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Managers with the public mental health agency that serves clients in Rockingham, Alamance and Caswell counties say they follow up with patients better than a stringent warning from state officials would indicate.

On Oct. 1, the Division of Mental Health put the Alamance-Caswell-Rockingham Local Management Entity on notice that they could lose the funding and authority to coordinate care for their most seriously ill mental health consumers. The state said that 45 percent of those who left a mental hospital and returned home to those three counties received follow-up care.

That’s below the state average and made the agency one of five across North Carolina at risk of losing their funding. But agency officials say that by their count, they outperform peers.

“We’re at upwards of 65 percent,” said Victor Armstrong, the agency’s care coordination manager.

Follow-up care is seen as particularly important to keep patients from returning to the hospital. And it is critical for patients who leave the hospital with only a 30-day supply of medication and need to see a doctor before they can get a refill.

The difference between the local agency and state’s numbers stems from how the two governments account for follow-up services.
State officials rely on records that show when a doctor or other mental health provider has been paid for a service with public Medicaid insurance money or other state funding.

Armstrong said that many of his agency’s customers get services from providers paid by private health insurance or who are slow to bill the county. Other billing problems can affect that count, he said. And, he added, there are services the county provides that don’t get billed to the state.

Armstrong added that the state’s warning has prompted his agency to start tracking follow-up care more closely. In turn, that will allow the agency to better evaluate the performance of private providers who treat patients.

By early next year, he said, that new crop of data going back to Oct. 1 should be able to convince regulators the agency is doing well enough. In response to a News & Record report on Thursday, the agency put out a news release saying state regulators had assured the agency their efforts would be taken into account.

“They have had conversations with our staff and they have talked about some of the things they think they are doing,” said Leza Wainwright, co-director of the Division of Mental Health.

She was cautious in her appraisal, noting that even though there is information the state doesn’t have — such as billing records for patients with private health insurance — that information was missing for all patients in its study. That means the Alamance-Caswell-Rockingham LME was compared to its peers based on the same set of information and its performance lacking relative to the 23 other agencies.

And some things the county may count as a follow-up service may not meet state standards. For example, Armstrong said the county has beefed up the staff that makes contact with patients coming home from the hospital.

Wake County, one of the other agencies put on notice, made a similar argument, Wainwright said.

The problem, she said, is care coordination — the term for keeping tabs on patients and getting them in touch with doctors and other services — does not count as a therapeutic service itself.

“That doesn’t count as a clinical intervention,” she said. If Alamance-Caswell-Rockingham is counting that kind of work, their tracking numbers may overestimate their follow-up rate, she said.

The state will watch the area agency through the end of the year and re-evaluate its efforts in February or March, Wainwright said.

If there is not enough improvement, she said, state officials would have to decide whether to continue working with the agency or strip it of funding and some responsibilities.

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com