QUALIFIED PROVIDER NETWORK DEVELOPMENT
        Conclusions/Recommendations

Service Capacity
1) The local business plan identifies the current qualified provider services lists and service array
   b) A current lists of all qualified service providers matched to service category and target populations
   c ) A comprehensive assessment of service capacity need has been completed, and a summary of its conclusions and recommendations are attached

There were significant differences in how programs determined capacity. Methods included surveys of providers, community forums, and service data. OPC went beyond simply trying to identify the existence of providers and used multiple sources of information and data analysis to compare projected need with provider capacity. Pathways program looked at linking capacity to a model of service, access, cultural competency, etc. versus simply trying to determine whether providers were interested in taking clients. Few plans looked at whether the service array reflected best practice or whether it reflected too much of a particular model of service, e.g. residential.

All plans recognized the need to expand the provider network. In most plans there were few specifics on how the expansion of the provider network could be accomplished. Rather, statements such as "will provide incentives", and "identified gaps will become priorities" were made. There also was wide variability in strategies to recruit providers and to provide training and technical assistance. Unfortunately, a few programs used this section to present data, usually simple surveys, that private providers weren’t interested in providing services and to justify the continuation of service provision by the LME.

Best Practices and Technical Assistance
2) The local business plan complies with the State Plan requirements in establishing a qualified provider network
   d) A QPN development plan is attached addressing

While some plans mentioned specific best practice services for target populations, most indicated that they were waiting for the state to identify best practice services. Most plans dealt with technical assistance activities in broad brush strokes, noting that technical assistance would be offered if requested. It wasn’t clear if all providers would receive technical assistance, or targeted assistance, how often and in what circumstances. Centerpoint’s plan did a good job of trying to link provider outcomes with technical assistance and contract development.

Identification of Individuals in Transition
4) The local business plan complies with State Plan requirements and establishes a system of services and supports for existing populations

•  Provides a plan for identification of individuals in transition
• Identifies generic community resources, such as faith-based groups, to provide services and supports to members of the non-target populations

There was a great deal of variability in terms of how well programs knew the transition population and, in particular, the service transition needs. Several plans mixed the issue of service divestiture in with transition of non-target populations. Plans generally reflected an effort to survey existing community resources and provide referral services to non-target populations. Outreach efforts or identification of community gaps were usually not discussed.

Significant development of this area needs to be undertaken through joint technical assistance efforts between the Division and LME’s to fully develop the capacity of LME’s to create and manage a provider network. The development of a strong provider network is absolutely essential to successful reform efforts. This effort needs to go well beyond being able to identify the name of a provider for a particular service. Systems need to be put in place to determine the required provider/service mix based on the needs of the target populations of the LMEs, to identify and recruit potential providers, to provide training and technical assistance on best practice services that will be purchased, and to engage in ongoing assessment of multiple provider dimensions, including both client and process outcomes. There should be clear links between network development and quality management activities. The state and LME’s, along with provider organizations, need to collaborate in the development of training and technical assistance to support LME’s in the development and implementation of these plans.

The state is in the process of providing guidance on best practice services and should require resubmission of that section by LME’s once best practices have been clearly defined for all target populations. Clearly the financing plan and rate structure will have a major impact on plans to develop provider networks.

North Carolina does not have a well-developed provider network and a major task of the reform effort is changing (and incentivizing) the models of services offered. Thus a strong technical assistance effort is necessary. A more planful approach is needed than is articulated in most of the plans reviewed. We would urge an effort that links technical assistance to provider outcomes and the quality management process. Again, technical assistance to LME’s on the development of such a plan will be helpful. We would also urge more development of plans to not only survey what exists in generic services but engage in community discussion of where gaps are and how to support service development.