NatCon 2018 Presentation: Pay for Success and Social Impact Bonds

In 2017, Telecare opened the nation's first mental health Pay for Success (PFS) program in Santa Clara County, California, called Partners in Wellness.

At NatCon2018, Telecare hosted a lunch and learn presentation sharing initial results from our PFS program, an overview of the PFS model, a clinical overview of the program, and learnings for other systems interested in possible implementation. We are pleased to share the presentation and findings below.

Presentation: Alternative Payment Models: Pay for Success and Social Impact Bonds

Initial Results


In the first year of operation, Partners in Wellness saved more than $508,482 above the target savings. The program reduced usage well over the target rate for all services, including 81% over the target of psychiatric emergency services visits and 100% over target for state hospital days. Significant clinical results were also shown: after a year, people with higher depression, psychosis, and drug and alcohol use scores showed significant improvement over time. Anxiety levels (measured through screenings) also improved, as well as physical health measurements such as HDL-C scores. 

PFS Model Overview:

Telecare's Partners in Wellness program is an innovative six-year, performance-based contract to deliver publicly-funded services. Telecare is at risk to deliver the savings targets outlined in the contract by reducing clients' use of psychiatric hospital, psychiatric emergency services, state hospital, and other mental health services while also ensuring each client’s whole-person wellness. The performance targets are set to fully pay for the program (in savings) and return additional savings at the end of the six years. Dr. Keith Humphreys of Stanford University objectively evaluates the program results. From the RFP process in December 2014 through the February 2017 opening of the program, more than two years of work went into the development of this program. 

What's Different About Pay for Success?

Pay for Success programs, including Partners in Wellness, include several areas of additional measures and tools, and a higher degree of community engagement than other programs typically provide. (Click on the chart to the right to see an outline of some of these differences.)

PFS Clinical Model Overview

The clinical care model for Partners in Wellness uses several tools to engage with consumers, also known as partners, on multiple fronts. Physical and mental health is measured through screenings and assessments, and a "whole health" care plan is created in partnership with the persons served. From there, the multidisciplinary team, including several peer specialists, works with the partner to ensure they have adequate housing, medications, physical health supports, care coordination, and assists in developing recovery tools as they work toward their wellness and recovery goals. Health measures are recorded in a monthly report to track progress over time. Treatments are adjusted as needs change. 

Lessons Learned

One of the most important lessons we have learned in our first year of operations is how crucial it is to have a firm understanding of the community in which we are working, as well as strong relationships within that community. Factors such as other community resources, housing costs, and employment pools can all make a big difference in the success of Pay for Success programs like Partners in Wellness. 

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