Whole-Person Care in Action with Julie Quisenberry

Julie Quisenberry: 00:00

What I preach to my team is if you keep the person that you're supporting in front of you all the time and you're looking at that person, you're never going to go wrong, right? You're going to be meeting their needs. You're going to be working for at what they're telling you, what it is that they want. You may think that somebody needs to go and get therapy. I hear that. I appreciate that. But you need to meet them where they are and where they are today may be a very different place than where they are six months from now. So let's engage them where they are. Let's get them to a place where they trust us. And how do and then let's build on what that looks like.

Thomas Royal: 00:36

Welcome to the Move to Value Podcast. Today we have a conversation with Julie Quisenberry, Director of Care Integration at Coastal Horizons. Julie’s team connects primary care, behavioral health, substance use treatment, and community resources to deliver whole-person care across more than half of North Carolina’s counties. We’ll talk about navigating Medicaid’s standard and tailored plans, using data to improve quality, and keeping the patient’s goals at the center—no matter how complex their needs.

Thomas Royal: 01:07

Julie Quisenberry, welcome to the Move to Value podcast.

Julie Quisenberry: 01:10

Thank you. Thank you for having me.

Thomas Royal: 01:13

Ok Julie, let's start with your role at Coastal Horizons. Can you paint a picture of the range of services that's offered there and where care management sits in that ecosystem and how it supports the overall health of your clients?

Julie Quisenberry: 01:25

Sure. So, my role is the Director of Care Integration and what that means, it's a fancy title for I work with our primary care folks, our psychiatric MAT folks and then also our care management team and our care management team, we provide care management on the standard plan side in collaboration with CHESS. You all do the care management for us on that side. We have an extender locally that works with the care manager at CHESS. And then on the tailored plan side, we are contracted with one of the tailored plans to provide care management in Brunswick, New Hanover and Pender counties. Coastal, overarchingly, is a very large organization. We are a large behavioral health substance use organization that also has primary care attached to it, as well as justice services. So, in the ecosystem, if you will, I think that's the term you use, the ecosystem of coastal, our care management teams work very collaboratively with all of the people that within the coastal system and ironically Coastal last year, last fiscal year in 24-25, Care management was the fastest growing team that we had. So, we touch kids ages 5 and up and then adults to death. So, our span and reach is huge, but we work collaboratively within the system. But I guess in terms of the ecosystem, we're a very small piece of that very large pie. Because like I said, we touched 56 of the 100 counties in North Carolina. I don't know if that's the right answer, but that's the answer I'm going to give you.

Thomas Royal: 03:07

those who aren't familiar, can you explain care management in real world, real world terms? And what would a typical care management journey look like for someone in a standard plan versus a tailored one? And does your approach change based on those needs?

Julie Quisenberry: 03:23

Sure. Yeah. So care management is really basically helping. We are treating the whole person, if you will. We're treating the physical health, we're treating the behavioral health, we're treating the substance use, we're treating the lack of resources, the social determinants of health. All of the things that impact everybody's life every day, yours, mine, the people we support and so making sure that people have what they need. So someone coming into our care management team is going to be assigned a care management care manager. They're going to be given a comprehensive assessment. It's going to identify kind of what their needs are. That encompasses all the things that we just talked about, you know, behavioral health, substance use, physical health, dental care, all the things. And then we've developed a care plan from there and so. Our care plan drives what our our person, individual that we're supporting, what we're doing with them. It is person-centered. It is individual specific. We're going to work on the things that are most important to that person and figure out how to provide the resources or what they need. So we're treating all of the

things and supporting all of the needs. They don't have to be in services with Coastal Horizons necessarily to to get care management from us. We have folks that are assigned to our panel that are receiving behavioral health services elsewhere. The difference between the standard plan and the tailor plan, I think the biggest difference for us is. The standard plan really focused on primary care and physical health, and in order to be in the tailored plan, you an individual has to have some complex behavioral health or substance use need. They it they've been in an inpatient facility, they're getting an enhanced outpatient service like Medicaid assisted treatment or family center treatment or there's something in their world that has elevated them in that behavioral health substance use space to needing more intense than just I'm going to see a therapist once a month and things are great, right? It elevates them to a different level of support in that behavioral substance use world. And so that's what kind of triggers them to move into that tailored plan space. But again, it doesn't for us, we're going to make sure that the whole person is being taken care of whether they're in the tailor plan space or in the primary, I mean in the standard plan space. CHESS does our care management for do the care management for us. I envision in my world, the world that I live in, which is different than most people's is that you are doing the same thing that on the standard plan side that we're doing on the tailored plan side and collaborating with our extender if someone needs to get, you know someone is experiencing some depression or their primary care is saying that gosh, their anxiety is just more than I can manage. How can we get them into somebody for some therapy and med management so.

I feel like that we are doing it the same way, but I encourage you to ask your colleagues if that is actually the case because I do think we are and I I think that we the relationship with CHESS is is was born out of that common goal of sharing.

