Salt Lake County Intercepts: An Integrated Behavioral Health – Criminal Justice Response System

1. Salt Lake County Intercepts:An Integrated Behavioral Health – Criminal Justice Response System RCPA 2014 Conference October 2014 Patrick Fleming Ken Anderson Director SLCO Behavioral Health VP Business Development – Optum

2. Salt Lake County Intercepts • Optum • Salt Lake County Overview • System Redesign • Outcomes and Results • What Remains to be Done • Lessons Learned

3. OPTUM is part of UnitedHealth Group Information and technology-enabled health services Helping to make the health care system work better for everyone. Health care coverage and benefits Helping people live healthier lives.

4. Behavioral and specialty medical solutions for Medicaid We build systems of care Behavioral Health • Comprehensive Behavioral Health • Medical/Behavioral Integration • EAP and WorkLife • Community Based Products Complex Medical Conditions • Transplant Solutions • Kidney Solutions • Infertility Solutions • Bariatric Resource Solutions Physical Health • Chiropractic • Physical Therapy • Speech Therapy • Occupational Therapy • Alternative Medicine OptumInternational • EAP • Wellness • Wellbeing • Technology Solutions • Network Management • We manage financial risk • We manage provider networks • We manage clinical care • We ensure quality measures are achieved

5. Public Sector Business Platform The goal of our public sector business is to improve community health care systems by improving clinical outcomes, expanding access to appropriate care, and strengthening individual capabilities to pursue wellness and recovery. • 4.3M Medicaid & SCHIP members • over 20 states • 1.2 M Medicare members • 1,500 Public Sector staff • 270 CMHCs under contract • Peer support programs in several markets • Facts & Figures • Fundamentally Committed to: • Improving Outcomes • Supporting Recovery • Managing Costs • Achieving Whole-Person Wellness

6. Our footprint: County/State contracts • OPTUM manages county behavioral health carve-outs in: • Pierce County, Washington since 2009 • Salt Lake County, Utah since 2010 • San Diego County, California (ASO) since 1997 • New York City , New York (ASO) since 2011 • OPTUM serves as the BHO for the following states: • Idaho since 2013 • New Mexico since 2009 (ASO since January 2014) • OPTUM provides behavioral health specialty network services in integrated models for several states: • Tennessee • Kansas • Texas • Ohio (including MME effective 4/1/2014) • Washington (including MME effective 7/1/2014) • 15 other states (for total of 20)

7. Salt Lake County Overview • Demographics of County • County Government Structure • Human Services Agency • County Jail • Criminal Justice System • Law Enforcement • Services Funding – Medicaid and General Fund • State Operated Services

8. Salt Lake County Snapshot • Urban County with a Population of Almost 1 Million • Utah is a State Where Counties are Required to Deliver Behavioral Health (SA/MH) Services • Two Jails (1 = Minimum/Medium and 1 = Medium/Maximum) 2,100 Total Operational Beds • SLCo Behavioral Health is a contracted, private/public partnership model with 18,000 mental health episodes and 12,000 substance abuse episodes per year

9. Long Standing Commitment in SLCO • Criminal Justice Advisory Council (CJAC) - 1982 • Human Services joins CJAC • 2004 Over Crowding Release Policy • Model CIT program • Jail Based Services • Therapy Courts • Co-occurring, Re-entry and Empowerment (CORE) • Jail Diversion Outreach Team (JDOT) • Receiving Center planning efforts

10. System Redesign • Move to Managed Care • Contract directly with State as PIHP • RFP for selection of MBHO Partner • Selection of Optum • Renewed Crisis System Planning – Part III • Inclusive process • Report to County Council • Release of procurement RFPs for services

11. What has been Added or Reconfigured • Mobile Crisis Outreach Team (MCOT) • New Receiving Center • New Wellness Recovery Center • Community Response Team (CRT) • Crisis Line and New Warm Line • Peer Bridger • Alternative to Incarceration (ATI) Transportation

