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

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

3. Enrollment in New York Peer Program (NYAPRS)3

4. 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

5. 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/ /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

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 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/ /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

7. Enrollment in Wisconsin Peer Program (GEP)7

8. 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

9. 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

10. 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

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 11

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 12

13. 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

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