CHARLOTTE, N.C. (WBTV) - When two of North Carolina’s largest counties wrote a letter to the N.C. Department of Health and Human Services detailing concerns about Cardinal Innovations, officials at DHHS consulted with Cardinal’s senior leadership about how to respond, records show.
Cardinal is the managed care organization that serves a 20-county catchment area that stretches from the Charlotte area, through the piedmont and into parts of the triangle.
The company, which is paid by the state to manage care for people who receive services for mental health, developmental disabilities or substance use disorders, has come under renewed scrutiny this year, after its previous leadership was replaced by state regulators in 2017.
At least five counties, including Mecklenburg, Union and Cabarrus, have publicly questioned Cardinal’s performance in recent months. Leaders in Union and Cabarrus counties have begun the process of severing ties with Cardinal in favor of another company. Mecklenburg County commissioners voted earlier this month to start the process, too.
But records provided to WBTV by DHHS in response to a public records request suggest a close relationship between senior DHHS leaders tasked with providing oversight to Cardinal and the company’s top leadership.
The documents provided to WBTV center, mainly, around a joint letter sent by the county managers in Mecklenburg and Forsyth counties to DHHS Secretary Dr. Mandy Cohen and Cardinal’s CEO, Trey Sutten, on October 23.
The letter outlined detailed problems both counties had experienced with Cardinal’s treatment of mental and behavioral health patients, including barriers to services and chronic underperformance by Cardinal compared to other MCO’s in the state.
“Our counties’ leadership and staff hear from many consumers, family members, clergy and advocates about significant barriers in their efforts to access and understand the behavioral health services in our communities,” the letter said.
“The toll these challenges take on our residents, families, congregations and entire communities are tremendous and cannot be quantified.”
The letter closed with six recommendations to address specific problems identified in the letter, including authorizing or denying requests for enhanced behavioral health services within 72 hours, increase provider accountability for timely authorization or services and increase timely access to therapeutic foster homes.
“If resolution is not met, we will have no choice but to explore additional options,” the letter concluded. The county managers asked for a response by November 9.
Emails show top leadership at Cardinal, including Sutten the CEO, worked with DHHS leadership, including Deputy Secretary for Medicaid Dave Richard, to formulate a response.
Leadership from both entities had a call on October 27 to discuss the letters and Sutten sent over a first draft of a response plan by October 30.
Emails show the plan was still back-and-forth with edits between Cardinal and DHHS up until November 9, when the response was sent.
Richard, the deputy DHHS secretary, also sent a draft of the letter DHHS intended to send to the counties on Friday, November 6.
“This is our draft of letter – working on how we would do the LD’s,” Richard wrote Sutten.
Sutten responded on Monday, November 9, with an edited version of the letter from DHHS. Tracked changes saved in the Word document attached to the email produced by DHHS shows the changes had been made by Cardinal’s general counsel, Chuck Hollowell.
None of the changes were used in the final version of the letter sent later that afternoon by Cohen. The emails show Cardinal got a copy of that letter before the counties, too.
Richard explained the edits Cardinal made to the DHHS letter in an interview with WBTV on Monday.
“We didn’t take any of those and would not have,” Richard said.
“Probably not the best for them to do but if there had been something factually wrong we would have wanted to know that.”
Richard said his office was working to respond to the concerns raised by Mecklenburg, Forsyth and other counties about Cardinal.
“We as a state agency know we have accountability as well and that what we want to do is work with Cardinal to respond appropriately to that,” he said. “We believe that Cardinal has a responsibility to respond to those, as they have concerns.”
A spokeswoman for Cardinal declined to answer questions on camera for this story but sent an emailed statement:
“We ordinarily interact with staff and leadership at DHHS and county governments on a wide range of subjects, from policy to case management decisions affecting individual members. The email dialogue between Cardinal innovations and DHHS staff regarding our response to Mecklenburg and Forsyth Counties is an example of this dynamic. We welcome the exchange -- especially the state’s leadership and feedback -- in the interest of improving our action plan and identifying the solutions that will best serve our members.”
Richard said he preferred to have a good working relationship with the entities his office regulates.
“You can certainly have a hammer and a stick to do certain things, of course, but what you want to do is work together because they are on the ground and they’ll see things that we won’t so we want to make sure we have that kind of relationship,” he said.