Of treating meeting people where they are and of making sure that we're meeting all of the needs. And so I think that that's my view from where I sit in my 10,000 foot view is that yes, we're doing it very much the same on both sides because we want to make sure people get.

connected. The important part is people identify the need and get them what they need. And how do we do that? And that's what the care manager facilitates.

Thomas Royal: 07:06

Yes, I'm, I'm, I'm confident that we are where there's a lot of synergy between the organizations. So which I think is what makes the relationship so beneficial. So another question I have is what pillars or guiding principles shape your care management model? And how do you balance client autonomy, clinical goals and system level requirements? And what makes your system uniquely responsive or effective?

Julie Quisenberry: 07:33

Well, I think that's a loaded question, right? Because you have lots of people telling you what you have to do and then don't have boots on the ground, right, that recognize like these are really the population that you're asking us to work with. Is this revolving door of people? We do not. I will say, let me back way up. We do not.

The IDD population, we only serve mental health and substance use are our target populations. When you talk about care management on the tailored plan side, on the on the standard plan side, they're assigned to us for primary care. That's how we get them on our panel. So when I speak to this, I think the alignment between those two models is so incredibly different in terms of what the expectations are in terms of engagement. That's my little editorial comment that you can actually leave in.

That when the state designed the system, they designed what they thought were going to be two parallel systems and this tailored plan has made a sharp right turn and definitely is not anything. We have a 85-page provider manual that we don't have on the standard plan side. So I think for us, the pillars that we tried, what I preach to my team is if you keep the person that you're supporting in front of you all the time and you're looking at that person, you're never going to go wrong, right? You're going to be meeting their needs. You're going to be working for at what they're telling you, what it is that they want. You may think that somebody needs to go and get therapy. I hear that. I appreciate that. But you need to meet them where they are and where they are today may be a very different place than where they are six months from now. So let's engage them where they are. Let's get them to a place where they trust us. And how do and then let's build on what that looks like. So if the immediate need is housing or the immediate need is food or the immediate need is getting into therapy, then let's focus on those things because once they trust you, you can then build on that to make them to move them forward. But our goal as a care manager. The goal for our care managers is to meet people where they are and to help them achieve what it is that they're asking for. Um. Without judgment, without bias. Now we all bring all those things to the table and we're recognizing that. But really taking a step back and saying, OK, yeah, this person really does need medication. This person really does need to get in to see somebody. But that's not where they are today. So let's focus on what we can today. So that's where we really start. And then build from there. And so I think that that's the model. Again, we work off the provider manual. That is changes every six months and so it's hard to navigate, right? So we keep saying keep that person in front of you, do the very do the next right thing and you will always be winning because you can't go wrong. I can defend anything that somebody does with somebody. As long as it's documented and as long as you're putting that person first. So being person-centered, being individualized, that's really what we want to make sure we're doing. And again, making sure that we are in compliance with what the state requires us to do is also we do focus on that because we do want to get paid, right? Because that's can’t do it for free. But how do we do that in a model that makes sense for us? And so we keep the person there and we're making sure you you got to do the assessment and then you got to do the care plan. You can't just jump right into getting somebody, taking somebody to the food bank, right. You got to make sure you're following the steps. So we do that. Which is hard sometimes because people don't want to, they don't trust you enough to fill out a to sit there for an hour and a half and do a comprehensive assessment. So we'll break it into sections. Well, let's do the first part. Let's build a goal off of that. Let's do the second part and build a goal off of that. So we just try to base it on where the person is, but again. Also being within the guidelines of the state and we're providing the services within the specifications that they put out there, however changing they might be.

Thomas Royal: 11:44

Outstanding. That sounds like you guys are really doing a lot of comprehensive work over there. That's exciting. Well, let's talk HEDIS. How does Coastal Horizons use HEDIS metrics to evaluate and improve care management performance and how are these metrics incorporated into the day-to-day? Is it more about performance review, real-time feedback or strategic planning? And how do you keep focus on quality?

