Developing A Value-Based Care Model With Peer Support—Two Case Studies
By Athena Mandros Open Minds September 11, 2018
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, www.openminds.com. All rights reserved. You may not alter, transform, or build upon this work without written permission from OPEN MINDS
The benefits of peer support service are widely known—the use of peer supports can result in reductions in hospital admissions, reduction of inpatient days, and increased use of outpatient services. Additionally, the model helps to improve consumer outcomes, including increased consumer empowerment, increased sense that treatment is responsive, and increased social support and social functioning (see Bringing Recovery Supports To Scale: Peer Support). As a result, the use of peers and peer support programs can lend itself to success with value-based arrangements.
Last month at The 2018 OPEN MINDS Management Best Practices Institute, I had the chance to hear from two organizations that have value-based arrangements related to peer supports during the session, The Future Of Peer Support Services: Successful Models For A Value-Based Market, led by OPEN MINDS Senior Associate Ken Carr.
First to speak was Briana Gilmore, Senior Strategy Consultant at Community Access in New York City, a 400-employee organization that provides supportive housing, recovery supports, and advocacy services. What makes Community Access unique is its aim to have at least 51% of staff with "lived experience." Community Access has a performance-based contract with the city of New York for their assisted competitive employment program; 20% of their contract payment is based on their success in supporting a number of individuals they work with in maintaining employment for three month, six month, and nine month intervals using the "find, get, keep" model. They are at risk for 20% of the contract payment if the peer employment specialists cannot support participants in obtaining and maintaining competitive employment.
Ms. Gilmore noted that the model is challenging for a couple of reasons. The first is that many people need support with logistics like completing school degrees or gaining skills on the computer. It can take time for people to be ready to find a job and not every participant is ready at the same pace, so it can be difficult to predict aggregated outcomes. Additionally, Ms. Gilmore noted that the supported employment model itself can be problematic, because the focus on competitive work in recovery services is sometimes not matched with a similar emphasis on well-being and other social determinants that help a person maintain employment.
Second on the agenda was Sue Ann Atkerson, LPC, MBA, the Chief Operating Officer at RI International. RI International is a multi-state (and multi-national) behavioral health organization headquartered in Arizona. RI International has about 1,000 employees, about 50% of which have lived experience. In Arizona, RI International uses peer recovery teams to provide group and one-on-one services to individuals transitioning from the Desert Vista Hospital and the Recovery Innovations Recovery Response Center Peoria. Funding for the program is in the form of monthly payments, plus quarterly performance-based incentives. The performance incentives are based on a variety of metrics, including: 95% of individuals receive services within 24 hours of referral; 90% receive a behavioral health medical professional (BHMP) appointment within seven days of discharge; and 90% are not readmitted to a hospital within 30 days.
What were my key takeaways from the speakers in this session?
Peer support has better outcomes—Peer support services do not just move the costs from higher-level employees to lower-level employees. The peer support model often has better outcomes for consumers than higher paid clinical professionals.
Peers can be deployed throughout the service system—Peers should not be regulated to certain jobs or roles. To run an organization that best serves consumers, there should be individuals with lived experience at all levels of the organization—including on the executive team and the board.
Push for shared savings opportunities—Peer support programs can result in big savings. Ms. Atkerson explained that some of these programs are huge cost savings in the millions of dollars, but provider organizations don't see the benefits of these savings. RI International is looking to move to shared model based on quality and value.
Keep track of the numbers—Any value-based arrangement needs data for real-time management of performance, outcomes, and expenses. To help track this data and to view it in "real-time", RI International created a series of dashboards that give a simple, visual snapshot of how the organization is performing. Ms. Atkerson noted that even if your organization isn't ready to develop a dashboard system, you can begin to track data using simple charts and reports for one or two items.