March 2019

1. March 2019 Max Casal, Marce Casal and Amy Roukie

2. Mission To create innovative programs and solutions to improve ACCESS to comprehensive care for the underserved. And to reduce overall COSTS of hospitalizations and improve patient outcomes.

3. Well Care offers comprehensive programs and services to aid each person in reaching their highest potential. Many of our clients have become independent, fully-functioning members of the community. Well Care’s goal is to aid the person in having their best experience, and to promote positive outcomes based on participating in the program.

4. Inpatient- CTC Outpatient- Clinic Crisis Stabilization Therapy & Support Groups Medically- Monitored Detoxification Case Management Psychiatric Assessment Medical Clearance Primary Care Services Well Care Services Psychiatric Urgent Facility Injection Clinic Mobile Assessment Therapy & Support Groups Substance Abuse Treatment Supportive Housing Intensive Case Management Transportation Services Medication Management

5. Additional Challenges • Medication and clinical visit compliance is inconsistent • Substance abuse issues prevalent • Lack of substance abuse programs and resources • Lack of affordable housing options • Lack of transportation resources • Poor participation in therapy and support groups (i.e. AA/NA/GA)

6. Behavioral Health Challenges • High homeless population • Hospitalization and readmission rates are high • High recidivism rate with the judicial system • Behavioral Health Services are fragmented • Lack of continuity of care • Lack of access and resources in the community

7. Solutions • Improve transportation to clinical appointments • Assist with SOAR program for SSI or SSDI; Medicaid enrollment • Connect individual with support systems • Substance Abuse resources and access to self-help groups • Chemical Dependency Intensive Outpatient Programs (CD-IOP) • Offer Medicated Assisted Treatment (Vivitrol & Suboxone) programs supporting long-term sobriety

8. CTC Success Metrics • Will reduce overcrowding at the Emergency Rooms and Jail; reduce time with law enforcement. • Improve response times to ER for evaluations, and 24-hour transport with warm-hand-off to CTC or PUF. • Medical clearance services at Primary Care. • Evaluate for medical necessity, utilize PUF as alternative 24-hours per day; plan for malingerers. • Limit cycling through jail, court system and hospitals.

9. Factors Contributing to Crisis: • Homelessness • Psychiatric Instability • Substance Abuse • Unmanaged Chronic Health The Well Care Continuum of Care Inpatient CTC Services: • Medical Evaluation • Detoxification- MAT • Psychiatric Stabilization • Case Management • Continuity of Care (Link to outpatient services) Outpatient Services: • Crisis Stabilization/ PUF • Housing Supports • Medication Mgt • MAT/LAI • Outpatient Treatment • Intensive Case Mgt • Transportation • Primary Care • Follow 30 days/beyond Crisis Inpatient (CTC) Services Outpatient Services

10. EMS Response- (Police /Fire) • Mobile Crisis Team Assessment • Utilize the PUF Crisis Cycle Crisis • Well Care transports to CTC • Transport to the Emergency Room via Ambulance Medically-Assess • CTC stabilizes & links to WellCare Outpatient services • Hospital stabilizes & refers to CTC Stabilization

11. MOBILE CRISIS ASSESSMENT TEAM- Clinicians assess in area hospitals. Reduces overcrowding and unnecessary hospitalizations. Well Care currently diverts approximately 50% of all assessments completed. PSYCHIATRIC URGENT FACILITY (PUF)- Drop-in resource center with supervision. Provides a safe place to be evaluated. In addition, participants are connected to necessary resources to help manage their mental illness. Services

12. INTENSIVE CASE MANAGEMENT- The most important component of care. Case Managers link to community services based on needs of each client. Monitors behaviors to aid in early intervention, prior to future issues. Provides face-to-face contact. Aids in compliance with treatment plan goals. Preferred method of interaction for those with recent episodes of crisis. Services

13. Foundation of services Aids in symptom management Severity of illness and functioning Ensures medications are effective Evaluates for side-effects Provider access monthly PRIMARY CARE Medical status evaluated regularly Chronic health conditions managed/ improved Lab services Pharmacy services Coordinated with Psychiatric care Created a Health Home Services PSYCHIATRIC CARE

