NorthCare Network
NorthCare Network 2019 Fiscal YearNor thCare Networ k2019 Fiscal YearAnnual Performance ReportAnnual Performance ReportInside This Report2Message from the CEO3In the Community4Governing Board Members5SUD Policy Board Members6-8Performance Report Card9NorthCare Network Finances10Veteran Navigator10DHIP CAFAS and PECFAS-Outcomes11Site Review Scoring Comparison11SIS Completion12Highlights of Evidence-Based Practices13-14Recovery Oriented System of Care14MI Health Link15SUD Primary Drug Admissions by County16-17Consumer Satisfaction17Integrated Health Care18IT Innovations & Advancements18MyStrength Online ResourceMission StatementNorthCare Network ensures that everyeligible recipient receives quality specialtymental health and substance use disorderservices and supports through theresponsible management ofregional resources.NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 1Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportFrom the Chief Executive OfficerDr. Tim Kangas, NorthCare NetworkDear Friends of NorthCare Network,NorthCare Network is excited to share our annual performance report. NorthCare Network is the Prepaid InpatientHealth Plan (PIHP) for the Upper Peninsula contracted through the Michigan Department of Health and HumanServices (MDHHS) to manage and provide a comprehensive array of specialty mental health and substance abuseservices and supports to Medicaid and Health Michigan Plan beneficiaries. Our performance is measured by metrics,compliance monitoring, financial audits, and site reviews to name a few. We are monitored by MDHHS, Health ServicesAdvisory Group (HSAG), our Governing Board, and consumers. Each year we strive to improve our performance.This report reflects the hard work of our entire provider network and staff as they continue to serve our consumersacross the U.P. They are the key to our success. This past year, I had the opportunity to attend board meetings at eachof the five Community Mental Health Service Programs (CMHSPs) and to meet with our Substance Use Disorder (SUD)Providers as we work together to continue to provide services to our consumers.We continue to put “people before profits” with any savings accrued during the year reinvested back into the publicbehavioral health system. We are continuing to work on long-term goals for the coordination of services. NorthCareNetwork has a deep commitment to prevention programming and supporting families and individuals to fulfill theirlife goals. We are a leader in the state with our staff expertise, community involvement, and financial commitment toprevention programming and engagement. We recognize that in order to affect generational issues we need to havea long-term commitment to using evidenced-based programming to effectively make change. NorthCare Network willcontinue to utilize its resources to invest in future generations of the U.P. in an effort to make long-term change.Thank you to our Governing Board Members, SUD Policy Board Members, CMHSPs, SUD Providers, Provider Network,Staff, Consumers, and the U.P. Communities and their County Commissioners for continuing to support the publicbehavioral health system.As I reflect on my first year here as CEO, I am proud to bepart of this great team.Our VisionSincerely,NorthCare Network envisions a full range ofaccessible, efficient, effective and integratedquality behavioral health services andcommunity based supports for residents ofMichigan’s Upper Peninsula.Dr. Tim Kangas, CEONORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 2Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportIn the CommunityNorthCare Network has been involved with the community on many different occasions and participatedin local healthcare awareness events. Below are some highlights from 2019.Staff participated in Pathways’ third annual Walk-a-Mile-in-My-Shoes Rally at Marquette Commons on May 24, 2019 (aboveand lower left picture). Staff also attended the Beating the Winter Blues Health Fair (bottom right)on February 2, 2019, at Ishpeming Armory.NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 3Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportNorthCare Network2019 Governing Board MembersEXECUTIVE OFFICERSChairpersonPat RozichCopper CountryJoe BonovetzGogebicJim MooreHiawathaGeorge EcclesineHiawathaMari NegroNorthpointeBoard Alternates:Bob