Strategies to Improve Treatment Engagement and Monitor Success: Effectiveness of Brief Care Management Intervention for

1. Strategies For Health Care Organizations to Improve Treatment Engagement, Monitor Success, and Maximize Resources: Effectiveness of a Brief Care Management Intervention for Reducing Psychiatric Hospital Readmissions Carole Taylor, MSN, RN, Chief Clinical Officer Jenny Flanagan, MA, LPC, Clinical Coordinator Shari Hutchison, MS, Manager of Outcomes

2. About Community Care • Behavioral health managed care company founded in 1996; part of UPMC and headquartered in Pittsburgh • Federally tax exempt non-profit 501(c)(3) • Major focus is publicly-funded behavioral health care services; currently doing business in PA and NY • Licensed as a Risk-Assuming PPO in PA; NCQA- Accredited Quality and Disease Management Programs • Serving over 750,000 individuals receiving Medical Assistance in 39 counties through a statewide network of over 1,800 providers

3. HealthChoices Regions Served Erie Warren Susquehanna McKean Potter Tioga Bradford Crawford Wayne Forest Wyoming Cameron Sullivan Lackawanna Pike Venango Elk Lycoming Pike Mercer Clinton Jefferson Luzerne Clarion Columbia Monroe Lawrence Montour Clearfield Centre Union Butler Carbon Armstrong Northumberland Snyder Northampton Beaver Mifflin Schuylkill Lehigh Indiana Juniata Allegheny Blair Berks Perry Dauphin Bucks Cambria Lebanon Huntingdon Westmoreland Montgomery Washington Cumberland Lancaster Bedford Fayette Chester Somerset Franklin York Philadelphia Greene Fulton Adams Delaware Southwest Region Southeast Region North Central Region: County North Central Region: County North Central Region: County Lehigh-Capital Region Northeast Region North Central Region: County North Central Region: State Community Care Office

4. Project Background • In psychiatric settings, it has been recently estimated that 18-67% of patients with serious mental illness (SMI) do not receive treatment immediately following psychiatric hospitalization • Continued engagement in care following psychiatric hospital discharge may prevent adverse outcomes, including re-hospitalization • Consequently, there is a pressing need to test strategies that may reduce adverse outcomes by preventing treatment dropout during this transitional period

5. Rationale • Individuals with multiple admissions to psychiatric inpatient service within a year and/or longer lengths of stay during inpatient are at high risk for psychiatric readmission within 30 days • Interventions and services targeting high-risk individuals are successful in decreasing readmission rate • In 2011-2012, two interventions aimed at decreasing hospital readmission in high-risk populations were initiated • High-Risk Care Management Focus on Multiple Readmissions • Critical Time Intervention in Acute Service Coordination

6. High Risk Care Management • Consists of eight care managers (CMs) who have LSW, LCSW, LPC, or RN licenses • CMs complete telephonic continued stay and discharge reviews for acute levels of care and specialized services • CMs attend multiple community meetings (disposition, treatment team & interagency) to assist with discharge planning • CMs receive referral requests for higher level community support services to screen for appropriateness (CTT, Mobile Meds & ECSC)

7. Target Population • Adult members with a 30-day inpatient mental health readmission to the two highest volume facilities in Allegheny County • Alternating weeks for each facility to differentiate between those members who received a high risk care manager intervention and those who did not • Pilot project with two high-volume facilities occurred from April 2011 – May 2012

8. Focus of Interviews • Barriers related to aftercare linkage and follow up • Awareness of and utilization of crisis plans • Identification of resources, services, and supports needed to assist the member with remaining in the community • Members frequently reported lack of housing, primary supports, and drug and alcohol use as major contributing factors

9. Care Management Interventions • Follow up occurred with the inpatient treatment team to ensure: • Linkage to aftercare providers • Linkage to higher level of community supports such as: • Acute Service Coordination • Mobile Medications • Community Treatment Team • Diversion and Acute Stabilization Units • Drug and Alcohol Rehabilitation Programs

10. Outcomes of Interviews • During the identified timeframe, 80 adult members received an interview and 80 did not • Demographics of individuals receiving the interview : • 41% female • 59% white • 41% black/African American • Age ranged from 18-64 years • Average age of 36 years

11. Outcomes of Interviews • The 30-day readmission rate for individuals receiving the interview was 39% lower than the readmission rate for individuals in the non-intervention comparison group • 23.8% versus 38.8%, respectively • Controlling for member characteristics and prior behavioral health service utilization, individuals in the non-intervention group were significantly more likely to be readmitted than those in the intervention group • aOR 2.38, 95% CI 1.03-5.48, p=.04

12. Critical Time Intervention in ASC • Acute Service Coordination (ASC) • Higher intensity service coordination; contact before inpatient discharge • Imbed Critical Time Intervention (CTI) to address transition in care • CMs receive referral requests for higher level community support services to screen for appropriateness (CTT, Mobile Meds & ECSC)

13. Target Population • Adult members with a 30-day inpatient mental health readmission and referred to ASC • Evaluation of outcomes for intervention and historical comparison cohorts • CTI training and implementation 2011; historical comparison cohort of ASC 2010

14. Results: ASC with CTI • During the identified timeframe, 160 adult members received ASC with CTI and 226 received ASC alone • Demographics of individuals receiving the interview : • 51% female • 56% white • 42% black/African American • Average age of 39 years

15. Impact of ASC with CTI on readmission • The 30-day readmission rate for individuals receiving ASC with CTI was significantly lower than the readmission rate for individuals in the comparison cohort • 26.3% versus 46.9%, respectively • Controlling for member characteristics and prior behavioral health service utilization, individuals in the non-intervention group were significantly more likely to be readmitted than those in the intervention group • aOR 2.92, 95% CI 1.77-4.80, p<.001

16. Contact Carole Taylor taylorc@ccbh.com Jenny Flanagan flanaganj@ccbh.com Shari Hutchison hutchisons@ccbh.com