Rebecca Cate, PhD Research Scientist Behavioral Health Sciences Department

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Rebecca Cate, PhD

Research Scientist

Behavioral Health Sciences Department

Peer Program EvaluationPreliminary Results

July 2013


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)

Total members who declined program

(N = 199; 60.5% of reached;23.6% of referred)

Total members who could not be

reached by NYAPRS(N = 513; 60.9% of referred )

Out of Service Area (N = 34; 6.6% of not reached)

Made 6 Unsuccessful Attempts to

Reach (N = 234; 45.6% of not

reached; 27.8% of referred

Total members who were reached by NYAPRS

(N = 329; 39.1% of referred)

Language Barrier

(N = 26; 5.1% of not reached)

Total members who Enrolled in Program


* 40 duplicate members were removed – kept most recent activity.

Total unique members referred to NYAPRS Peer Program

09/17/10 – 07/31/12(N = 1046)*

Wrong Address (N = 134;

26.1% of not reached)

Total unique members referred to NYAPRS Peer Program

09/17/10 – 07/31/12 and closed as of 07/31/12

“Referred”(N = 842)

In Facility (N = 23;


Incomplete Data (N = 20;


Other (e.g. incarcerated,

moved, deceased)(N = 42;


Member completed at least 6 months in program

(N = 70; 53.9% of agreed;

21.2% of reached;8.3% of referred)


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 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


Demographics of Participants in New York Peer Program (NYAPRS)

*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

Enrolled (N = 54)Profile

Age Mean Age 34.9Proportion 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 5.6%Disorders Usually Diagnosed in Infancy, Childhood or Adolescence 1.9%Eating Disorders 0.0%Impulse Control Disorders 0.0%Mood Disorders 51.9%

Bipolar 50.0%Depression 50.0%

Personality Disorders 0.0%Schizophrenia and other Psychotic Disorders 14.8%Substance Related Disorders 20.4%

Alcohol-Related 36.4%Substance-Related 63.6%


Impact on Behavioral Health Utilization – Participants in New York Peer Program (NYAPRS)

Enrolled (N = 54)

6 month

Pre-Period6 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 p<.001

Inpatient Days 11.2 4.4 p<.001

% of Members Who Used Intermediate Services 5.6% 11.1% ns

Intermediate Cost $102.84 $314.76 nsOutpatient Cost $693.79 $1,118.62 p<.01% of Members Who Used Outpatient Services 79.6% 85.2% nsOutpatient Visits 8.5 11.8 p<.05Total BH Cost $9,998.69 $5,291.59 p<.01

*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


Enrollment in Wisconsin Peer Program (GEP)

Total members who declined program


Total members who could not be

reached (N = 285; 54.2% of referred )

Closed without a reason given

(N = 15; 5.3% of not

reached)

No Response (N = 163; 57.2% of not reached)

Total members who were reached (N = 241;

45.8% of referred)

Not Called (N = 14;


Total members who agreed to Program


Not Eligible (N = 93;


Total unique members referred to WI Peer Program 12/09/09 – 12/31/11 and

closed as of 04/15/12“Referred”(N = 526)

Members engaged in program at least 6 months

(N = 81; 40.7% of agreed

33.6% of reached15.4% of referred)


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 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


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 Age 36.2Proportion 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 0.8%Schizophrenia and other Psychotic Disorders 23.4%Substance Related Disorders 13.3%

Alcohol-Related 58.8%Substance-Related 41.2%


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 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 ns

% of Members Who Used Outpatient Services 83.9% 86.9% ns

Outpatient Cost $999.32 $1,422.88 p<.05

Outpatient Visits 9.1 11.8 p<.01

Total BH Cost $7,555.49 $5,716.31 p<.05


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


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

Proprietary and Confidential. Do not distribute.

Pilot Study Results – Yale StudyOn 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 3.0

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

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Rebecca Cate, PhD Research Scientist Behavioral Health Sciences Department

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