Santa Clara County’s Partners in Wellness Program

The Problem

Many residents of Santa Clara County, CA, with severe mental illnesses currently visit several of the County’s psychiatric facilities for emergency or inpatient treatment purposes to receive regular care. These facilities are both expensive and underserve patients by not providing the most appropriate long-term care. With this project, the County “hopes to move away from an episodic, reactive model of care to a more proactive model” of sustained and permanent care.

The Basics

Location: Santa Clara County, CA

Policy area: Mental Health

Service provider: Telecare Corporation

Size of investment: N/A

Maximum success payments possible: $11.2 million. Over the course of the six-year PFS project, the County will either make or withhold payments of $1.4 million to Telecare, depending on its success at meeting outcomes. If Telecare meets its target levels of impact at the end of six years, the County will pay Telecare the full $11.2 million under their agreement.

Investor: Santa Clara County, CA

Other partners: Third Sector Capital Partners, Government Advisor and Transaction Coordinator; Fenwick & West LLP, Legal Advisor; Palantir Technologies, Technology Support; Step Up Silicon Valley, Catholic Charities of Santa Clara County, The Sobrato Family Foundation, The Health Trust, California Pay for Success Initiative (administered by Nonprofit Finance Fund and funded by The James Irvine Foundation), California HealthCare Foundation, Corporation for National and Community Service’s Social Innovation Fund Pay for Success program; Early Community and Project Development Supporters

Evaluator: Dr. Keith Humphreys at Stanford University

Evaluation methodology: Randomized control trial

Outcome payor: Santa Clara County, CA

Outcomes that yield payments: (1) Reducing utilization of costly emergency, inpatient, and contracted psychiatric services; (2) reducing jail days; and (3) improving or maintaining patients’ health and wellbeing.

Timeframe: Six years

Date announced: December 2016

The Intervention

Intervention: As the service providers of Partners in Wellness, Telecare Corporation will provide community-based behavioral health and housing services to about 250 severely mentally ill residents of Santa Clara County. This differs from the County’s current services, which involve placing individuals in locked psychiatric treatment settings. The project aims to improve care coordination in order to help individuals most effectively access primary care and community support resources. Treatment is personalized and will include 24/7 access to support, comprehensive health and wellness screenings, substance use education and treatment, and practical assistance with life needs (e.g., symptom management, housing security, financial help, etc.).

Evidence base behind the intervention: Based on its own data, Telecare reports significant success in its more than 90 programs across nine states serving over 34,000 people. More generally, community-based behavioral health service models have been found in multiple instances to be more effective than traditional psychiatric services. Studies of children with mental illnesses receiving intensive case management have found that they require fewer restrictive services, such as psychiatric hospitalizations, than children who do not receive case management. Another study of children and adolescents found that multi-systemic therapy (a method incorporating community-based behavioral health services) was more effective in the short term in reducing youths’ emergency psychiatric symptoms than emergency hospitalization. Additionally, in a review of the components of mental health services, researchers concluded that evidence supports a balanced approach of providing both community and hospital services.