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Contracting with Integrity

Contracting with Integrity. Harvey Rosenthal, Tanya Stevens NYAPRS ACMHA Peer Leaders Seminar March 25, 2014. Back to Basics. Trusted, Safe Relationships Person driven and Directed Acceptance, Empathy and Example Honesty and Shared Accountability Hope , Respect and Dignity

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Contracting with Integrity

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  1. Contracting with Integrity Harvey Rosenthal, Tanya Stevens NYAPRS ACMHA Peer Leaders Seminar March 25, 2014

  2. Back to Basics Trusted, Safe Relationships Person driven and Directed Acceptance, Empathy and Example Honesty and Shared Accountability Hope, Respect and Dignity Power, Choice and Freedom, Human rights

  3. Back to Basics Healing and Wellness, Alternatives Connection, Community Embracing Differences Re-framing, Re-naming, Raising awareness Learning New Ways Trauma Informed: what happened, not what’s wrong?

  4. New Tools and Innovations Wellness Recovery Actions Plans Advance Directives 8 Dimensions of Wellness Whole Health Peer Support Whole Health Action Management groups New Models of Support: Crisis Respite, Wellness Coach, Bridger

  5. Our Time Has Come We’ve gone from being ahead of our time to being Right on Time!

  6. NYS Medicaid Spending • $54 billion Medicaid Program 5 million beneficiaries • 20% (1 million beneficiaries) use 80% of these dollars • Hospital, emergency room, medications, longtime ‘chronic’ services • 40+% have behavioral health conditions • NYS avoidable Medicaid hospital readmissions: $800m to $1 billion annually • 70% have behavioral health conditions, 3/5 of these admissions are for medical reasons

  7. Sample ContractingPeer Bridger Example

  8. SOLID PROGRAM DESIGN‘Elevator Speech’ for Peer Bridger Proposal • “Building on 21 years of experience in creating and providing peer bridger services, we propose to operate a peer bridger program that will support an identified number of NYC residents who are high repeat users of behavioral health inpatient and ER services to successfully transition to community settings and to reduce their use of those costly settings.”

  9. Past Performance DataOptum CDIP 2008-11One Person’s Outcomes • 40 year old man with long standing addiction, mental health and medical issues • 2009-prior to enrollment: 7 detox stays (4 different facilities) $52,282 BH Medicaid • Peer coach services: transitional and follow up support, re-engagement in AA, wellness coaching, relapse prevention aid • 2010-1 detox, 1 rehab (referred by the CIDP team) $20,650 Abstinent for 1 year • 2011-1 relapse with detox/rehab no claim

  10. Past Performance Data1998 National Health Data Systems During the 2-year baseline period, the Matches were hospitalized an average of 60% of the time; while enrolled in the program, however, they were re-hospitalized only 19% of the time…an improvement of 41%.

  11. Peer Bridger Model • Hospital based engagement and discharge support • Stabilization and community adjustment support • Self directed wellness planning • Activation of Wellness Self Management, Recovery and Health Literacy education and support, Relapse prevention and hospital diversion • Community connection

  12. Outreach Process • Upon receipt of a referral, referrals are assigned by NYAPRS to Peer Bridgers based on home address of the referred individual. • Peer Bridgers are expected to make initial contact within one week of receipt of referral. • Peer Bridgers make six (6) or more attempts at various times of day, by person or via the phone or mail, to contact each referral before a case is closed. • Peer Bridgers have been trained in engagement skills and each Peer Bridger is equipped with brochures on the program to be left if no one is home at the time of an in-person visit.

  13. Outreach Challenges • Incorrect or insufficient data on home addresses and phone numbers. • Challenges in gaining access to inpatient hospital settings which increases the projects dependence on accurate information on referral addresses and phone numbers

  14. Bridger Contracted Activities • Assistance with accessing clinical and community services and supports. • Specific areas to be addressed are: • Housing • Social network • Crisis support • Personal advocacy (self-help) • Wellness Self Management • Education I employment • System advocacy

  15. Contracted Outcomes 40% reduction in inpatient admissions 15% reduction in total bed days .5 day reduction in inpatient length of stay 15% increase in community tenure 20% increase in outpatient engagement

  16. Summary of Preliminary Utilization & Cost Findings2013 Optum External Peer Evaluation 6 months pre-post, members who enroll in the program show: Significant Decreases in % who use inpatient services NY: 47.9% decrease (from 92.6% to 48.2%) Significant Decreases in # of inpatient days NY: 62.5% decrease (from 11.2 days to 4.2) Significant Increases in # of outpatient visits NY: 28.0% increase (from 8.5 visits to 11.8) Significant Decreases in total BH costs NY:47.1% decrease (from $9,998.69 to $5,291.59) *Among subsample of enrollees in NY (N = ) and WI (N = 130) with continuous eligibility 6 months pre-referral and 6 months post-referral and at least one behavioral health claim during that period 16

  17. Outcome Measures are Critical to Preserving Integrity Housing stability Economic stability Social connection Increased health literacy, self management Reductions in inpatient admissions, ER visits

  18. Reimbursement , Submissions All inclusive quarterly payments of $43,000 and $96,000; includes 1 quarter start up Deliverables: notes documenting visits and activities Tracker: Name, DOB, County, Date sent, Date assigned, Date enrolled or refused, name of bridger assigned, Date closed

  19. Bridger Compensation In the 1990’s, we began with part time bridgers who wanted to remain on disability benefits. All new projects focus on promoting careers with FT annual salaries at $40,000 with healthcare and retirement plan (per Pillars of Peer Support findings)

  20. Protecting the Integrity of Peer Support Peer workers are not ‘cheap staff who get people to take their meds’ or act as assistant case managers or transportation aides Rather, peers start with the person and their stated needs; we don’t begin with diagnosis and meds but focus on the development of a relationship based on empathy and hope… and on the development of a person defined wellness plan.

  21. Protecting the Integrity of Peer Support If that wellness plan includes a request for help with appointments & medications, peers can then include this as part of a broader array of personalized peer supports Peers frequently work for subcontracted peer run agencies and are supervised by peers Peers who are embedded in traditional settings without peer supervision are at risk for co-optation. Groups are developing competency, training, credentialing and accreditation standards for peer delivered services

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