Barr, HiawathaKatie Carlson-Lynch, PathwaysAnn Martin, NorthpointeDan Siirila, GogebicVice-ChairBill DaviePathwaysJan HafemanNorthpointeMargaret RaynerGogebicTom KorpiNorthpointeDr. John ShobergHiawathaGoverning Board PastChairpersons:Rudy KemppainenKaren RaetherDan LaFoilleSecretaryGeorge BotbylPathwaysMike KoskinenCopper CountryJim TervoCopper CountryFred MargrifPathwaysSteve ThomasGogebicThank you:Thank you to our outgoingboard members for servingon the Governing Board:Pat Bureau, PathwaysGerald McCole, NorthpointeNORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 4Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportSubstance Use Disorder Policy2019 Board MembersAlger CountyCatherine PullenOntonagon County Robert NousiainenBaraga CountyMichael KoskinenSchoolcraft County Craig Reiter, Vice-ChairChippewa CountyJames Moore, ChairpersonDelta CountyDavid RivardDickinson CountyKevin PirlotGogebic CountyJoe BonovetzHoughton CountyRoy BritzIron CountyJames Brennan IIIKeweenaw CountyRandy EckloffLuce CountyNancy MorrisonMackinac CountyJim HillMarquette CountyStephen AdaminiTHANK YOUto our outgoing board membersfor serving on the SUD Policy Board.Ann Martin (Dickinson County)Tim Palosaari (Houghton County)John Nelson (Menominee County)Menominee County Steve GromalaNorthCare Network Has a New HomeAs NorthCare Network continued toexpand its staff, we found ourselvesoutgrowing our space at Pathways. In October2019, NorthCare Network leased office space ina new building. It took months of planning,two days of moving, and several weeks tounpack, but we are settled in and enjoying ournew location.THANK YOU PATHWAYS. The NorthCareNetwork Governing Board Members, staff,and CEO, Dr. Kangas, want to thank Pathwaysfor sharing their building with us for so manyyears!NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 5Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportPerformance Report CardNorthCare Network is monitored each year for performance in a variety of ways, one of which is through anindependent review organization. The Health Service Advisory Group (HSAG) is the External Quality ReviewOrganization (EQRO) contracted by the Michigan Department of Health and Human Services (MDHHS) to conduct a3-part survey of all Prepaid Inpatient Health Plans (PIHPs) in Michigan. This external review is mandated by the BalancedBudget Act (BBA) of 1997 and is conducted in accordance with the Centers for Medicare and Medicaid Services EQR(External Quality Review) guidelines. This three-part review consists of:1. Compliance Monitoring which is an assessment of NorthCare Network’s compliance with applicable BBAregulations and MDHHS contract requirements. HSAG reviewed nine of the 17 standards in FY19. Severalmodifications to the review process were made for this year’s compliance monitoring review compared to previousyears. The decrease in scores is, in part, a result of changes in the Managed Care regulations (BBA) and stateapprovals versus federal regulations. HSAG noted areas for improvement and required corrective action.See table below for results:Areas Reviewed for Compliance Monitoring Review(NA indicates standards not evaluated for that year.*)FY15FY16FY17FY18FY19*Quality Assessment & Performance Improvement Plan & Structure100%NANANA88%Performance Measures100%NANANA75%Practice Guidelines100%NANANA75%Staff Qualifications100%NANANA100%Utilization Management100%NANANA69%Customer Services100%NANA87%NAEnrollee Grievance Process100%NANA92%NAEnrollee Rights & Protections100%NANANA85%Subcontracts & Delegation100%NANA91%NAProvider ss & Availability94%100%NA95%NACoordination of Care100%NANANA100%Appeals89%100%NA78%NADisclosure of Ownership, Control, & Criminal Convictions72%100%NA100%NAConfidentially of Health InformationNANANANA100%Management Information SystemsNANANA83%NAOverall98%100%NA87%82%2. Performance Measure Validation (PMV) is a comprehensive review of our state mandated performancemeasure, encounter, and demographic data. HSAG looks at how the data is collected, calculated, and reported,and evaluates the accuracy, completeness, and timeliness of our data. They continue to find our data integration,NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 6Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportPerformance Report Card (cont.)data controls, and performance indicator