After two years of planning with local leaders, Alliance Health is expanding services in Cumberland County.
Alliance Health is a public, state-funded behavioral health care management organization serving Cumberland, Harnett, Johnston, Wake, Durham, Orange and Mecklenburg counties. It is one of four regional groups in North Carolina that contract with providers to care for uninsured residents with mental health and substance use disorders and intellectual and developmental disabilities.
Using state dollars and Cumberland County’s behavioral health fund balance, Alliance Health will establish a jail liaison and post-release coordination team at the Cumberland County Detention Center. It will also pick up funding for Cape Fear Valley Health’s emergency medical services Post-Overdose Response Team (PORT), which connects patients who overdose with treatment. Finally, it’ll work with Cape Fear Valley Health to create a new integrated behavioral health and primary care clinic.
“There’s still going to be needs in the community,” said Rob Robinson, Alliance Health CEO, during a presentation to county commissioners on April 10. “But what we’re recommending will have the biggest impact.”
Robinson said the services were selected after extensive consultation with county officials, providers and community members. The goal was to expand services in areas of need that the organization and county could financially sustain.
Jennifer Green, director of the Cumberland County Department of Public Health, told the commissioners that the expanded services help fill gaps identified by the department’s recent sequential intercept model mapping. A SIM map shows community and government resources that divert residents with mental health and substance use disorders, and intellectual and developmental disabilities, away from the criminal justice system and incarceration.
Cumberland County’s SIM map identified its many resources, from the Recovery Resource Center to the Cumberland County Reentry Council. It also highlighted gaps in care, including a lack of PORT funding, housing resources and care for those in crisis.
Green said Alliance Health would fill some care gaps not supported by funding sources like the county’s share of national opioid settlements by funding PORT, and creating the integrated behavioral health and primary care clinic and the jail liaison and post-release coordination team. She said the expanded services work alongside efforts by groups like the Cumberland-Fayetteville Opioid Response Team (C-FORT).
“We’re not duplicating a service,” Green told the commissioners. “We’ve been thoughtful about how to make sure these pieces work in alignment.”
Coming soon to Cumberland County
Cape Fear Valley Health and Alliance Health are still in early discussions as to what the integrated behavioral health and primary care clinic will look like, Chaka Jordan, vice president of marketing and communications for Cape Fear Valley Health, told CityView.
No matter what shape the clinic takes, it could improve patient outcomes for the 4,603 Cumberland County residents who use Alliance Health and don’t have access to integrated behavioral and primary care. Studies cited by the American Psychological Association find that integrating behavioral health and primary care improves patient adherence to treatment plans and reduces symptoms.
The clinic could become a resource that Cape Fear Valley Health’s PORT recommends to residents. Alliance Health will continue funding PORT, preserving the service it calls “critical” for Cumberland County.
Launched in 2022, PORT is made up of licensed clinical social workers and peer support professionals who connect residents treated for an overdose by EMS with support groups and treatment.
Cumberland County has the highest overdose death rate of the seven counties Alliance Health serves, and one of the highest in North Carolina. In 2023, 190 people died of an overdose in Cumberland County, according to North Carolina Department of Health and Human Services data. According to Alliance Health, Cape Fear Valley’s community paramedics — an EMS team that helps residents access primary and preventive care so they don’t turn to the emergency department — responded to 3,599 adult overdoses in 2023.
Some of those overdoses could have involved people recently released from the Cumberland County Detention Center. A study from the UNC-Chapel Hill Gillings School of Global Public Health found that those previously incarcerated in North Carolina were at greatest risk of dying from an opioid overdose within the first two weeks after release.
The statistic is one reason Alliance Health is creating a jail liaison and post-release coordination team. The team, composed of two case managers and a certified peer support specialist, will ensure residents are immediately connected to behavioral health and substance use disorder services upon their release from the detention center. If immediate care connections can’t be made, the team will support the reentrant until they are.
The team adds to the care provided by the Cumberland County Department of Public Health’s social worker and peer support specialist inside the detention center. These county workers help treat those who are incarcerated with substance use disorders thanks to funding from national opioid settlements.
Green said the department’s workers don’t have the capacity to work outside the detention center, so Alliance Health’s liaison team will be crucial once residents are released.
“What we envision and imagine is that the health department’s licensed clinical social worker and the detention center’s peer support specialist would work very closely with the jail liaison team to get people connected while they’re in the detention center and then make sure there’s a hot handoff outside of the detention center,” she said.
Establishing services that last
State dollars will primarily pay for Alliance Health’s expanded services, Kelly Goodfellow, chief financial officer for Alliance Health, told the county commissioners. Only once those dollars run out will Alliance Health pull from the county’s behavioral health fund.
Alliance Health plans to spend the entirety of the county fund, which has a total of about $9 million. The organization’s proposal said it’d use a one-time payment of about $1.2 million to start the integrated behavioral and primary health clinic. Those funds would also replace a grant that ended in October 2024 for PORT.
Alliance Health will also need $985,190 on a recurring basis to support PORT and the jail liaison and the post-release coordination team. Based on the funding plan selected by the county commissioners, by fiscal year 2028, the county will need to provide an additional $665,181 to continue the services.
A handful of proposed services didn’t make the expansion cut. Alliance Health previously recommended expanding office-based opioid treatment, the prescribing of opioid use disorder treatment drugs like buprenorphine, and developing a residential substance use disorder facility.
Goodfellow said the startup costs to build a residential facility are steep, and the organization couldn’t find funding for patients’ long-term care at such a facility. She said facilities are already available or becoming available in Wilmington, Concord and Raleigh. Alliance Health is or will contract with these facilities, and will help transport Cumberland County residents to access their care.
Fayetteville already gained an office-based opioid treatment provider when SouthLight opened its Fayetteville office off Ramsey Street. Like Alliance Health, SouthLight provides treatment for the uninsured.
While the selected expanded services have funding sources, Cumberland County Board of Commissioners Chair Kirk deViere is still concerned about their longevity should the state’s Medicaid expansion be rolled back.
“I know there’s a lot of efforts around it [keeping Medicaid expansion], but I think we need to look at a stark reality that [cutting Medicaid expansion] could potentially happen,” deViere said. “I think it could happen in phases based on the tea leaves that I’m reading.”
Experts from KFF, an independent health policy organization, believe current federal budget proposals would require cuts to Medicaid, triggering a loss of the state’s Medicaid expansion. Many of the services Alliance Health now provides stem from Medicaid expansion dollars, Goodfellow said.
“We would have to revert back and probably cut some new programs that we’ve developed to support the uninsured,” Robinson said when asked by deViere about the impact a loss of Medicaid expansion would have on Alliance Health.
Alliance Health was also impacted by federal funding cuts by the U.S. Department of Health and Human Services. While the cuts are on hold as a lawsuit filed by North Carolina Attorney General Jeff Jackson and other state attorneys general is litigated, Robinson said Alliance Health cannot access $8 million in pandemic-era funds it had yet to draw down. He said some programs are “on the chopping block” unless the state can supplement the lost funding.
“We know there’s some critical services in place that we want to continue to fund,” Robinson said. “The funding cuts have started. We haven’t felt the heat completely yet, but we’ll see.”
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the News Foundation of Greater Fayetteville.