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Salt Lake County Intercepts: An Integrated Behavioral Health – Criminal Justice Response System. RCPA 2014 Conference October 2014 Patrick Fleming Ken Anderson Director SLCO Behavioral Health VP Business Development – Optum.

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Salt lake county intercepts an integrated behavioral health criminal justice response system

Salt Lake County Intercepts:An Integrated Behavioral Health – Criminal Justice Response System

RCPA 2014 Conference

October 2014

Patrick Fleming Ken Anderson

Director SLCO Behavioral Health VP Business Development – Optum


Salt lake county intercepts
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
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
Behavioral and specialty medical solutions for Medicaid

We build systems of care

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

OptumInternational

  • EAP

  • Wellness

  • Wellbeing

  • Technology Solutions

  • Network Management

  • We manage financial risk

  • We manage provider networks

  • We manage clinical care

  • We ensure quality measures are achieved


P ublic s ector b usiness platform
Public Sector Business Platform

The 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.

  • 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

  • Fundamentally Committed to:

  • Improving Outcomes

  • Supporting Recovery

  • Managing Costs

  • Achieving Whole-Person Wellness


Our footprint county state contracts
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
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


Long standing commitment in slco
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
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
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
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


Salt Lake County Intercepts

Best Clinical Practices: The Ultimate Intercept

I. Law Enforcement/Emergency Services

# of individuals

Accessing Services

Recidivism

CIT, CITIU, Mobile Crisis Teams, Receiving Center,

Wellness Resource Recovery Center, Crisis Line & a Warm Line

II. Jail

Jail MH Svcs, Mental Health Release, CATS, CRT

Based on the Munetz and Griffin Sequential Intercept Model

III. Courts

Mental Health Courts

Legal Defender Social Services Position

Case Resolution Coordinator

IV. Re-Entry

AP&P = Adult Probation and Parole

ATI = Alternatives to Incarceration

CATS = Correction Addiction Treatment Svcs

CIT = Crisis Intervention Team

CITIU = CIT Investigative Unit

CJS = Criminal Justice Services

CORE=Co-occurring Reentry & Empowerment

CRT = Community Response Team

DORA = Drug Offender Reform Act

JDOT = Jail Diversion Outreach Team

MHC = Mental Health Court

MHM = Mental Health Management

MHR = Mental Health Release

NAMI = National Alliance on Mental Illness

RIO = Right Person In/Out

SUD = Substance Use Disorder

USARA = Utah Support Advocates for

Recovery Awareness

RIO Housing, Top Ten, JDOT

CRT, CORE, ATI Transport, DORA &

SUD Programs

  • Community

CJS, AP&P

NAMI,

USARA, Rep Payee


Outcomes and results
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



Medical Cost AvoidanceData from Crisis Program diversions show substantial savings to overall health system - $2.88 million for first quarter


Evidence of Success

Study Design:

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


Evidence of Success

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).

CRT

(Remaining Attached After 90 Days)


Evidence of Success

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

Overall,

ATI Transport (Attached)

  • 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)

CRT

(Remaining Attached After 90 Days)


What remains to be addressed
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
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 information
Contact Information

Salt Lake County

Optum

Ken Anderson

Vice President – Optum Public Sector Business Dev.

360-239-1394

Kenneth.anderson@optum.com

Rick Elorreaga

Executive Director-Public Sector Solutions Optum Salt Lake County

801-963-6088

Richard.Elorreaga@optum.com

www.optumhealthslco.com

Patrick Fleming

Director, SLCO Behavioral Health

385-468-4707

pfleming@slco.org

http://behavioralhealthservices.slco.org

Tim Whalen

Director, SLCO Behavioral Health

twhalen@slco.org

http://behavioralhealthservices.slco.org

SLCO PSA Video

http://www.youtube.com/embed/qeW2YBzzSRA


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