Proprietary and Confidential. Do not distribute. 1 Rebecca Cate, PhD Research Scientist Behavioral Health Sciences Department Peer Program Evaluation Preliminary Results July 2013

Proprietary and Confidential. Do not distribute. 2 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

Proprietary and Confidential. Do not distribute. 3 Enrollment in New York Peer Program (NYAPRS)

Proprietary and Confidential. Do not distribute. 4 Engagement in New York Peer Program (NYAPRS) Engagement 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 Engagement14.9 Average # of hours spent with Peer**14.4 Average # of 15-minute units with Peer57.5 Type of Contact: Average # Phone Contacts10.8 Average # Phone Hours6.7 Average # of Face-to-Face Contacts2.7 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

Proprietary and Confidential. Do not distribute. 5 Demographics of Participants in New York Peer Program (NYAPRS) *Among subsample referred to NY Peer Program 09/01/ /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 Enrolled (N = 54) Profile Age Mean Age34.9 Proportion Aged % Age Breakdown: % 20's40.7% 30's16.7% 40's24.1% 50's14.8% % Diagnosis Adjustment Disorders5.6% Anxiety Disorders5.6% Disorders Usually Diagnosed in Infancy, Childhood or Adolescence1.9% Eating Disorders0.0% Impulse Control Disorders0.0% Mood Disorders51.9% Bipolar50.0% Depression50.0% Personality Disorders0.0% Schizophrenia and other Psychotic Disorders14.8% Substance Related Disorders20.4% Alcohol-Related36.4% Substance-Related63.6%

Proprietary and Confidential. Do not distribute. 6 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 Services92.6%48.2%p<.001 Inpatient Cost$9,212.05$3,858.21p<.001 Inpatient Days p<.001 % of Members Who Used Intermediate Services5.6%11.1%ns Intermediate Cost$102.84$314.76ns Outpatient Cost$693.79$1,118.62p<.01 % of Members Who Used Outpatient Services79.6%85.2%ns Outpatient Visits p<.05 Total BH Cost$9,998.69$5,291.59p<.01 *Among subsample referred to NY Peer Program 09/01/ /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

Proprietary and Confidential. Do not distribute. 7 Enrollment in Wisconsin Peer Program (GEP)

Proprietary and Confidential. Do not distribute. 8 Engagement in Wisconsin Peer Program (GEP) *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 Engagement 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 Peer14.3 Average # of 15-minute units with Peer26.7 Average # of hours spent with Peer6.7 Average # of minutes per contact24.9 Type of Contact: Average # Phone Contacts11.5 Average # Phone Hours3.5 Average # of Face-to-Face Contacts2.0 Average # Face-to-Face Hours2.8

Proprietary and Confidential. Do not distribute. 9 Demographics of Participants in Wisconsin Peer Program (GEP) *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 Enrolled (N = 130)* Profile Age Mean Age36.2 Proportion Aged % Age Breakdown: % 20's31.5% 30's34.6% 40's22.3% 50's9.2% % Diagnosis Adjustment Disorders3.1% Anxiety Disorders4.7% Disorders Usually Diagnosed in Infancy, Childhood or Adolescence2.3% Mood Disorders52.3% Bipolar55.2% Depression44.8% Personality Disorders0.8% Schizophrenia and other Psychotic Disorders23.4% Substance Related Disorders13.3% Alcohol-Related58.8% Substance-Related41.2%

Proprietary and Confidential. Do not distribute. 10 Impact on Behavioral Health Utilization – Participants in Wisconsin Peer Program (GEP) *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 Enrolled (N = 130) Pre-PeriodPost-Period Sig. of Pre- Post Difference % of Members Who Used Inpatient Services71.5%43.9%p<.001 Inpatient Cost$6,247.48$3,881.54p<.01 Inpatient Days6.44.5p<.05 % of Members Who Used Intermediate Services22.3%23.9%ns Intermediate Cost$308.70$411.88ns % of Members Who Used Outpatient Services83.9%86.9%ns Outpatient Cost$999.32$1,422.88p<.05 Outpatient Visits p<.01 Total BH Cost$7,555.49$5,716.31p<.05

Proprietary and Confidential. Do not distribute. 11 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

Proprietary and Confidential. Do not distribute. 12 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, to $5,291.59) WI: 24.3% decrease (from $7, 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

Proprietary and Confidential. Do not distribute. Pilot Study Results – Yale Study On average, enrollees in two peer programs showed positive outcomes, scoring above the midpoint on all survey measures* Scale WisconsinTennessee 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) Recovery Markers Scale (1-4) I am involved in activities I find meaningful State Hope Scale (1-4)I can think of many ways to reach my current goals Social Support Questionnaire (1-5) There is a special person who is around when you are in need Mental Health Confidence Scale (1-6) Right now, how confident are you that you could do something to face a bad day *At time of survey, majority of respondents ( 82%) had been in peer program at least 5 months

Proprietary and Confidential. Do not distribute. 14 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