documentation to be acceptable. HSAG had no concerns regardingNorthCare Network’s Eligibility and Enrollment Data System nor with the Claims and Encounter System. Onesuggested area for improvement is to perform additional checks beyond the state-specified requirements before datais submitted to the State as an added level of validation in support of Behavioral Health Treatment Episode Data Set(BH-TEDS) data quality and completeness.The following chart represents a five-year comparison of indicators that measure timeliness of service delivery. Wereceived a "fully compliant" rating on all performance measures reviewed and have maintained or improved in sixof seven indicators over last year. The following data is a comparison HSAG validation data over time:20152016201720182019Percentage of Children Receiving a Pre-Admission Screening for PsychiatricInpatient Care for Whom the Disposition Was Completed Within Three Hours94%100%100%97%100%Percentage of Adults Receiving a Pre-Admission Screening for PsychiatricInpatient Care for Whom the Disposition Was Completed Within Three Hours100%100%100%100%100%Percentage of new persons receiving an assessment w/in 14 days of requestfor non-emergency service.98%99%93%96%95%Percentage of new persons starting on-going services w/in 14 days of nonemergent assessment.99%98%98%99%99%Percentage of children discharged from psychiatric inpatient unit who areseen for follow-up care w/in 7 days of discharge.100%100%100%100%100%Percentage of adults discharged from psychiatric inpatient unit who are seenfor follow-up care w/in 7 days of discharge.95%100%97%87%100%Percentage of discharges from a substance abuse detox unit who are seenfor follow-up care w/in 7 days of discharge.100%100%100%100%100%Performance Measures3. Performance Improvement Project (PIP) Validation is the evaluation of the PIP required by the MDHHS. HSAG'svalidation review is to determine if the PIP is written and conducted in a way that can assure valid and reliableoutcomes and that the outcomes show statistically significant improvement that is sustained over time.A new PIP was implemented in 2019 which is to ensure individuals receive a follow-up appointment afterhospitalization for mental illness within 7 days of discharge for members ages 6 years and older. The goal of this PIPis to increase follow-up visits with a mental health practitioner within seven days after an inpatient discharge forselected mental illness diagnoses. Follow-up after inpatient discharge is important in the continuity of care betweentreatment settings and in ensuring that members receive care and services. Members receiving appropriate follow-upcare with a mental health practitioner can reduce risk of repeat hospitalization. This PIP topic represents a key area offocus for improvement. Baseline data is from January 1, 2018 through December 1, 2018. Reports show that 59.2% ofindividuals ages six through twenty had received a follow-up visit within 7 days of discharge from psychiatric inpatienthospitalization, while 58.4% of individuals ages 21 and older received a follow-up visit within 7 days of discharge.HSAG’s assessment of the validity and reliability of the results are based on CMS validation protocols . This ensuresthat the project design has a high confidence rate in reported results. All critical evaluation elements were Met, and80 to 100 percent of all evaluation elements were Met across all activities. The next assessment will be of theimplementation phase of this project and is expected to occur around July 2020.NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 7Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportPerformance Report Card (cont.)Performance Improvement Project—Documentation ImprovementAs a result of various auditing and monitoring processes, the need for consistent documentation tools and training acrossthe region has been identified. NorthCare Network’s focus for this PIP is on documentation for paraprofessional services.Our staff continue to work with regional contractors and sub-contractors and have established minimum documentationrequirements and have developed a paraprofessional note in the Electronic Health Record (EHR) to be deployed in earlyFY20. NorthCare Network had developed a PowerPoint training geared toward the documenting of paraprofessionalservices which has been distributed