1. Care Coordination Project: 2007-2011 Overview and Results Grant Mitchell, MD Commissioner Westchester County Department of Community Mental Health 1

2. Westchester’s Care Coordination Program To improve health outcomes and reduce costs, Westchester County implemented a more self-directed, recovery- focused, care coordination program for individuals with historically poor outcomes and high costs. Goals: Goals: –Individuals to have greater control of and responsibility for their own care –Expand the “menu” of services beyond those reimbursed by Medicaid by providing self-directed funds. –Improve health outcomes and reduce costs –Ensure access to needed services –Coordinate services to address fragmentation 2

3. Westchester’s Care Coordination Program Eligibility: Eligibility: –Voluntary –Serious mental illness –High service utilization/costs –History of criminal justice involvement and/or homelessness (not required) 3

4. Westchester’s Care Coordination Program 4 Service-Resistant Clients? OR Client-Resistant Services?

5. Traditional Approaches A Traditional Sequence of Delivering Services PERSONDREAM SUPPORTRESOURCES 5

6. An Alternative to Traditional Approaches PERSONDREAM SUPPORTRESOURCES 6

7. Goals of the Care Coordination Program Culture change to emphasize person-centered planning and recovery. Culture change to emphasize person-centered planning and recovery. Empower individuals through service planning that promotes choice and is shared across the service system. Empower individuals through service planning that promotes choice and is shared across the service system. Coordinate services delivered by multiple providers. Coordinate services delivered by multiple providers. Implement evidence-based and best practices where available. Implement evidence-based and best practices where available. Allocate resources based on individual need. Allocate resources based on individual need. Utilize information systems that provide timely, useful information. Utilize information systems that provide timely, useful information. Determine performance by measuring outcomes. Determine performance by measuring outcomes. 7

8. Care Coordinators Each Care Coordinator partners with 12 enrollees Each Care Coordinator partners with 12 enrollees Individual creates an Individual Service Plan (ISP) that is shared across services (Web-based) and includes use of self- determination funds for non-traditional services and supports (like the Peer Mentor Program.) Individual creates an Individual Service Plan (ISP) that is shared across services (Web-based) and includes use of self- determination funds for non-traditional services and supports (like the Peer Mentor Program.) Arrange admission into desired or needed standard health services Arrange admission into desired or needed standard health services Coordinate mental health, chemical dependence, medical, legal, housing and needed support services Coordinate mental health, chemical dependence, medical, legal, housing and needed support services Collect and report outcomes data Collect and report outcomes data 8

9. Self-Directed Funds $1500 per individual/year Individual control over how dollars are spent related to goals as established in the ISP Expand the array of services/supports beyond those covered by Medicaid 9

10. Self-Directed Funds Examples: –Housing: Furnishings, household items, maintenance, temporary housing –Education: Courses, computers, –Medical care: Dental, medication –Employment: Resume, clothing for interviews –Other: gym membership, exercise equipment, yoga, music, books, personal care 10

11. Peer Mentoring Program Option to select a recovery mentor Mentors participate in engagement & ISP development Serve as role models, partners with enrollee and the care coordinator Crisis prevention and intervention Not case managers

12. Employment/Training 48 slots/3 years 48 slots/3 years 1 week intensive program 1 week intensive program Assistance in locating employment Assistance in locating employment

13. Care Coordination Program Costs Staffing Medicaid Funded County Share= $ 69,000 Self Determination $ 70,000 Peer Mentoring $ 25,000 Employment $ 12,000 Total $ 176,000 for 48 enrollees Per Year for 48 Enrollees 13

14. Program Outcomes Medicaid Costs Medicaid Costs Days in State Hospital Days in State Hospital Days Incarcerated Days Incarcerated Visits to ER Visits to ER Homelessness Homelessness Quality of Life Indicators Quality of Life Indicators Satisfaction with Program (staff/enrollee) Satisfaction with Program (staff/enrollee) Person-centeredness Person-centeredness 14

15. Baseline Data Days Incarcerated Costs of Incarceration Days in State Hospital Costs of State Hospital Medicaid Costs Total Costs Per Enrollee 88$27,780153$81,187$63,726$167,692 Average Costs Per Enrollee for the One Year Period Prior to Entering the Program (N=44) 15

16. Results: Pre & Post-Enrollment Cost Data (N= 31) Results: Pre & Post-Enrollment Cost Data (N= 31) 16

17. Cost Outcomes (N= 31) Medicaid (other than state hospital) IncarcerationState HospitalTotal 2007- 2008 Pre-Enroll $ 822,119$ 870,260$ 592,150$ 2,284,529 2008-2009 1 year after $ 535,634$ 410,860$ 129,850$ 1,076,344 Savings $$ 286,485$ 459,400$ 462,300$ 1,208,185 Savings %35%53%78%53% 17

18. Average Days Homeless 18

19. Chemical Dependency 19

20. Other Outcomes Enrollees report feeling more in control of life. “Authority” Enrollees report feeling more in control of life. “Authority” Care Coordinators report job satisfaction levels are up vs. working in traditional ICM role (“This is why I went into the field.” “In many ways, my job is now significantly easier).” Care Coordinators report job satisfaction levels are up vs. working in traditional ICM role (“This is why I went into the field.” “In many ways, my job is now significantly easier).” Trumpet; birthdays Trumpet; birthdays

21. Partnering to Achieve Goals NY Care Coordination Program (NYCCP) 21

22. NY Care Coordination Program (NYCCP) –Care Coordination –Person-centered planning –Managed care as a vehicle to achieve flexibility –System transformation –Existing working relationships with Beacon Health Strategies –Pay for Performance 22

23. Next Steps—Westchester’s Care Coordination Program Western New York—Care Coordination Program Western New York—Care Coordination Program –7 County Consortium –Years of Experience –Better Outcomes and Reduced Costs System reform System reform –Align funding and structures to improve outcomes and reduce health care costs –Expand the “menu” of services—flexible spending –Prepare for Health Care Reform- Regional BHO’s and Health Homes 23