NatCon 2018 Presentation: Pay for Success

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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.

Alternative Payment Models:
Pay for Success

Initial Results

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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 the 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 hospitals, psychiatric emergency services, state hospitals, 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 beginning in December 2014 through the January 2017 official launch 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 data analytics, 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 are 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 assistance in developing recovery tools as they work toward their wellness and recovery goals. Data from health measures and a daily "Wellness Snapshot" are entered and used to produce a Huddle Report that prioritizes the team's treatment and intervention planning in their morning huddle. A monthly report tracks partners' 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 Conservator or Public Guardian Policies can all make a big difference in the outcomes of Pay for Success programs like Partners in Wellness. 

More Information

 

Telecare Partners in Wellness Open House

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Click here to watch the open house celebration for Telecare's Partners in Wellness program.

The Telecare Partners in Wellness program, along with the County of Santa Clara and Third Sector Capital Partners, Inc., hosted an open house for community stakeholders and members on February 8 at their new facility in San Jose, CA.

"Telecare opens many new programs, but this has been a unique experience in terms of the level of effort invested by so many parties to launch this innovative model,” said Anne Bakar, President and CEO of Telecare. "We are thrilled to have been chosen by Santa Clara for this important work. It is in perfect alignment with the value we place on public/private partnerships as the industry shifts toward performance-based funding.”

Opened on September 14, 2016, Telecare Partners in Wellness is the nation's first mental health focused Pay for Success (PFS) project. The program aims to provide community-based mental health services to individuals in Santa Clara County who have a severe mental illness, with the goal of measurably improving wellbeing and quality of life while reducing more costly service usage, including the psychiatric emergency room and inpatient psychiatric settings.

PFS is a performance-oriented contracting model that drives government resources toward social programs that best provide results to the people who need them most. Through this model, Santa Clara County has contracted Keith Humphreys of Stanford University, who is conducting a rigorous 6-year evaluation of the program.

“With this project and our prior Pay for Success project, the County is better defining our objectives in serving vulnerable populations, and is creating incentives that ensure service providers achieve those objectives,” said Chief Assistant County Counsel Greta Hansen. “Through the evaluations of each program, we will have a much better understanding of how to further increase the impact of these and other programs going forward.”

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Speakers for the event included Anne Bakar, President and CEO of Telecare; Greta Hansen, Chief Assistant County Counsel for Santa Clara County; Kavita Narayan, Deputy County Counsel for Santa Clara County; Toni Tullys, Director of Behavioral Health Services for Santa Clara County; Miguel Marquez, Chief Operating Officer for Santa Clara County; and Caroline Whistler, President and Co-Founder of Third Sector Capital Partners, Inc.

We welcome the chance to participate in this innovative partnership with Santa Clara County and Third Sector, and are honored to have the opportunity to provide services in a new area.