Addressing the Behavioral Health Needs of Cook County Residents Douglas Elwell, Deputy CEO for Finance and Strategy Cook County Health and Hospitals System June 22, 2017

Learning Objectives Learn about the strategies the Cook County Health and Hospitals System (CCHHS) has undertaken to integrate behavioral health, including mental health and substance use services, into primary care settings Share progress of initiatives to connect justice-involved individuals with behavioral health services, in an effort to reduce recidivism and improve health outcomes Share best practices and challenges

Presentation Outline Overview of Cook County Health and Hospitals System Behavioral Health Needs CCHHS Initiatives Lessons Learned Questions?

Overview of Cook County Health and Hospitals System

Cchhs mission To deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; To foster partnerships with other health providers and communities to enhance the health of the public; And to advocate for policies which promote and protect the physical, mental, and social well-being of the people of Cook County.

CCHHS Facilities CCHHS is comprised of four major component parts: Provider - we have a broad geographic network of that includes two acute-care hospitals, a robust network of community-based clinics providing a robust array of services including behavioral health. Correctional Health – we provide health services for detainees of both the Cook County Jail and the Cook County Juvenile Temporary Detention Center,. Public Health – we provide public health services in suburban Cook Couny. Plan – we own and operate CountyCare, our Medicaid managed care health plan.

Annual utilization at CCHHS 300,000+ unique patients 914,000 outpatient clinic registrations 5 million lab tests performed and analyzed 1.9 million outpatient prescriptions filled annually 55,000 intake screenings at Cook County Jail 46,000 visits to the Ruth Rothstein CORE Center, one of the largest HIV treatment providers in the nation

Behavioral Health Needs of Illinois and Cook County Residents

State and local data 43% of women and 34% of men in Illinois reported poor mental health status1. About 5.4% of the population of Illinois had a serious mental illness in 2012, and 16.7% of adults in Chicago had been diagnosed with a depressive disorder in 20142. Only 55.1% of children (ages 2-17) with emotional, developmental, or behavioral problems received mental health care in Illinois3. Sources:  1. Behavioral Risk Factor Surveillance System ,2012-2014; 2. Illinois Mental Health Services, Five Year Strategic Plan, 2013; Healthy Chicago 2.0, October 2015; 3. Child and Adolescent Health Measurement Initiative. 2011 National Survey of Children's Health

Cook county data Roughly 23% of detainees in the Cook County jail present with mental illness1. In 2015 there were 603 deaths related to opiates in Cook County, and 413 related to heroin2. Sources: 1. Data from May 2015 – April 2016 presented at special Meeting of the CCHHS Board of Directors on May 23, 2016; 2. Cook County Medical Examiner’s Office

Cook County Health and Hospitals System 14% of emergency room visits and 16% of inpatient visits at Stroger Hospital are attributed to the growing problems of addiction Source: Illinois Hospital Association

CCHHS Initiatives to Respond to Behavioral Health Needs

CCHHS Strategic plan focus areas Deliver High Quality Care Grow to Serve and Compete Foster Fiscal Stewardship Invest in Resources Leverage Valuable Assets Impact Social Determinants of Health

CCHHS Behavioral Health Strategies Improving & Streamlining Access Addressing the Opioid Crisis Innovations & Partnerships

Timeline of Cchhs behavioral health initiatives Behavioral Health Consortium Convened in April 2016 Justice and Mental Health Collaborative convened in July 2016 Assisted Outpatient Treatment (AOT) Oct 2016 Vivitrol at Cermak Health Services May 2017 West Side Community Triage Center TBD Housing solutions for justice-involved TBD Behavioral Health Integration at PCMHs January 2016 Expanded services for medication assisted treatment (MAT) April 2016 Roseland Community Triage Center Fall 2016 Opioid Taskforce March 2017 Pilot BH Screening & Case Management at Bond Court June 2017

Improving & Streamlining access Integration of behavioral health services into Patient Centered Medical Homes Creation and support of behavioral health consortium

Addressing the opioid crisis Expanded Medication Assisted Treatment (MAT) Buprenorphine waiver trainings for MDs/NPs/PAs Naloxone training and distribution for ED, pharmacists, correctional health staff Vivitrol pilot at the Cook County Jail Opioid Taskforce

Innovations & Partnerships Community Triage Center Justice and Mental Health Collaborative Assisted Outpatient Treatment Care Coordination Screening and Services at Cook County Bond Court

Lessons Learned

Challenges and opportunities Historically Fragmented Funding Sources and Disinvestments in Community-based Behavioral Health Our Lack of Knowledge of Other Providers State Budget Impasse Federal Budget & Policies Opportunities Housing Illinois 1115 Waiver Application Broad Support to Address the Opioid Crisis County Support and Commitment to Implementation of CCHHS Strategic Plan Initiatives

Questions?