12. What has been added, cont. • Housing Initiatives • RIO Housing • HARP Housing • Mental Health Court Housing • Top Ten review process and planning • Jail Mental Health Release process • Case Resolution Coordinator • DORA

13. Salt Lake County Intercepts Best Clinical Practices: The Ultimate Intercept I. Law Enforcement/Emergency Services # of individuals Accessing Services Recidivism CIT, CITIU, Mobile Crisis Teams, Receiving Center, Wellness Resource Recovery Center, Crisis Line & a Warm Line II. Jail Jail MH Svcs, Mental Health Release, CATS, CRT Based on the Munetz and Griffin Sequential Intercept Model III. Courts Mental Health Courts Legal Defender Social Services Position Case Resolution Coordinator IV. Re-Entry AP&P = Adult Probation and Parole ATI = Alternatives to Incarceration CATS = Correction Addiction Treatment Svcs CIT = Crisis Intervention Team CITIU = CIT Investigative Unit CJS = Criminal Justice Services CORE=Co-occurring Reentry & Empowerment CRT = Community Response Team DORA = Drug Offender Reform Act JDOT = Jail Diversion Outreach Team MHC = Mental Health Court MHM = Mental Health Management MHR = Mental Health Release NAMI = National Alliance on Mental Illness RIO = Right Person In/Out SUD = Substance Use Disorder USARA = Utah Support Advocates for Recovery Awareness RIO Housing, Top Ten, JDOT CRT, CORE, ATI Transport, DORA & SUD Programs • Community CJS, AP&P NAMI, USARA, Rep Payee

14. Outcomes and Results • Reduced inpatient utilization • Reduced jail bookings and length of stay in jail • Increased connection to services • Increased access to housing • Increasing use of crisis services • Savings in ER and inpatient admit avoidance

15. Reduced Inpatient Utilization

16. Medical Cost AvoidanceData from Crisis Program diversions show substantial savings to overall health system - $2.88 million for first quarter

17. Evidence of Success Study Design: *Results include only bookings in the SLCO jail. They do not reflect prison or out-of-state bookings.

18. Evidence of Success Participation in the County’s Housing programs increases the power of the Alternatives to Incarceration programs significantly, particularly for jail bookings for new charges (21% greater reduction) and length of stay in jail (45% greater reduction). CRT (Remaining Attached After 90 Days)

19. Evidence of Success The ATI Transport and CRT were effective in attaching participants to behavioral health services upon leaving incarceration. Overall, ATI Transport (Attached) • 89% of ATI participants attached to services within 30 days. • 100% of CRT participants attached to • services and 63% of CRT participants • remained attached after 90 days. CRT (Remaining Attached After 90 Days) CRT (Remaining Attached After 90 Days)

20. What Remains to be Addressed • Programs specific for women • Youth Services programs (MCOT and FAST) • Address DCFS Medicaid carve-out and Coordination • Medicaid Enrollment Process at Corrections • ACA Impacts – Utah’s version of Medicaid Expansion • Council of State Governments Study

21. Lessons Learned • Political Support and Alignment • Everyone is welcome – needed at the table • County is a single payer for all these services- what delivers best outcomes and efficiency • Align incentives with mission and vision • Persistence is a virtue and strength • OK to proceed incrementally

22. Contact Information Salt Lake County Optum Ken Anderson Vice President – Optum Public Sector Business Dev. 360-239-1394 Kenneth.anderson@optum.com Rick Elorreaga Executive Director-Public Sector Solutions Optum Salt Lake County 801-963-6088 Richard.Elorreaga@optum.com www.optumhealthslco.com Patrick Fleming Director, SLCO Behavioral Health 385-468-4707 pfleming@slco.org http://behavioralhealthservices.slco.org Tim Whalen Director, SLCO Behavioral Health twhalen@slco.org http://behavioralhealthservices.slco.org SLCO PSA Video http://www.youtube.com/embed/qeW2YBzzSRA