across the region.Michigan Mission-Based Performance Indicator System (MMBPIS)The Michigan Department of Health and Human Services (MDHHS) requires each PIHP to collect and report performanceindicator data as outlined in the MMBPIS protocols. The performance indicators selected measure dimensions of qualitythat include access/timeliness for services, efficiency, and outcomes. MDHHS has established five performance indicatorsthat are the responsibility of the PIHP to submit on a quarterly basis. The established standards for indicators #1, #2, #3and #4 are 95% or above and the standard for indicator #10 is 15% or less.MMBPIS – Performance ren100%100%100%95.7%Adults99.6%100%99.6%99.6%Child – MI100%100%100%100%Adult – MI100%100%100%100%Child – I/DD100%100%100%100%Adult – %93.0%94.7%95.0%Child – MI98.2%100%98.3%98.8%Adult – MI98.9%98.6%99.3%99.0%Child – I/DD100%100%100%100%Adult – 99.0%99.5%99.3%Indicator #4a: The percent of discharges from a psychiatric inpatient unit who are seen for follow-up care within 7 days.Indicator #4b: The percent of discharges from a substanceabuse detox unit who are seen for follow-up care within 7 SUD100%100%100%100%Indicator #10: The percent of children and adults readmitted toan inpatient psychiatric unit w/in 30 days of %Indicator #1: Percent of children and adults receiving apre-admissions screening for psychiatric inpatient care forwhom the disposition was completed w/in 3 hoursIndicator #2: The percent of new persons receiving a face-toface assessment with a professional within 14 calendar daysof a non-emergency request for service.Indicator #3: Start of ongoing service w/in 14 days of nonemergent face-to-face assessment w/a professional.NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 8Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportNorthCare Network FinancesNorthCare Network is responsible for the management of Medicaid and other Block Grant funds to provideservices to beneficiaries with mental illnesses, intellectual/developmental disabilities, and substance usedisorders across the 15 counties in the Upper Peninsula of Michigan. NorthCare Network receives the Medicaid fundsand then advances these funds per MDHHS contract to the five Community Mental Health Service Programs(CMHSPs) as well as other providers.NorthCare Network can utilize Medicaid carryforward funds in one of two ways. First, money can be transferred intoan Internal Service Fund to protect the region if Medicaid or Healthy Michigan is overspent in a future year. Second,money can be directed toward improvements in clinical services or creating administrative efficiencies to reducefuture expenditures. NorthCare Network’s Internal Service Fund is currently 96% funded and NorthCare Networkcontinues to assess areas of improvement to streamline functions and accessibility to care. Regional savings forFY19 were 4,403,266 for Medicaid.CCCMH - Copper County Community Mental Health GCCMH - Gogebic County Community Mental HealthHBH - Hiawatha Behavioral Health NBHS - Northpointe Behavioral Health SystemsPWCMH - Pathways Community Mental HealthNORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 9Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportVeteran NavigatorNorthCare Network has had aVeteran Navigator sinceSeptember 13, 2017. Veteran Navigatorsmeet monthly with the State and aredeveloping more consistent relationshipswith providers, including those in the VAsystem, to assist Veterans and theirfamilies in accessing services.During FY19, the Veteran Navigator contacted 43 new Veterans, 86% of whom were male and had either retired or completedtheir term of service in the armed forces. Approximately 46.5% of Veterans seeking services were younger than age 50. A total of32 referrals were made for mental health and SUD services to agencies such as Community Mental Health Service Programs(CMHSP), SUD providers, hospital/medical providers, and the Veteran’s Health Administration. Additional referrals for an array ofongoing community supports were made to the regional Veteran’s Community Action Team (VCAT), county Veteran ServiceOfficers (VSO), and other community resources. Referrals have increased 26.5% throughout FY19 for Veterans, Service members,and their families seeking services.DHIP CAFAS and PECFAS—OutcomesThe local CMHSPs receive MDHHS Incentive Payments (DHIP) for