1. Michigan Health and Wellness Initiatives: Peer Services in Federally Qualified Health Centers and Integrated Health Settings Lynda Zeller, Deputy Director Behavioral Health and Developmental Disabilities Administration Pam Werner, Recovery Oriented Systems of Care Behavioral Health and Developmental Disabilities Administration Mary Beth Evans, CPSS Mid-Michigan Community Health Services

2. Michigan Department of Community Health (Public Health, Medicaid, Behavioral Health and Developmental Disabilities, Aging) Strategic Priorities  Promote and Protect Health, Wellness and Safety  Improve Outcomes for Children  Transform the Healthcare System  Strengthen Workforce and Economic Development

3. Key Strategic Action Items: “Transform Health System”  Integrated Care for Dual Eligible Demonstration (Medicaid/Medicare)  Healthy Michigan Plan (Medicaid Expansion)  State Innovation Model “Blueprint for Health Integration” testing payment and delivery

4. Michigan Managed Care & Specialty Services System Physical Health and Behavioral Health General Population (Mild-Moderate BH) Specialty Behavioral Health & Developmental Disabilities Managed Care- Medicaid (Majority in managed care plans=except NH- LTC) -Competitively Bid -13 Medicaid Health Plans -Multiple plans within regions -Includes Mild/Moderate BH -Model consistent for over a decade -CMH First Opportunity through regional PIHP -PIHP Sole Sourced in 10 Regions -Shared Risk, A-87 -1915 (b)(c) concurrent -CMH SMI, SUD, DD, SED Services Healthy Michigan Plan (Medicaid Expansion) ABP-SPA & 1115 -Repeat items above -Added: Savings Acct, Personal Incentives, Contributions -Repeat items above -Added: Broader addiction & recovery services Non Medicaid Funds-Michigan Marketplace (Exchange-EHB include BH) -SUD federal, state, local (SUD Coordinating Agency merging with PIHP) -CMH state, local, federal SMI, DD, SED

5. Michigan’s Peer Trained Workforce 2005 - 2014

6. MDCH 1915 (b)(c) Managed Care Specialty Services Waiver  Medicaid Provider Description for Peer Specialist Covered Services  Developing health and wellness plans  Developing advance directives  Integration of physical and mental health care  Developing, implementing and providing health and wellness classes to address preventable risk factors for medical conditions

7. Transformation Transfer Initiative (TTI) Project  Employment of 3 CPSS as Healthcare Navigators and Wellness Coaches  Selection of two Federally Qualified Health Centers (FQHC). One urban and one rural serving 1,552 and 423 individuals with behavioral health needs respectively.  Utilization rates for behavioral health needs at Michigan FQHC sites  2011: 26,382 served with mental health needs 1,953 for persons with Substance Use Disorders

8. Number of Mental Health & Substance Abuse Visits in Michigan FQHCs* *2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic increases more accurately reflect the population prevalence.

9. Number of Mental Health & Substance Abuse Patients in Michigan FQHCs* *2012 was the first year Health Centers were required to report for all diagnoses, not just primary. Dramatic increases more accurately reflect the population prevalence.

10. TTI Program Objectives  Enhance knowledge and access to primary care  Increase self-management of chronic conditions  Enhance physical and behavioral health and wellness  Improve quality of life  Enhance recovery

11. Peer Roles and Responsibilities  Health Navigation  Assistance with appointments, follow up with specialty services and managing complex health and service systems  Identifying community resources, benefits, and referral to outside agencies  Linking to community based formal and informal supports

12. Peer Roles and Responsibilities  Health and Wellness Coaching  Developing Wellness Recovery Action Plans  Facilitating classes and support groups in smoking cessation, Whole Health Action Management (WHAM), diabetes, pain management, and increasing physical activity.  Providing individual support related to managing two or more chronic conditions

13. TTI Individual Patient Outcomes Anecdotal Evidence  Teaching benefits of diabetes self-management including walking and healthy eating – one individual lost 18 pounds, reduced insulin and in Hemoglobin A1c test dropped from 8.2 to 5.9  Teaching navigation - supported an individual who had a goal of employment how to navigate the public bus system to go to Michigan Works, a job placement/GED organization

14. TTI Individual Outcomes Anecdotal Evidence  Teaching better self-management of finances – supported one individual who was homeless and on disability how to budget to rent her own apartment – also supported the same individual to locate and lease an affordable apartment  Introducing the Wellness Recovery Action Plan (WRAP) for recovery self-management – worked one-on-one with an individual to create a WRAP plan identifying early warning signs, triggers and how to build a wellness toolbox.

15. Continuing Education  Smoking Cessation/Tobacco Recovery: University of Colorado and CHOICES of New Jersey  Wellness Recovery Action Planning  Trauma Informed Peer Services and Supports  Emotional CPR (e-CPR), National Empowerment Center  Leadership  Whole Health Action Management

16. Peer Specialist and Recovery Coach Innovations and Opportunities  2010 Association of State and Territorial Health Officials Vision Award for Peer-led Health and Wellness Initiative  Michigan Cancer Consortium 2012 Spirit of Collaboration Award for Peer to Peer Tobacco Recovery Program  Stanford CDSMP research study  Spotlight Agency for Health Care Research and Quality Innovations Exchange

17. Vision and Mission Our Guide on the Journey Toward Population Health Our Vision Our Vision is to improve the experience of health care, improve the health of populations, and reduce per capita costs of health care Our Mission Our Mission is to protect, preserve and promote the health and safety of the people of Michigan with particular attention to providing for the needs of the vulnerable and under-served populations

