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NatCon 2018 Presentation: Pay for Success and Social Impact Bonds


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Faith Richie, SVP of Development at Telecare, as well as Shannon Mong, Director of Innovation Initiatives at Telecare, provided an insider’s perspective on the planning and implementation of our “pay for success” behavioral health program, Partners in Wellness. This community-based program in San Jose, California, establishes performance incentives that align clinical goals and social impact regarding reducing expensive utilization of wraparound services.

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NatCon 2018 Presentation: Pay for Success and Social Impact Bonds

  1. 1. 1 SUB-ACUTE Length of stay: Typically 3-6 months ACUTE Length of stay: Typically 3-10 days CRISIS Length of stay: Few hours to 30 days COMMUNITY Membership: 90 days to 5+ years COMMUNITY Membership: 90 days to 5+ years Telecare Corporation Our Mission Deliver excellent and effective behavioral health services that engage individual with complex needs in recovering their health, hopes and dreams
  2. 2. 2 Partners in Wellness: Santa Clara County & Telecare First “Pay for Success” mental health program in the country • An innovative six-year, performance-based contract to deliver publicly-funded services. • Provider (Telecare) at risk to deliver savings by reducing clients’ use of Psychiatric Hospital, Psychiatric Emergency Services, State Hospital, and other mental health services while also ensuring clients’ wellness. • Objectively evaluated by Dr. Keith Humphreys, Stanford University. • Performance targets set to fully pay for program and return additional savings at the end of the six years.
  3. 3. Project Construction Timeline Overview Project Selection Release RFP on Acute Mental Health PFS Project Selection Project Launch Begin Budget Negotiations Service Delivery; Begin evaluation of outcomes Select Lead Agency Formal Announcement Determine success metric definition Launch Ramp-Up MAY 2015 DEC 2014 JULY 2015 AUG 2015 JUNE 2016 JAN 2017 • Finalize project design, programmatic details, operational plan, evaluation design and economic model • Determine target outcomes and intervention impact • Contract negotiations between stakeholders • Board of Supervisors approval, MOU, Press Releases • Determine target outcomes/measures tied to payment • Begin ramp-up period prior to full project launch • Pilot service delivery
  4. 4. TYPICAL PROGRAM LEADERSHIP PAY FOR SUCCESS: TYPICAL “PLUS” 1. Operational Clinical Leadership  Assure good clinical quality  Recovery-oriented culture  Client & staff safety  FSP/ACT wraparound program model  Whole Person Care elements, with “Treat to Target” focus and discharge planning  Measure clinical improvement with multiple screening measures 2. Finance/Budget  Work within annual expense budget  Monitor staff productivity  Assure MediCal revenue earnings  Monthly tracking of cashable savings with 6 year time horizon - + $1.4 million risk for client utilization + overall cost risks 3. Stakeholder/ Community Engagement  Maintain good relationship with county customer  Network with other providers, NAMI, etc.  Need very tight relationship with Acute/PES, 24-Hour Care Unit  High visibility with county – fishbowl  External Evaluator at Stanford
  5. 5. Multidisciplinary Team “Partners” (not clients, patients…) Med Reconciliation Peer Support Psychiatry Care Coordination Housing First MI, SBIRT Illness Self- Management Referral & Linkage SERVICE ARRAY Clinical Care Model TREATMENT PLANNING Screenings My Whole Health Plan Assess- ments Whole Health Care Plan Adjusts Level of Service PRIORITIZATION TOOLS Huddle Priority Report in EHR Referral & Linkage
  6. 6. Partners in Wellness Program
  7. 7. 7 Partners in Wellness – Santa Clara County & Telecare Cost Savings In the first year of operation, the program saved $508,482 over the target Partners in Wellness: January – December 2017 % Reductions in Usage Over Target - Year One Results 25% 35% 81% 100% 22% 0% 20% 40% 60% 80% 100% 120% Acute Days Subacute Days Psychiatric Emergency Services Visits State Hospital Days Crisis Residential Days
  8. 8. 8 Partners in Wellness – Santa Clara County & Telecare Clinical Outcomes For the first year of operation Partners in Wellness: January – December 2017 Clinical Outcomes • Screening Tools included: BPRS, PHQ-9, GAD-7, DAST & AUDIT. • Partners were also screened for BMI, HDL-C, HbA1C and blood pressure. • As of 12/12/17, partners with higher depression, psychosis (as measured by BPRS), drug and alcohol use score showed significant improvement over time in the program. • Partners with high levels of anxiety shown in the first screening showed improvement by the second screening • There was also a significant improvement for those with HDL-C scores less than 40