children and youth that are served in the MichiganFoster Care or Child Protective Services system. The average initial Child and Adolescent Functional AssessmentScale (CAFAS) and Pre-School Child Functional Assessment Scale (PECFAS) scores of the children and youth for whichthe incentive payment was received were compared to the average of the last CAFAS/PECFAS scores during a fiscal year.The graphs below depict the comparison and 3-year trend of the average scores. Below you will see that the last CAFAS/PECFAS scores trended lower than the initial score, representing overall improvement in the children/youth’sbehavioral health.NORTHCARE NETWORK, 1230 Wilson Street, Marquette, MI 49855 Page 10Website: www.northcarenetwork.orgPhone: 888-333-8030
NorthCare Network 2019 Fiscal YearAnnual Performance ReportSite Review Scoring ComparisonOur provider network site review comparison scores, throughout the past five fiscal years are below for both ourCMHSPs and SUD providers.Community Mental Health Service Program (CMHSP)Site Review 5-Yr. ComparisonSUD Provider Site Review 5-Yr. ComparisonNorthCare Network—SIS CompletionNorthCare Network conducts Support IntensityScale (SIS) assessments once every three yearswith individuals who meet the expected criteria setforth by MDHHS. The graph (right) shows how manyconsumers, for whom a SIS assessment is required,had an up-to-date SIS assessment (assessment noolder than 3 years) as of the end of FY19.Denominator. All consumers who were openfor service at a CMHSP at any time between 10/1/18and 9/30/19 who qualify for a SIS assessment basedon MDHHS criteria (Intellect
Ann Martin, Northpointe Dan Siirila, Gogebic Governing Board Past Chairpersons: Rudy Kemppainen Karen Raether Dan LaFoille Thank you: Thank you to our outgoing board members for serving on the Governing Boa
network.edgecount Return the Number of Edges in a Network Object network.edgelabel Plots a label corresponding to an edge in a network plot. network.extraction Extraction and Replacement Operators for Network Objects network.indicators Indicator Functions for Network Properties network.initialize Initialize a Network Class Object
disorder treatment services must sign any release they choose to give; parental signatures are NOT required. Public Health Code, MCL 333.61.21. Consent to Share Behavioral Health Information for Care Coordination Purposes - Universal Consent MDHHS-5515 form The properly completed Universal Consent MDHHS-5515 must be faxed to NorthCare, 248-406-
Certified Network Defense (CND) Outline . Module 01: Computer Network and Defense Fundamentals Network Fundamentals Computer Network Types of Network Major Network Topologies Network Components Network Interface Card
Old Objectives (N10-005) New Objectives (N10-006) Network Concepts 1 Network Architecture Network Installation & Configuration 2 Network Operations Network Media & Topologies 3 Network Security Network Management 4 Troubleshooting Network Sec
FOR NETWORK FUNCTIONS VIRTUALIZATION NETWORK FUNCTIONS VIRTUALIZATION: A PRIMER 3 VIRTUALIZING NETWORK FUNCTIONS: COULD NFV MEAN NETWORK NIRVANA? NEW MODELS New Management Models Needed for NFV When a cadre of giant global network oper-ators started the initiative known as Network Functions Virtualization (NFV) in late 2012,
Administrator Guide SolarWinds Orion Network Atlas 14 Installing Orion Network Atlas 3. In the Network Map resource, click Download Network Atlas. Note: If you do not see a Download Network Atlas link in your Network Map resource, click Edit, and then check the Show Network Atlas Download link option on the Edit Network Map resource page
Subnetting, VLSM, and IPv6 161 3. Refer to Figure 8.2. All routers in the network have been config-ured with the ip subnet-zero command. Which subnet addresses should be used for Network A and Network B? (Choose two.) FIGURE 8.2 Network diagram. A. Network A – 192.168.1.112/25 B. Network A – 192.168.1.112/26 C. Network A – 192.168.1.128/25
Point Club – Received for earning 500 points in both Regional and National competition. “Luck is in catching the wave, but then you have to ride it.” – Jimoh Ovbiagele 5 2nd 2017 Bushido International Society Inductee Mr. Drake Sass VISION: To keep a tradition that has withstood the test of time, to validate ancient fighting arts for modern times. INSTRUCTORS RANK: Matsamura Seito .
