1. Divert, At What Cost?
Diversion, Team Support and Innovative Payment Strategies

2. Learning Objectives
Identify diversion strategies and maintain the clinical relevance and responsibility of a diversion intervention.
Define Social Impact Bonds/Social Stock Exchange and strategies to implement in your community.

3. Integral Care About Us

4. Our History
1967: Established as local authority for mental health and intellectual and developmental disabilities in Travis County as designated by state law
1 of 39 Community Mental Health Centers in Texas
Authority and Provider Roles
Many people aren’t aware of this but Integral Care has been serving our community for over 50 years.
Back in 1967, we started with one location on Red River Street with a Quonset hut next door, which housed our methadone clinic.
Now, we have over 40 locations across Travis County as well as mobile teams providing care out in the community.
We serve our community in both provider and authority roles.

5. What We Do - Provider Care Coordination 24/7 Crisis Response
Integrated Behavioral Health
Residential Services
Homelessness and Housing Services
Jail Diversion
Substance Use Treatment
Prevention and Wellness
We provide a wide range of services, including 24/7 crisis response through our Helpline, mobile teams and urgent care walk-in clinic.
We provide integrated behavioral health where individuals can receive both primary and mental health care as well as substance use disorder treatment - all in one location. This is important because people who live with mental illness die 25 years earlier on average. This is not from a mental illness. It’s from an unmanaged chronic diseases like diabetes or heart disease.
We provide residential crisis services to prevent inpatient hospitalization and support people coming out of in-patient hospitalization.
We have a team of almost 100 staff engaging individuals who are experiencing homelessness in our community. We work to get them on a path to housing. We currently house over 450 people in permanent supportive housing, which includes providing the rehabilitation supports to help them gain stability and get on a path to recovery from homelessness, mental illness and/or substance use disorder.
As we know, too many individuals with mental health and substance use issues end up in jail. We have a strong working relationship with law enforcement and the justice system to help divert individuals from jail into treatment rather than incarceration. Our Mobile Crisis Outreach Team can co-respond with law enforcement and divert an individual from arrest.
We provide a range of substance use treatment services including outpatient detox and medication assisted treatment. The individuals we serve in this area also have a co-occurring mental illness.
Lastly, we know that individuals we serve often lack the resources or knowledge to pursue living a healthier life, which can benefit their mental health. We offer wellness services, such as tobacco cessation programs, nutrition counseling and support, exercise training and support for people who want to learn ways to lead a healthy life.

6. Programs and services offered
Overview
Total Number of People Served, By Area
45+
30+
Locations with
direct services and
mobile teams
Programs and services offered

7. What is diversion?
We hear the word in our sleep… Divert, divert, divert. But what are we saying?
Are we acting like bouncers at a popular nightclub?

8. What is diversion?
Are we getting distracted from the real goal and mission of our work?

9. Diversion
Use of legal leverage with behavioral health services are not wanted.
Use of behavioral health services when legal leverage is not needed.

10. What does diversion look like?
Criminal Justice
Inpatient Settings
Outpatient Settings
Diversion Courts
Strategic Use of Legal Leverage
Community Crisis Plans
Collaborative Assessment
Transitional Housing/Crisis Respite
On call systems

11. Strengthening Jail Diversion
Expanded Mobile Crisis Outreach Team co-responds with Law Enforcement and EMS
3,244 Dispatches by 911 last year
Respond to booking to divert post arrest prior to booking
Expanded training opportunities
Austin Travis County EMS, Travis County Sheriff’s Office (TSCO), Court Staff, Jail Staff, Probation Staff, Inmates, etc.
Forensic Assertive Community Treatment (FACT)
90 individuals to be served with housing for 60
Austin State Hospital Redesign
Judge Guy Herman Center for Mental Health Crisis Care
Receives emergency detentions from TCSO and other law enforcement

12. Do we really want to divert?

13. Or do we want to engage?

14. Tailoring Services
What we are really trying to do in our “diversion” work is to be prudent with our resources. Ensure clients are receiving care at the right place, time and in the right amount of care to meet their needs. We want to guide our clients to the least restrictive, most helpful resource or provider to meet their needs, so we can better engage them.
Diversion interventions will not be one size fits all. Diversion should still be person centered and voluntary.

