaid population but also drive better health outcomes for those with complex care needs.”
An integrated, multi-modal and community-based care model
Alliance Health’s BH I/DD Tailored Plan includes an expanded network of PCPs, SCPs, ancillary providers, pharmacies, and other organizations designed to deliver a more integrated, comprehensive approach to member care and care management.
As one of these providers, Cityblock will apply its multidisciplinary care model that allows patients to see their care team virtually, in their homes, or at a Cityblock clinic. The model’s technology core includes custom-built tools that span care team operations and the member experience.
"Alliance believes that Cityblock's treatment approach of providing community-based integrated primary care, behavioral health care, and attention to social supports is an ideal model to address the complex needs of our members," noted Alliance Health COO Sean Schreiber in the partnership press release. "We have been impressed with their desire and commitment to engage and serve our population."
Cityblock’s Matthews adds: “With Alliance Health’s extensive experience serving the state’s Medicaid population, our community-based care model . . . will aim to address both the clinical and non-clinical needs of those in Alliance Health’s Tailored Plan.”
A number of firsts
The partnership with Cityblock is Alliance Health’s first risk-bearing contract and includes performance targets for better quality, outcomes, equity and sustained value. More broadly, these targets will help support North Carolina’s new Tailored Plans, which went into effect as part of the state’s Medicaid Expansion.
Tailored Plans are “a new kind of NC Medicaid Managed Care health plan” that support the more complex needs of members with SMI, SUD or IDD. North Carolina’s Tailored Plans went into effect as part of the state’s Medicaid Expansion efforts. The expansion has enrolled 500,000 new members in seven months — far exceeding the goal of 600,000 people in two years. Nearly 1 in 4 people in North Carolina were already on Medicaid, or 3.5 million statewide.
It’s great news in a year that has seen 23 million people disenrolled from Medicaid since April 2023 and the beginning of the “unwinding” — the return to Medicaid program eligibility redeterminations suspended during the pandemic.
It’s also great news for Medicaid expansion in general. As of May 2024, 41 states (including DC) have expanded their program eligibility to adults earning up to 138% of the Federal Poverty Level as approved by the Affordable Care Act. North Carolina’s expansion in December 2023 makes it the newest state to approve. Other state innovations include a July 1 request to CMS that make hospitals’ receipt of enhanced Medicaid funds contingent on their waiver of $4B in existing medical debt for low and middle-income residents.
“We want you to innovate”
Additional callouts from the Alliance Health-Cityblock press release speak to the importance of Medicaid innovation in North Carolina.
"Access to integrated care for people with behavioral health needs is critical to . . . [our] priority of behavioral health and resilience. People have better outcomes when we treat the mind and body – the whole person," said Kelly Crosbie, Director, Division of Mental Health, Developmental Disabilities, and Substance Use Services, NC Department of Health and Human Services. "NCDHHS applauds Alliance and Cityblock's leadership in tailoring this innovative model to address the whole-person needs of people with behavioral and substance use disorder needs."
Cityblock CEO and cofounder Dr. Toyin Ajayi adds: "Together, and on the heels of North Carolina's groundbreaking transition to Medicaid managed care, we will deploy care to treat individuals holistically and reduce health disparities, and we look forward to delivering clinical and financial outcomes for marginalized and underserved communities throughout the state."
In a prior interview with HealthLeaders, Dr. Ajayi noted the overall move toward advancing Medicaid not only by her company but in programs nationwide.
"There's been a real trend there, States aren't just saying, 'We want you to manage the population. Here's the rate book.' They're saying, 'We want you to innovate.'"
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
MCO Alliance Health and integrated primary care provider Cityblock have partnered to serve specialized Medicaid populations in North Carolina.
The Medicaid members include those with intellectual/development disabilities, serious mental illness and/or substance use disorder.
The specialized coverage and partnership reflect the state’s successful Medicaid expansion plan and NC Innovations Waiver.