Salt Lake County Intercepts: An Integrated Behavioral Health

Report
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
Salt Lake County Intercepts
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Optum
Salt Lake County Overview
System Redesign
Outcomes and Results
What Remains to be Done
Lessons Learned
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
benefits
Helping people live
lives.
and
healthier
Behavioral and specialty medical solutions for Medicaid
We build systems of care
• We manage financial risk
• We manage provider networks
• We manage clinical care
• We ensure quality measures are achieved
Behavioral
Health
• Comprehensive
Behavioral Health
• Medical/Behavioral
Integration
• EAP and WorkLife
• Community Based
Products
Complex
Medical
Conditions
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Transplant Solutions
Kidney Solutions
Infertility Solutions
Bariatric Resource
Solutions
Physical
Health
Optum
International
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Chiropractic
Physical Therapy
Speech Therapy
Occupational Therapy
Alternative Medicine
EAP
Wellness
Wellbeing
Technology Solutions
Network Management
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.
•Facts & Figures
• 4.3M Medicaid & SCHIP members
• over 20 states
• 1.2 M Medicare members
Fundamentally Committed to:
• 1,500 Public Sector staff
• Improving Outcomes
• 270 CMHCs under contract
• Supporting Recovery
• Peer support programs in several markets
• Managing Costs
• Achieving Whole-Person Wellness
Our footprint: County/State contracts
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OPTUM manages county behavioral health carve-outs in:
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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)
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OPTUM provides behavioral health specialty network services in integrated models for
several states:
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Tennessee
Kansas
Texas
Ohio (including MME effective 4/1/2014)
Washington (including MME effective 7/1/2014)
15 other states (for total of 20)
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
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
Substance Abuse
$4,352,351 ,
20%
Mental Health
$5,762,124 ,
27%
$9,097,967 ,
17%
$794,178 ,
2% State Funding
State Funding
Federal Funding
Federal Funding
Federal Medicaid
Federal Medicaid
County Funding
County Funding
$4,300,000 ,
20%
$7,165,133 ,
33%
$9,418,821 ,
18%
$33,370,000
, 63%
Long Standing Commitment in SLCO
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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
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
What has been Added or Reconfigured
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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
What has been added, cont.
• Housing Initiatives
– RIO Housing
– HARP Housing
– Mental Health Court Housing
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Top Ten review process and planning
Jail Mental Health Release process
Case Resolution Coordinator
DORA
Salt Lake County Intercepts
Best Clinical Practices: The Ultimate Intercept
# of
individuals
Accessing
Services
I. Law Enforcement/Emergency 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
III. Courts
Based on the Munetz and Griffin
Sequential Intercept Model
Mental Health Courts
Legal Defender Social Services Position
Case Resolution Coordinator
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
IV. Re-Entry
RIO Housing, Top Ten, JDOT
CRT, CORE, ATI Transport, DORA &
SUD Programs
V.
Community
CJS, AP&P
NAMI,
USARA, Rep Payee
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
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Outcomes and Results
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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
Reduced Inpatient Utilization
Average Daily In-Patient Census by Month of Service
40.0
MCOT fully
operational as
Receiving Center
35.0
Average Daily Bed Census
30.0
Wellness Recovery
Center opened in
25.0
20.0
FY12
FY13
15.0
FY14
10.0
5.0
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Month of Service
Feb
Mar
Apr
May
Jun
Medical Cost Avoidance
Data from Crisis Program diversions show substantial savings to overall health system $2.88 million for first quarter
July
MCOT ER Visits Saved *
WRC ER Visits Saved
ER Cost Savings ($2000/visit)
August
Sept
Total
$
126
11
274,000 $
130
12
283,000 $
147
4
302,800 $
403
27
859,800
MCOT IP Stays Saved**
RC IP Stays Saved
WRC IP Stays Saved
IP Cost Savings ($915/day @5.5 days)
$
90
21
44
780,038 $
86
30
45
812,120 $
91
25
36
766,450 $
268
76
125
2,358,607
Subtract Other Stays (WRC, RC)
Total Savings to Health System
$
$
(122,550) $
931,488 $
(123,970) $
971,150 $
(89,900) $
979,350 $
(336,420)
2,881,987
* Savings based on estimated 85% receiving MCOT outreach would otherwise have gone to ER.
** Savings based on estimated 75% of the 85% that would have gone to the ER.
Evidence of Success
CORE & JDOT
Total Jail Bookings
(past and new
charges)
% Reduction
Total
CORE/JDOT
Study Design:
CORE
19%
Length of Stay in Jail
(for all bookings)
JDOT
7%
11%
CORE
36%
JDOT
13%
22%
Jail Bookings for
New Charges
CORE
59%
Length of Stay in Jail
(new charge bookings)
JDOT
31%
39%
CORE
44%
JDOT
28%
33%
The outcomes data presented follow the group who participated in services in FY2012 (July1, 2011-June 30,
2012). The outcomes compare 1 year prior to program enrollment and 1 year after program enrollment.
Because the ATI transport and CRT are one-time/short-term involvement, the outcomes will focus on whether
participants were engaged in treatment services 30 days after release from jail for ATI and 90 days for CRT.
Housing data show a comparison of housing at enrollment and at discharge from the program.
*Results include only bookings in the SLCO jail. They do not reflect prison or out-of-state bookings.
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Evidence of Success
Combined With SL Co Housing
% Increase
CORE
43%
JDOT
20%
Total CORE/
JDOT
27%
Homeless that moved
into New Housing
Total Jail Bookings
(past and new charges)
11%
% Reduction
SLCO
Housing
22%
Length of Stay in Jail
(for all bookings)
22%
SLCO
Housing
52%
Jail Bookings for
New Charges
39%
SLCO
Housing
61%
Length of Stay in Jail
(new charge bookings)
33%
SLCO
Housing
78%
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).
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Evidence of Success
ATI Transport & CRT
% of Participants Attached to VMH
Services after Enrollment
100%
80%
The ATI Transport and CRT were effective
in attaching participants to behavioral
health services upon leaving incarceration.
ATI Transport
(Attached)
60%
40%
CRT
(Remaining Attached
After 90 Days)
20%
0%
Q1 12
Q2 12
Q3 12
Q4 12
Q1 13
Q2 13
Overall,
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89% of ATI participants attached to
services within 30 days.
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100% of CRT participants attached to
services and 63% of CRT participants
remained attached after 90 days.
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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
Lessons Learned
• Political Support and Alignment
• Everyone is welcome – needed at the table
• County is a single payer for all these serviceswhat delivers best outcomes and efficiency
• Align incentives with mission and vision
• Persistence is a virtue and strength
• OK to proceed incrementally
Contact Information
Salt Lake County
Optum
Patrick Fleming
Ken Anderson
Director, SLCO Behavioral Health
385-468-4707
[email protected]
Vice President – Optum Public Sector Business Dev.
360-239-1394
[email protected]
http://behavioralhealthservices.slco.org
Tim Whalen
Rick Elorreaga
Director, SLCO Behavioral Health
[email protected]
http://behavioralhealthservices.slco.org
Executive Director-Public Sector Solutions Optum
Salt Lake County
801-963-6088
[email protected]
www.optumhealthslco.com
SLCO PSA Video
http://www.youtube.com/embed/qeW2YBzzSRA

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