1. Connecticut Behavioral Health Homes IMPROVING THE EXPERIENCE IN CARE… IMPROVING HEALTH OUTCOMES… REDUCING HEALTH CARE COSTS

2. A survey of mortality data of eight states concluded that, on average, Americans with major mental illness die 14 to 32 years earlier than the general population. Source: Thomas InselThomas Insel on September 6, 2011 http://www.nimh.nih.gov/about/director/2011/no- health-without-mental-health.shtml

3. The gap between life expectancy in patients with a mental illness and the general population has widened since 1985. http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens- between-those-mental-illness-and-general-population

4. Comparative Mortality Risks Behaviors and/or Disorders Recurrent Depression Bipolar Disorder Schizophrenia Drug and Alcohol Abuse Heavy Smoking Reduction in Life Expectancy 7-11 years 9-20 years 10-20 years 9-24 years 8-10 years Source: Mental illness threat to life expectancy similar to heavy smoking 28 May 2014 - 8am PSThttp://www.medicalnewstoday.com/articles/277388.php

5. Connecticut Life Expectancy: Source: http://www.worldlifeexpectancy.com/usa/connecticut-life-expectancy GenderLife ExpectancyAvg. Life Expectancy – for those with MI Male77.6945.69 - 63.69 Female82.4450.44 - 68.44 Total80.1848.18 - 66.14

6. DMHAS Persons Served: Ages

7. Most of the risk associated with reduced life expectancy can be attributed to physical illness such as cardiovascular and respiratory diseases and cancer (80% of deaths). http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens- between-those-mental-illness-and-general-popula

8. Researchers suggest that efforts to reduce the gap in life expectancy should focus on improving physical health. http://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens- between-those-mental-illness-and-general-population

9. Behavioral Health Home (BHH): an innovative, integrated healthcare service delivery model for people diagnosed with SPMI emphasizes care coordination services Is recovery-oriented, person and family centered A model which promises better patient experience and better outcomes than those achieved in traditional services. 9

10. Origin In 2010, the Patient Protection and Affordable Care Act (ACA) established a “health home” option under Medicaid that serves enrollees with chronic conditions. 10

11. 11 Connecticut BHH Eligibility SPMI:  Schizophrenia and Psychotic Disorders;  Mood Disorders;  Anxiety Disorders;  Obsessive Compulsive Disorder;  Post-Traumatic Stress Disorder; and  Borderline Personality Disorder Medicaid Eligibility Medicaid claims > $10k/year 11

12. 12 Connecticut’s BHH Service Population Medicaid population with SPMI (2013): 58,055 BHH eligible and enrolled at an LMHA: 6549 Eligible and over 60 years of age: 903.76 (13.8%) BHH eligible and to receive outreach and engagement: 19,000 Over 60 years of age: 3230 (17%) 12

13. Improved experience in care Improved health outcomes Reduction in health care costs 13 The Goals of Health Homes align with the aim of the Affordable Care Act (ACA)

14. 14 GOAL 1: Improve Quality By Reducing Unnecessary Hospital Admissions And Readmissions Decrease the readmission rate within 30 days of an acute hospital stay Decrease the rate of ambulatory care-sensitive admissions Reduce ambulatory care-sensitive emergency room visits

15. 15 GOAL 2: REDUCE SUBSTANCE USE Increase the number of tobacco users who received cessation intervention Increase the percentage of adolescents and adults with a new episode of alcohol or other drug dependence (AOD) who initiated AOD treatment or engaged in AOD treatment

16. 16 GOAL 3: IMPROVE TRANSITIONS OF CARE Increase the percentage of those discharged from an inpatient facility for whom a transition record was transmitted for follow-up care within 24 hours of discharge Increase the percentage of individuals who have a follow up visit within 7 days of discharge from an acute hospitalization for mental health 16

