Peer Program Evaluation Preliminary Results July 2013 Rebecca Cate, PhD Research Scientist Behavioral Health Sciences Department 1

Definitions Enrollment: Which members are we able to reach to tell about the program? Which members agree to participate? How many attempts and how long does it take to get a member to agree to participate in the program? Engagement (among those who agree to participate) What is the level of involvement in the program by the member/peer? # of contacts Average length of contacts Average # of months in the program

Enrollment in New York Peer Program (NYAPRS) 3

Engagement in New York Peer Program (NYAPRS) All Engaged Members (N = 109 )* Average # of Months Member was Engaged (from enrollment date to date case closed) 7.3 Average # of Successful Contacts with Peer During Engagement 14.9 Average # of hours spent with Peer** 14.4 Average # of 15-minute units with Peer 57.5 Type of Contact:   Average # Phone Contacts 10.8 Average # Phone Hours 6.7 Average # of Face-to-Face Contacts 2.7 Average # Face-to-Face Hours* 7.2 *Engagement defined as having at least one peer contact after their enrollment date **Note that for face-to-face contact, travel time is also included so actual hours with member may be less 4

Demographics of Participants in New York Peer Program (NYAPRS)   Enrolled (N = 54) Profile Age Mean Age 34.9 Proportion Aged 18-26 32.8% Age Breakdown: 18-20 3.7% 20's 40.7% 30's 16.7% 40's 24.1% 50's 14.8% 60+ 0.0% Diagnosis Adjustment Disorders 5.6% Anxiety Disorders Disorders Usually Diagnosed in Infancy, Childhood or Adolescence 1.9% Eating Disorders Impulse Control Disorders Mood Disorders 51.9% Bipolar 50.0% Depression Personality Disorders Schizophrenia and other Psychotic Disorders Substance Related Disorders 20.4% Alcohol-Related 36.4% Substance-Related 63.6% *Among subsample referred to NY Peer Program 09/01/09 - 07/31/12, agreed to participate, had a closed case at the time of analysis, had continuous eligibility 6 months pre and post referral, and at least one behavioral health claim during that period 5

Impact on Behavioral Health Utilization – Participants in New York Peer Program (NYAPRS)   Enrolled (N = 54) 6 month Pre-Period 6 month Post-Period Sig. of Pre-Post Difference % of Members Who Used Inpatient Services 92.6% 48.2% p<.001 Inpatient Cost $9,212.05 $3,858.21 Inpatient Days 11.2 4.4 % of Members Who Used Intermediate Services 5.6% 11.1% ns Intermediate Cost $102.84 $314.76 Outpatient Cost $693.79 $1,118.62 p<.01 % of Members Who Used Outpatient Services 79.6% 85.2% Outpatient Visits 8.5 11.8 p<.05 Total BH Cost $9,998.69 $5,291.59 *Among subsample referred to NY Peer Program 09/01/09 - 07/31/12, agreed to participate, had a closed case at the time of analysis, had continuous eligibility 6 months pre and post referral, and at least one behavioral health claim during that period 6

Enrollment in Wisconsin Peer Program (GEP) 7

Engagement in Wisconsin Peer Program (GEP) All Engaged Members (N = 152)* Average # of Months Engaged in Program (From First Contact to Date Case Closed) 8.0 Average # of Successful Contacts with Peer 14.3 Average # of 15-minute units with Peer 26.7 Average # of hours spent with Peer 6.7 Average # of minutes per contact 24.9 Type of Contact:   Average # Phone Contacts 11.5 Average # Phone Hours 3.5 Average # of Face-to-Face Contacts 2.0 Average # Face-to-Face Hours 2.8 *Engagement defined as members who agreed to program, received an outreach attempt, and had at least one contact (phone or face-to-face) with the peer 8

Demographics of Participants in Wisconsin Peer Program (GEP)   Enrolled (N = 130)* Profile Age Mean Age 36.2 Proportion Aged 18-26 16.9% Age Breakdown: 18-20 1.5% 20's 31.5% 30's 34.6% 40's 22.3% 50's 9.2% 60+ 0.8% Diagnosis Adjustment Disorders 3.1% Anxiety Disorders 4.7% Disorders Usually Diagnosed in Infancy, Childhood or Adolescence 2.3% Mood Disorders 52.3% Bipolar 55.2% Depression 44.8% Personality Disorders Schizophrenia and other Psychotic Disorders 23.4% Substance Related Disorders 13.3% Alcohol-Related 58.8% Substance-Related 41.2% *Among subsample referred to the WI program between 12/09/09 – 12/31/11, agreed to participate, had a closed case at the time of analysis, had continuous eligibility 6 months pre and post referral, and at least one behavioral health claim during that period 9