14. Clinical evaluations Symptom management Coping skills Aid in navigating past trauma and challenges Individual and family therapy INJECTION CLINIC Long-Acting Injectables (LAI) Medication Assisted Treatment (MAT) Improves compliance and adherence to medications Assists when client is homeless Services THERAPY SERVICES

15. Services SUBSTANCE ABUSE PROGRAM • CD-IOP program • Engage support systems • Outpatient MAT (Medication Assisted Treatment) Suboxone and Vivitrol program • LAI (Long-Acting Injectables) • Self-help groups

16. Services TRANSPORTATION • Often an obstacle to success, this service aids in compliance with clinical and social services appointments. • Transports participants to provider appointments, DMV, Court appearances, Social Services, Social Security and job interviews. • This is a value that is added to those participating in our programs.

17. Services PHARMACY • Vital in managing participants’ mental stability, these services improve compliance. • Reduce unnecessary ER visits • Coordinate with Well Care’s Clinical Team to monitor medications • Delivering to participants in shelters, group homes or other facilities. • Well Care offers an auto-refill program and long-acting psychotropic injectables.

18. Improves outcomes, and reduces the frequency of future crises Support increases medication compliance and improves nutrition All housing is supervised 24/7 Without housing More unnecessary ER visits Increased arrests Not connected to services long-term Services HOUSING SERVICES Well Care = 150 beds • Supportive services, emergency, short-term and transitional living beds. • Housing is often the single most-effective approach to reducing crises in this population. • Shelter, considered a basic need. • Stability increases the likelihood of an ongoing connection to services. • Decreases cost to the community.

19. NAMI on Housing According to NAMI: “For someone with a mental health condition, the basic necessity of a stable home can be hard to come by. The lack of safe and affordable housing is one of the most powerful barriers to recovery. When this basic need isn’t met, people cycle in and out of homelessness, jails, shelters and hospitals. Having a safe, appropriate place to live can provide stability to allow you to achieve your goals. Many people with a serious mental illness live on Supplemental Security Income (SSI), which averages just 18% of the median income and can make finding an affordable home near impossible. Finding stable, safe and affordable housing can help you on your journey to recovery and prevent hospitalizations, homelessness and involvement in the criminal justice system.” https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Securing-Stable-Housing

20. The Well Care Difference • Increased access to services and housing; aids in independence and improved functioning. • Reduces the fragmented system of care for this population. • Utilizes HMIS to aid in tracking services and monitoring the status of use of other resources. • Improved monitoring with Intensive Case Management and following of participants after discharge for 30- days and beyond. • Connections to SOAR (SSI/SDI) and Medicaid enrollment.

21. Well Care Metrics • Reduces ER overcrowding, unnecessary admissions and readmissions to hospitals which will mitigate costs. • Arrests for CPC, (Civil Protective Custody) and other non-violent and nuisance complaints, will be reduced, saving law enforcement time and resources. • Measurable outcomes will provide evidence of improvement in the management of this population. • Return on Investment- will be evident as this population is managed on an improved level and for long periods of time.

22. The Well Care Difference • Creates better HOUSING options: HOUSING IS HEALTHCARE! • Provides job training and resources; access to DMV and transportation. • Innovative programs to improve the continuity of care and ensure improved outcomes. • Provides increased access to provider networks.

23. Person-Centered Services Transportation Psychiatric Urgent Facility Mobile Crisis Assessment Team SOAR Medicaid Eligibility

24. Reno Max Casal, Managing Director 850 Mill St., Reno, NV 89502 Cell: 702-810-0629 max@thewellcaregroup.com Contact Information Las Vegas Marce Casal, CEO 5412 Boulder Hwy, Las Vegas, NV 89122 Cell: 818-468-6355 marce.casal@mywellcarepharmacy.com

25. Contact Information Amy Roukie, Director Community Triage Center 315 Record Street, Reno (775) 571-0282 a.roukie@wellcareservicesreno.com