Partners in Wellness: Evaluation of a Pay for Performance Program for High-Utilizers of Mental Health Services

Summary

Healthcare systems in the United States (U.S.) have long faced the considerable challenge of managing budgetary pressures while at the same time helping people with serious mental illness and/or addiction. One potential way to address this challenge is to offer community-based services for individuals who are high-utilizers of expensive emergency and inpatient psychiatric services. Due to the decentralized nature of California governance, responsibility for mental health services falls primarily to the individual counties. The County of Santa Clara, CA invests significantly in community-based services as well as 24-hour care settings. This County adopted an innovative Pay for Performance (PFP) model and contracted with a new care provider to better meet the needs of this patient population and, in turn, reduce demand on the County's 24-hour psychiatric services. Whether this innovative contracting framework will help individuals who thus far have not responded well to mental health services is unknown. The purpose of this study was to determine whether the quality of care for these high-need patients was improved and at a sustainable cost. To this end, a randomized clinical trial (RCT) was conducted to determine whether this innovative quality improvement initiative, referred to as "Partners in Wellness", was successful at reducing the total cost of 24-hour psychiatric care used by enrollees compared to individuals who concurrently received services from the county. Individuals were randomly assigned to the Usual Care (UC) or Pay-For-Performance (PFP) conditions. The primary outcome of this evaluation was reduction in the total cost of 24-hour psychiatric services in the target population.

the primary outcome of this evaluation was reduction in the total cost of 24-hour psychiatric services in the target population.

Conditions

• Psychotic Disorders
• Bipolar Disorder
• Substance Use Disorders

Interventions

BEHAVIORAL

Pay For Performance (PFP)

Wraparound mental health, psychosocial, and addiction treatment services provided by contractor under an schedule of rewards or penalties that was agreed to with Santa Clara County.

BEHAVIORAL

Usual Care (UC)

Outpatient and inpatient mental health and psychosocial services delivered by Santa Clara County services and systems.

Sponsors & Collaborators

• Stanford University

  lead OTHER

Principal Investigators

• Keith Humphreys, PhD · Professor of Psychiatry

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2016-08-01

Primary Completion

2022-12-31

Completion

2023-07-01