Impact on Behavioral Health Utilization – Participants in Wisconsin Peer Program (GEP)   Enrolled (N = 130) Pre-Period Post-Period Sig. of Pre-Post Difference % of Members Who Used Inpatient Services 71.5% 43.9% p<.001 Inpatient Cost $6,247.48 $3,881.54 p<.01 Inpatient Days 6.4 4.5 p<.05 % of Members Who Used Intermediate Services 22.3% 23.9% ns Intermediate Cost $308.70 $411.88 % of Members Who Used Outpatient Services 83.9% 86.9% Outpatient Cost $999.32 $1,422.88 Outpatient Visits 9.1 11.8 Total BH Cost $7,555.49 $5,716.31 *Among subsample referred to the WI program between 12/09/09 – 12/31/11, agreed to participate, had a closed case at the time of analysis, had continuous eligibility 6 months pre and post referral, and at least one behavioral health claim during that period 10

Summary of Enrollment & Engagement Findings (NY & WI) This is a difficult population to reach and enroll despite strong efforts Reach rates: NY = 39.1%, WI = 45.8% Of the 60.9% not reached in NY, 45.6% were outreached to 6 times (maximum attempts) Enrollment rates: NY = 39.4% of reached; WI = 82.6% of reached Lesson learned: Outreach needs to occur as soon as possible, ideally while member still in the hospital (original model) Once enrolled, individuals are actively engaged in the program Engaged over substantial period of time NY = 7.3 months on average WI = 8.0 months on average High number of contacts with their peers NY = 14.9 contacts; 14.4 hours WI = 14.3 contacts; 6.7 hours 11

Summary of Preliminary Utilization & Cost Findings 6 months pre-post, members who enroll in the program show: Significant Decreases in % who use inpatient services NY: 47.9% decrease (from 92.6% to 48.2%) WI: 38.6% decrease (from 71.5% to 43.9%) Significant Decreases in # of inpatient days NY: 62.5% decrease (from 11.2 days to 4.2) WI: 29.7% decrease (from 6.4 days to 4.5) Significant Increases in # of outpatient visits NY: 28.0% increase (from 8.5 visits to 11.8) WI: 22.9% increase (from 9.1 visits to 11.8) Significant Decreases in total BH costs NY:47.1% decrease (from $9,998.69 to $5,291.59) WI: 24.3% decrease (from $7,555.49 to $5,716.31) *Among subsample of enrollees in NY (N = ) and WI (N = 130) with continuous eligibility 6 months pre-referral and 6 months post-referral and at least one behavioral health claim during that period 12

Pilot Study Results – Yale Study On average, enrollees in two peer programs showed positive outcomes, scoring above the midpoint on all survey measures* Scale   Wisconsin Tennessee Sample Item (n = 18) (n = 31) Quality of Life (1-7) Which of the following best describes how you feel about your life as a whole? (1 = Terrible; 7 = Delighted) 3.8 5.0 Recovery Markers Scale (1-4) I am involved in activities I find meaningful. 2.7 3.0 State Hope Scale (1-4) I can think of many ways to reach my current goals. 2.5 Social Support Questionnaire (1-5) There is a special person who is around when you are in need. 3.3 3.5 Mental Health Confidence Scale (1-6) Right now, how confident are you that you could do something to face a bad day 3.7 4.2 *At time of survey, majority of respondents ( 82%) had been in peer program at least 5 months

Pilot Study Results – Yale Study Data gathered in focus groups shed light on the important subjective qualities of the peer relationship that might have contributed to the program’s positive outcomes: appreciation for having someone to talk to who genuinely cared for them and was willing to listen peer specialists’ skillful balancing of friendship and structured support fostering the development of concrete personal goals in the wake of difficulties practical support received from peers in advocating for various issues or locating services