1. Overview of KP Behavioral Health Delivery System Dr. Stuart Buttlaire Regional Director of Inpatient Psychiatry and Continuing Care Regional Chair, Integrated Urgent Services

2. 2 KP is an Integrated Healthcare System HEALTH PLAN MEMBERS HOSPITAL SERVICESMEDICAL SERVICES KAISER FOUNDATION HEALTH PLAN KAISER FOUNDATION HOSPITALS THE PERMANENTE MEDICAL GROUP

3. A BETTER WAY to take care of business Northwest (OR, WA) 515,000 Northern CA 3,735,000 Southern CA 3,950,000 Colorado 620,000 Georgia 275,000 Mid-Atlantic (MD, VA, DC) 565,000 Hawaii 240,000 Our Service Areas (with Regional Membership) EAP Collaboration with Kaiser Permanente 3

4. A BETTER WAY to take care of business EAP Collaboration with Kaiser Permanente 4

5. 5 KPNCR is NCQA Disease Management Certified Attention Deficit Hyperactivity Disorder (Pediatric) Asthma (Adult) Cardiovascular Disease Diabetes Depression

6. Office of the Patient Advocate State of California’s Office of the Patient Advocate (the “OPA”) recognized Kaiser Permanente in Northern California as the only HMO or PPO program in the state to receive the highest rating of four stars for Behavioral and Mental Health Care

7. Inpatient Treatment Adult Adolescent Child Eating Disorder ECT KPPACC - SNF Behavioral Health Center Integrated Urgent Services Intensive Outpatient Service (IOP) Regional Call Center & placement center Intensive case management Inpatient Case Management Partial Hospitalization 23 Hours Observation – Crisis Stabilization Residential Services – Adults/Adolescents/Seniors/Dual DX Crisis Services Outpatient ECT Outpatient rTMS McFarlane MFGs programs Continuum of Care in Mental Health Continuum of Care in Chemical Dependency Services CD Outpatient Includes early and continuing recovery services – mostly evening programs CDRP Sub-Regional Services Day treatment Intensive outpatient treatment Residential Recovery Service Outpatient Dx Assessment Med Management Therapy Case Management C&L and On-Call Behavioral Health Ed Autism Assessment Centers Education-Classes The Continuum of Care in Mental Health and Chemical Dependency Inpatient CD Treatment Contracted Detox and Treatment KP Inpatient Detox The Continuum of Care in MH & CD Embedded MH Prof in Primary Care and other settings

8. MCP services to be carved-in effective 1/1/14 Individual/group mental health evaluation and treatment (psychotherapy) condition Psychological testing when clinically indicated to evaluate a mental health condition Psychiatric consultation for medication management Outpatient laboratory, supplies and supplements Screening and Brief Intervention (SBI) Drugs, excluding anti-psychotic drugs (which are covered by Medi-Cal FFS) MCP services to be carved-in effective 1/1/14 Individual/group mental health evaluation and treatment (psychotherapy) condition Psychological testing when clinically indicated to evaluate a mental health condition Psychiatric consultation for medication management Outpatient laboratory, supplies and supplements Screening and Brief Intervention (SBI) Drugs, excluding anti-psychotic drugs (which are covered by Medi-Cal FFS) Medi-Cal Managed Care Plans (MCP) County Mental Health Plan (MHP) (MHP) Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Outpatient Services Mental Health Services (assessments plan development, therapy, rehabilitation and collateral) Medication Support Day Treatment Services and Day Rehabilitation Crises Intervention and Crises Stabilization Targeted Case Management Therapeutic Behavior Services Residential Services Adult Residential Treatment Services Crises Residential Treatment Services Inpatient Services Acute Psychiatric Inpatient Hospital Services Psychiatric Inpatient Hospital Professional Services Psychiatric Health Facility services Target Population: Medi-Cal beneficiaries enrolled in Managed Care Plans Target Population: Children and adults who meet medical necessity or EPSDT criteria for Medi-Cal Specialty Mental health Services Medi-Cal MHSUD Delivery System County Alcohol and Other Drug Programs (AOD) Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services Inpatient Detoxification Services (Administrative linkage to County AOD still being discussed) Outpatient Services Outpatient Drug Free Intensive Outpatient (newly expanded to additional populations) Residential Services (newly expanded to additional populations) Narcotic Treatment Program Naltrexone New Services Inpatient Detoxification Services (Administrative linkage to County AOD still being discussed) Target Population: Children and adults who meet medical necessity or EPSDT criteria for Drug Medi-Cal Substance Use Disorder Services

10. 10 General Hospitals w/Psych # Psych Beds Acute Psych Hospitals & PHFs # Psych BedsTotal Hospitals Total Beds Nation122937,92122425,944145363,865 49 States114134,38917523,109131657,498 California8835324928351376367 Psychiatric Inpatient Care Units and Freestanding Psychiatric Hospitals 2011 Comparative Data – Nation and California 2011 Population Comparison Nation311,591,9171 psych bed for every 4879 people 49 States 273,551,1151 psych bed for every 4758 people California 38,040,8021 psych bed for every 5975 people Experts estimate a need for a minimum of 1 public psychiatric bed for every 2000 people for hospitalization for individuals with serious psychiatric disorders.

11. Building for the Future Building out own med/psych inpatient hospital Feedback Informed Care into our outpatient care pathways integration and a shared electronic medical record to focus on proactive intervention and prevention We also have behavioral health professionals embedded in adult and family medicine, pediatrics, chronic pain, occupational medicine and oncology. our own large training program where we train over 100 mental health professionals every year. Establishing a medical school Our Community Benefit program has helped develop trauma-focused treatment programs in schools

12. Building for the Future We have established a partnership with the Steinberg Institute to work with stakeholders to develop consensus on public policy issues related to behavioral health care services. we want to bring excellent behavioral health care to all who need it, including those who will not go to a mental health specialist because of stigma We want Kaiser Permanente to be the best place to work for mental health professionals