17. 17 GOAL 4: IMPROVE THE PERCENT OF INDIVIDUALS WITH MENTAL ILLNESS WHO RECEIVE PREVENTIVE CARE Improve BMI education and health promotion for enrolled individuals Early intervention for individuals diagnosed with depression 17

18. 18 GOAL 5: IMPROVE CHRONIC CARE DELIVERY FOR INDIVIDUALS WITH SPMI Increase the percentage of individuals with a diagnosis of hypertension (HTN) whose blood pressure (BP) is adequately controlled Increase the percentage of individuals with asthma and who were dispensed a prescription for medication Increase the percentage of adults with diabetes, whose Hemoglobin HbA1c is within a normal range Increase the percentage of adults with coronary artery disease (CAD) whose LDL is within a normal range 18

19. 19 GOAL 6: INCREASE PERSON-CENTEREDNESS AND SATISFACTION WITH CARE DELIVERY Increase general satisfaction with care including: access to care; quality and appropriateness of care; participation in treatment; and cultural competence. 19

20. 20 GOAL 7: INCREASE CONNECTION TO RECOVERY SUPPORT SERVICES Decrease the number of individuals who experienced homelessness and increase housing stability Increase the number of individuals who become involved in employment and/or educational activities 20

21. 21 CT BHH Designated Providers DMHAS Local Mental Health Authorities (LMHAs) and contracted LMHA affiliate providers (Affiliates) will serve as designated providers of behavioral health home services.

22. It has been argued that for those individuals who have relationships with behavioral health organizations, care may be best delivered by bringing primary care, prevention, and wellness activities onsite into behavioral health settings. Source: SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS, MAY 2012 22

23. Mental Health Practitioners have an Opportunity to Impact Life Expectancy preventing suicides, discouraging risky behavior, encouraging a healthy lifestyle, and general primary medical care. Reviewed by John M. Grohol, Psy.D. on July 13, 2010 http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental- illness/15502.html

24. CT Behavioral Health Home Core Services Comprehensive care management Care coordination Health promotion Comprehensive transitional care Patient and family support Referral to community support services

25. Comprehensive Care Management Assessment of service needs Development of a treatment and recovery plan development in conjunction with the individual Assignment of health home team roles Monitoring of progress

26. Care Coordination Implementation of the treatment and recovery plan in collaboration with the individual to include linkages Ensuring appropriate referrals, coordination and follow-up to needed services and supports Ensuring access to medical, behavioral health, pharmacological and recover support services

27. Health Promotion Health education specific to an individual’s chronic condition(s) Assistance with self-management plans Education regarding the importance of preventative medicine and screenings Support for improving natural supports/social networks Interventions which promote wellness and a healthy lifestyle

28. Comprehensive Transitional Care Specialized care coordination focusing on the movement of individuals between or within different levels of care Care coordination services designed to: Streamline plans of care Reduce hospital admissions Interrupt patterns of frequent hospital Emergency Department use

29. Patient and Family Support Services aimed at helping individuals to Reduce barriers to achieving goals Increase health literacy and knowledge about chronic conditions Increase self-management skills Linking individuals to resources which support their highest level of wellness and functioning within their families and communities

30. Referral to Community Support Services Ensuring access to a myriad of formal and informal resources which address social, environmental and community factors Assistance in overcoming access or service barriers; increasing self-management skills; improving overall health

31. BHH Next Steps PNP LMHAs to begin providing BHH Core Services to +/- 3500 persons fall 2014 State-Operated LMHAs to begin providing BHH Core Services to +/- 3000 persons winter 2014 Implementation of an IT system to collect and report BHH Core Services and Outcome Measures early 2015 Submission of a final State Plan Amendment allowing CT to be eligible to receive enhanced rate of Medicaid reimbursement for BHH services

32. Questions? Cheryl.Stockford@ct.gov 860 418-6749 www.ct.gov/dmhas/BHH Cheryl.Stockford@ct.gov www.ct.gov/dmhas/BHH 32