Salt Lake County Intercepts: An Integrated Behavioral Health – Criminal

Justice Response System

RCPA 2014 Conference October 2014

Patrick Fleming Ken AndersonDirector SLCO Behavioral Health VP Business Development – Optum

Salt Lake County Intercepts

• 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 and benefits

Helping people live healthier

lives.

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• Transplant Solutions• Kidney Solutions• Infertility Solutions• Bariatric Resource

Solutions

Physical Health• Chiropractic• Physical Therapy• Speech Therapy• Occupational Therapy• Alternative Medicine

Optum International• EAP• Wellness• Wellbeing• Technology Solutions• Network Management

Public Sector Business PlatformThe 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.

Fundamentally Committed to:• Improving Outcomes• Supporting Recovery• Managing Costs• Achieving Whole-Person Wellness

• 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

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)

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

5762124;

27%

7165133;

33%

4300000;

20%

4352351;

20%

Substance Abuse

State Funding

Federal Funding

Federal Medicaid

County Funding

9418821;

18%

$794,178 , 2%

33370000; 63%

9097967;

17%

Mental Health

State Funding

Federal Funding

Federal Medicaid

County Funding

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

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

• 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

• Top Ten review process and planning• Jail Mental Health Release process• Case Resolution Coordinator• DORA

13

Salt Lake County Intercepts

CIT, CITIU, Mobile Crisis Teams, Receiving Center,Wellness Resource Recovery Center, Crisis Line & a Warm Line

Jail MH Svcs, Mental Health Release, CATS, CRT

Mental Health CourtsLegal Defender Social Services Position

Case Resolution Coordinator

RIO Housing, Top Ten, JDOTCRT, CORE, ATI Transport, DORA &

SUD Programs

CJS, AP&PNAMI,

USARA, Rep Payee

I. Law Enforcement/Emergency Services

II. Jail

III. Courts

IV. Re-Entry

V. Community

Best Clinical Practices: The Ultimate Intercept

JDOT = Jail Diversion Outreach TeamMHC = Mental Health CourtMHM = Mental Health ManagementMHR = Mental Health ReleaseNAMI = National Alliance on Mental IllnessRIO = Right Person In/OutSUD = Substance Use DisorderUSARA = Utah Support Advocates for Recovery Awareness

AP&P = Adult Probation and ParoleATI = Alternatives to IncarcerationCATS = Correction Addiction Treatment SvcsCIT = Crisis Intervention TeamCITIU = CIT Investigative UnitCJS = Criminal Justice ServicesCORE=Co-occurring Reentry & EmpowermentCRT = Community Response TeamDORA = Drug Offender Reform Act

# of individualsAccessing Services

Recidivism

Based on the Munetz and Griffin Sequential Intercept Model

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

Reduced Inpatient Utilization

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun -

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0 Average Daily In-Patient Census by Month of Service

FY12FY13FY14

Month of Service

Ave

rage

Dai

ly B

ed C

ensu

s Wellness Recovery Center opened in mid October 2012

Receiving Center opened in July 2012

MCOT fully operational as of April 2012.

Medical Cost AvoidanceData from Crisis Program diversions show substantial savings to overall health system -

$2.88 million for first quarter

July August Sept Total

MCOT ER Visits Saved * 126 130 147 403WRC ER Visits Saved 11 12 4 27ER Cost Savings ($2000/visit) 274,000$ 283,000$ 302,800$ 859,800$

MCOT IP Stays Saved** 90 86 91 268RC IP Stays Saved 21 30 25 76WRC IP Stays Saved 44 45 36 125IP Cost Savings ($915/day @5.5 days) 780,038$ 812,120$ 766,450$ 2,358,607$

Subtract Other Stays (WRC, RC) (122,550)$ (123,970)$ (89,900)$ (336,420)$ Total Savings to Health System 931,488$ 971,150$ 979,350$ 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.

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

CORE & JDOT

11% 39%

7%

Total CORE/JDOT

Total Jail Bookings(past and new

charges)Jail Bookings for

New Charges

% ReductionCORE19%

JDOTJDOTCORE

59%31%

33%

Length of Stay in Jail(new charge bookings)

JDOTCORE44% 28%

22%

Length of Stay in Jail(for all bookings)

JDOT13%CORE

36%

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.

Study Design:

Evidence of Success

18

Combined With SL Co Housing

CRT (Remaining Attached

After 90 Days)

Total Jail Bookings(past and new charges)

% Reduction11% SLCO

Housing22%

Length of Stay in Jail(for all bookings)

SLCO Housing

52%

22%

Jail Bookings for New Charges

SLCO Housing

61%

39%

Length of Stay in Jail(new charge bookings)

SLCO Housing

78%

33%

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).

% IncreaseJDOT20%

CORE43%

Homeless that moved into New Housing

Total CORE/JDOT27%

Evidence of Success

19

ATI Transport & CRT

Q1 12 Q2 12 Q3 12 Q4 12 Q1 13 Q2 130%

20%

40%

60%

80%

100%

% of Participants Attached to VMH Services after Enrollment

ATI Transport (Attached)

CRT (Remaining Attached

After 90 Days)

The ATI Transport and CRT were effective in attaching participants to behavioral health services upon leaving incarceration.

Overall, • 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)

Evidence of Success

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 services-

what delivers best outcomes and efficiency• Align incentives with mission and vision• Persistence is a virtue and strength• OK to proceed incrementally

Contact InformationSalt Lake County

Patrick FlemingDirector, SLCO Behavioral Health385-468-4707pfleming@slco.orghttp://behavioralhealthservices.slco.org

Tim WhalenDirector, SLCO Behavioral Healthtwhalen@slco.orghttp://behavioralhealthservices.slco.org

SLCO PSA Video http://www.youtube.com/embed/qeW2YBzzSRA

Optum

Ken AndersonVice President – Optum Public Sector Business Dev.360-239-1394Kenneth.anderson@optum.com

Rick ElorreagaExecutive Director-Public Sector Solutions Optum Salt Lake County801-963-6088Richard.Elorreaga@optum.comwww.optumhealthslco.com