Peer support program improves outcomes, reduces costs

High Point Treatment Center offers inpatient and outpatient substance abuse and mental health treatment programs at sites in Brockton, New Bedford, Plymouth, and Taunton, Massachusetts. The Center admits more than 12,000 inpatient clients and 6,700 outpatient clients each year, many of them covered by MassHealth, the state’s government health insurance for low- and moderate income residents. The Massachushetts Behavioral Health Partnership (MBHP), a subsidiary of ValueOptions, is the payer for MassHealth clients.

High Point’s MBHP clients tend to have complicated case management, social service, and care coordination needs. The variety of challenges they face affect their ability to complete substance abuse treatment successfully, leading to high readmission rates to inpatient programs.

Seeking a way to reduce these expensive readmissions, the High Point leadership team turned to the Community Support Program (CSP) worker model that had a proven track record in mental health treatment. CSP programs in mental health had decreased inpatient readmissions and increased tenure in the community.

Janet Feingold, Vice President and Chief Operating Office for Outpatient and Community Based Services, and Maggie Cahill, Director of the Community Support Program at High Point, described the CSP program they developed for substance abuse patients in their how-to workshop, “How to partner with payers: Decrease THEIR costs,” at the 2012 SAAS Annual Conference and NIATx Summit in New Orleans.

The Massachusetts-based Association for Behavioral Health Care recognized High Point’s program in 2011 with an Innovative Practice Award for outstanding service to addiction treatment and recovery.

Titled the “Acute Treatment Services Community Support Program,” or ATS CSP, this community-based program is staffed by mobile paraprofessionals, who are people in healthy recovery themselves. The hourly wage includes benefits and expenses.

Developed in cooperation with MBHB, High Point’s program includes a wide range of reimburseable activies and is designed to allow for the flexibility required to meet a client’s specific needs.

Program director Maggie Cahill is committed to hiring and training community support program coordinators (CSPC) who can connect effectively with the high-need clients the program serves. Coordinators begin to work with the patients before their discharge from inpatient treatment, mapping out a service plan to help patients make a successful transition to their home communities.

Once the clients are discharged from treatment, the CSPC works with them to help them access all resources available to meet their needs and maintain recovery. A pilot of the program begain in July 2009, and it was adopted in March 2010, when Maggie come on board as director. She began with two coordinators and now directs a team of 12, with plans to hire one more. A recently hired coordinator is actually an alumni of the program. Each coordinator is engaged with anywhere from 10 to 15 patients.

High Point’s ATS CSP results have been impressive. For example, the rate of readmission to inpatient treatment within 90 days of discharge for MBHP patients decreased by more than 50 percent in the period covering July 1 through December 31, 2011.

The success of the program with MBHP has led to similar contracts with other insurers, and now three additional payers cover High Point’s ATS CSP services. While the program was designed to serve high-risk substance abusers who have had multiple admissions to detox, High Point has expanded the program to include clients in other levels of care.

And in August, MBHP and ValueOptions received a Health Care Innovation Award from the Centers for Medicare and Medicaid Services to expand a peer recovery support based on the High Point model to three other substance abuse treatment providers in Massachusetts.

The High Point leadership team feels that the ATS CSP fits well with the move toward health homes and integration between specialty care and primary care. “It’s a great model for care coordination, which improves outcomes,” says Maggie.

“Leading a team that’s full of passion for the work that they do is very gratifying,” she adds. Having worked as a clinician, Maggie is also thrilled to see patients be successful in recovery. She offers the following tips for other organizations interested in developing their own CSP program:

1. Focus on peer-to-peer support. “Many of our coordinators have also ‘walked the walk,’” says Maggie. “The first two coordinators I hired were people with a solid recovery, and they provided the foundation for building the strong staff we have today.”
2. Provide support for your team. “Our coordinators are out in the field, on the front lines, and safety is sometimes a concern,” comments Maggie. Weekly staff meetings give coordinators a chance to check in with Maggie and with each other.
3. Hold staff accountable for taking care of themselves. “Our coordinators understand what it means to be in healthy recovery,” says Maggie. “They are hired with the understanding that they will responsible for maintaining it.”
4. Design your paperwork to meet the demands of the program. “I set up the paperwork thinking of the data that I want to collect in advance,” explains Maggie. While data is now collected using paper forms, High Point has plans to automate the process with the rollout of an electronic medical record

To view a PowerPoint of  “How to partner with payors: Decrease THEIR costs,” visit the 2012 Conference Archive.  For information on the High Point Treatment Center Acute Treatment Services Community Support Program, contact Maggie Cahill, Program Director, Community Support Program, High Point Treatment Center, mcahill@hptc.org