15. Tailoring Services

16. Social Determinants of Health

17. Forensic ACT Specialized Mental Health and Case Management
Registered Nurse & Nurse Practitioner
24/7/365 On call
Transitional and Permanent Supported Housing
Integrated Primary Care
Peer Support & Substance Use Counseling

18. Case Example

19. Tips to Support Staff Build strong partnerships at leadership levels.
Additional resources for “non billable services”
Advocate for macro level/systemic change.
Celebrate the small successes

20. What do we get for all of that work?

21. IMPACT DATA

22. $127,896

23. Outcomes!!

24. Outcomes!!

26. Cost savings to the community for 12 months of service
12 Months Impact
Reduction in emergency medical services decreased by 44%, totaling $419,696
Reduction in psychiatric hospitalization resulted in a 71% decrease, totaling $78,785
Cost savings to the community for 12 months of service
$598,841

27. Forensic ACT

28. FACT Baseline 0-1 year prior to enrollment
0-1 year prior to enrollment
1-2 year prior to enrollment
2-3 year prior to enrollment
# of Arrests (N = 48) 4 3
Total # of Days in Jail (N = 48)
153
133 90
Average state hospital days (N = 58) 85 57 32
Average % of year spent in jail
65%
52%
33%

30. What makes a successful diversion?
Cost effective interventions.
Positive treatment outcomes.
Marked reduction in emergency service utilization
Collaboration

31. I understand diversion I understand the need I understand the positive impacts
Now…How to I get paid?!

32. Types of Payment Models
Social Impact Investments
Value Based Payments
Capitated Payments, Bundled Payments, Case Rates

33. Social Impact Investments
Pay for Success – NEW stakeholders coming to the table to try their luck in the Social Stock Exchange.
It is time to prove up our worth and social service providers. She
How many of you have had someone gawk over you at a party? “I can’t believe you do that work.” “It takes a special kind of person”. “Our community is so lucky to have you”. Well…times have changed and opportunities have arisen to allow everyone the opportunity to be

34. Social Impact Investments

35. Value Based Sustainability January 4, 2018
Martin Cook
Director of Reimbursement Management

36. Value Based Payments
Provide services that help a client to their best possible outcome for that individual.
Social determinants of health

37. Value Based Sustainability Model
Operational Excellence
Patient Value
Community Value
Community Leadership
Funding and Investment

38. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Definition - A philosophy of organizational leadership that stresses continuous improvement, teamwork, and problem solving throughout the organization by focusing on the needs of the customer, empowering employees, and focusing management attention towards sustainable improvement of organizational performance.

39. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Patient value = Patient Outcomes / Cost of Care
Focus :
Person- Centered
Trauma informed Care
Evidence based practices
Culturally Competent Care
Cost Effectiveness

40. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Patient Value x Target Population
Access
Provider Capacity
Service Locations
Continuum of services
Strong community relationships
Payers
Partners
Stakeholders
Health information network
Reputation
Excellence
Innovation

41. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Key member of Health Safety Net
Active participation in Local and State health initiatives
Effective communication and brand awareness efforts
Advocate for target populations
Openness to strategic partnerships

42. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Community Leadership leveraged for Competitive Advantage
Talent acquisition and retention
Expand funding opportunities
Contract negotiations based on Value vs Volume
New populations

43. Operational Excellence
Patient Value
Community Value
Community Leadership
Community Investment
Where do we start?

44. Where to start? Recommendation:
Organize cross functional Task Force with the following objectives:
Develop sustainable solutions for targeted improvement opportunities
Facilitate the transition and adoption of solutions into ongoing operations
Track KPI’s to monitor solution effectiveness
Incorporate Task Force learnings into recommendation for enterprise change management strategy focused on achieving operational excellence

45. Value Based Payment Partnerships
Determine Desired Outcomes
Know what your payer needs (i.e. reduction in childhood diabetes, reduction in inpatient admissions)
Managed Care Companies seeking to adhere to CCBHC measures

46. Data – importance and challenges
Interventions should be data driven
Data should capture to goals of the payor
Data agreements may need to be developed

47. Questions? David Weden, Chief Administrative and Financial Officer
Elizabeth Baker, Practice Manager of ACT