Julie Quisenberry: 12:08

It's all the things, yeah. I mean, I think it's all the things. I mean, I think we pay more attention to the HEDIS measures for the folks that chest is care managing for us because that is the folks that are in our primary care, they're attached to us for primary care. The tailored plan hasn't actually put out, put out like they put out a few HEDIS measures, but like they haven't put out their quality metrics or more around, you know, getting somebody in out staying out in the ED, right. So we work collaboratively with your team. And we have dashboards that track our measures that do all the things our our care manager, our extenders look at that. We share that data with our also with our providers that are providing primary care so that they know when you know Julie's coming in for her next appointment or whatever. So we look at it like from a 10,000 foot view. But then also somebody we also share that too that our providers kind of know where we are. We are currently in the process of switching EHRs and we're going to be using Dynamic Health, which will allow us to track our HEDIS measures better um through our existing our. Our previous EHR, we had to build out a lot of things that just didn't align quite right. But Dynamic Health will really allow us to run reports and to use HEDIS measures that will drive the quality of the care in a better way, in a more intentional way that we really haven't had before. So that's supposed to be out, knock on wood, sometime early September, which for me means really October in my brain. So I don't get my hopes up and then be like, oh, we don't have it. So hopefully we'll have that in the next few months and then we can really start making some intentional decisions about how do we drive that care, how do we? How do we drive the quality? What do we need to do? We've looked at some of the data we've done around like some A1C and blood pressure. We've done some community outreach. We just did one last week where we focused on A1C and focused on blood pressure checks just in this community health event. And actually of the 50 people we saw, three of them have appointments in primary care next week that we didn't have before. So we're creative in how we do it, but I think we need to be more intentional. I don't know that we do a really great job, but we're getting there. It's it's something that we're working on. It's something that we're going to continue to work on and hopefully the new EHR will help us to do that. And we really lean into you all to help us with that too on the standard plan side. We use the dashboards that Chess has created. I mean, you all have even created some other dashboards for us. We're working. We are actually working with you all right now on a population health project on the Tailored Plan side around some quality measures around annual physicals for adults and kids, dental visits. Getting the comprehensive assessment done. So we're working around with you all and you all created a dashboard for us. So we're looking at that all of the time. And we do use, I mean we're looking at penetration rates, we're looking at engagement rates through the dashboards that you all have created for us that really help us to drive what we need to do and how we need to improve it. So you know your IT team, we've worked with Paul and Jennifer primarily. Shout out to them because without them I couldn't do what they do and really embrace our crazy and all the changes that we ask for and all the things that we want to work within a system that sometimes isn't as forgiving, I think, as we would like it to be. But somehow your team manages to create all of the things and pull the data that we need for whatever we need it for. So again, we lean into you all for all of that.

Thomas Royal: 15:50

I say that we do have some some pretty sharp folks on our team, but you're doing the really important work. We're just assisting you in in in in helping serve the patients. So, so how does your care management team coordinate it with other programs at Coastal like behavioral health, primary care, crisis services? You talked about this a touch. But is there a, is there some specific protocols or things that would be of interest that like to talk about?

Julie Quisenberry: 16:16

I mean, our care managers work with anybody and everybody, right? Like they are resource-driven. They are about beating the bushes to try and find people and find resources for people. If they're connected to Coastal Horizons for like our behavioral health substance use services, they'll go into our EHR and find out when the next appointment is and go meet somebody there. They will. I mean they are driven to try and figure out how they can best meet people's needs. I think that they they they attend. We have huddles like I think is what you call them. We call them, we call them, they call them. I don't even know, but there are huddles and where we have interdisciplinary team meetings where we have like the psych providers there, the, you know, the the therapist is there. So we're doing those things. We have those Meetings with our child teams, we have them with our adult teams and our care managers attend and if there's a certain individual that that they're struggling with, they'll put it out on the agenda like, hey, does anybody have any ideas how I can get in touch with this person? I've been trying to find them. Has anybody seen them? It doesn't look like it, you know? And so they'll huddle around that. They reach out through our through teams and through e-mail to say, hey, I'm seeing this person they attend psychiatric appointments and come in at the end of therapy appointments if necessary with our folks internally. And we work with a lot of our supportive employment providers around the 1915i and working collaboratively because we don't provide that service so. We have to have collaborative relationships with our 1915i providers because that process in of itself is incredibly cumbersome on any, on any level. And so we have monthly Meetings with those people, those providers, those community providers, we have monthly Meetings with them just so that we're all on the same page because we're responsible for doing the assessment and making sure that the treatment plan is done and that it's submitted for approval for somebody else to provide the service, which I think that when tailored care management was designed, that wasn't the design. And if you work in the IDD population and somebody is receiving innovation services, that world makes perfect sense. In the behavioral health world that that logic doesn't make sense to us. It's not something that we historically have done. And so we've had a lot of growing pains and have found that meeting with these providers monthly has really helped us to grow the relationships to one and two to better understand what everybody's what everybody's role is in helping to meet that person's need. And so we do that. I mean, our folks are serving on, you know, community panels, community, you know, boards to make those connections. And I think those relationships help us to then be able to better serve people. And that goes beyond just care management. I mean, Coastal as a whole really invests in our community as well. And so my colleagues, myself, we all serve on various and sundry boards and advisory committees with other providers. And that way we can collaborate because we're all treating the same people. And we've got to make sure that we're all doing that in a way that makes sense and in real time. But that's kind of what our care managers do is that they they they're everywhere and anywhere and engaging with anybody who will talk to them.

Thomas Royal: 19:40

OK. Well, Julie, this has been a great conversation. Would you be willing to stick around a little bit longer so that we can continue talking about coastal?

Julie Quisenberry: 19:47

Absolutely.