18. Georgia’s Health Integration through Peer Support Georgia Department of Behavioral Health & Developmental Disabilities Frank W. Berry, Commissioner Wendy White Tiegreen, Director of Medicaid and Health System Innovation and Georgia Mental Health Consumer Network Sherry Jenkins-Tucker, Executive Director for the National Association of State Mental Health Commissioners July 2014

19. Georgia’s Foundation Peer Support approved in Summer 1999 First specific “Peer”-delivered Medicaid approved service in nation Approximately 1000 Certified Peer Specialists certified in GA Medicaid approved Peer Support Whole Health and Wellness Medicaid-billable service to Medicaid State Plan in 2012 (implemented January 2013)

20. Peer Support Whole Health and Wellness Key Modification: Prevention Modified Medicaid Rehab Option State Plan to add: “…support and coaching interventions to individuals to promote recovery and healthy lifestyles and to reduce identifiable behavioral health & and physical health risks and increase healthy behaviors intended to prevent the onset of disease or lessen the impact of existing chronic health conditions by teaching more effective management techniques that focus on the individual’s self-management and decision making about healthy choices which ultimately extend the members’ lifespan.” Georgia: New & Now

21. Georgia: New and Now Specific Interventions Include: Skills development for sharing basic health information; Promoting awareness regarding health indicators; Assisting the individual in understanding the idea of whole health and the role of health screening; Supporting behavior changes for health improvement; Building skills on the use of wellness tools (e.g. relaxation response, positive imaging, wellness toolboxes, daily action plans, stress management, etc.) to support the individual’s identified health goals;

22. Specific Interventions, continued: Working with the individual in his/her selection of incremental health goals; Teaching/modeling/demonstrating skills such as nutrition, physical fitness, healthy lifestyle choices; Promoting and offering healthy environments and skills- development to assist the individual in modifying his/her own living environments for wellness; Supporting the individual as they practice creating healthy habits; Personal self-care, self-advocacy and health communication; Assisting in the coaching related to disclosing history, discussing prescribed medications, asking questions in health settings Georgia: New and Now

23. TECHNICAL ELEMENTS  Requires Professional Supervision in accordance with CMS-SMDL #07-011  Requires goal(s) on the official Treatment (Recovery) Plan  Requires health-related training for the Certified Peer Specialist (CPS)

24. Georgia: New and Now  CPS Training: Whole Health Action Management (WHAM) o Engaging in person-centered planning to identify strengths and supports in 10 science-based whole health and resiliency factors; o Supporting the person in writing a whole health goal based on personal motivation and person-centered planning; o Supporting the person in creating and logging a weekly action plan; o Facilitating WHAM peer support groups which create new health behaviors; o Building the person’s Relaxation Response skills to manage stress; o Building the person’s cognitive self-management skills to avoid negative thinking. http://www.thenationalcouncil.org/cs/press_releases/eight_weeks_to_whole_health_national_council_offers_wham_peer_trainings

25. Georgia: New and Now TECHNICAL ELEMENTS Health-trained CPSs are the lead practitioners Partnered with an agency-designated Behavioral Health Registered Nurse/s who provides technical medical advice, referral, and support as requested and as necessary

26. Georgia: New and Now TECHNICAL ELEMENTS: HCPCS Billing Code: Health and Wellness Supports, H0025 Rate for 15 minute unit: Ranges from $15.13 to $24.36 depending on CPS education level and location of service

27. Georgia: New and Now Health-Certified CPSs have the ability to function in a variety of settings Health-Trained Certified Peer Specialist RN providing medical technical support EmergencyRoom FQHC Community BH Center

28. Georgia’s Foundation Model Billing: Emergency Rooms: Negotiations with Medicaid FQHCs: Per Diem billing Options for consideration: CMHC Partnership Specialized Medicaid Enrollment for Peer Support Outcomes Orientation

29. Behavioral Health* Medical FQHCs WHOLEHEALTH “Medical history, physical examination, assessment of health status and treatment of a variety of conditions amendable to medical management on an ambulatory basis by a physician”* “Evaluation and Diagnostic services” “Services and supplies incident to a physician services including pharmaceuticals “ “Centers may offer additional services that are beyond the scope of FQHC core…” Psychiatric Diagnostic or Evaluative Interview Procedures Psychiatric Therapeutic Procedures Office or Other Outpatient Services New Patient Established Patient Core Optional *Substance Abuse Center Services are non-covered

30. Behavioral Health Rehabilitation Medical Behavioral Health Diagnosis/ Treatment* FQHCs Performance Based WHOLEHEALTH

31. Points of Dialogue Dialogue: Mutual goals Role discernment Our role, their role, combined roles Behavioral Health Treatment and Rehabilitation Complementary functions/strengths Medicaid penetration

32. Georgia’s Foundation Lived Experience Perspective Improved Lives Health Engagement Patient Activation

33. Georgia’s Foundation Emerging Outcomes: Health and Recovery Peer (HARP) Program study (Druss, et.al): “…significantly greater improvement in patient activation than those in usual care.” Cobb/Douglas Community Service Board (SAMHSA PBHI grantee) : Significant improvements in cardiometabolic risk factors were seen (hypertension, smoking status (breath CO), and A1C). Individuals with high blood pressure: % in sample group normal range increased from 33% to 41% 8% in sample group (n=21) quit smoking Improvements were also seen in BMI, total and LDL cholesterol (statistically insignificant).

34. Contact Information Wendy White Tiegreen wtiegree@dbhdd.ga.gov wtiegree@dbhdd.ga.gov