1 Cultural Impacts on Improving Behavioral Health Margins and Making the Parity Law work for Patients and Providers Richard Wohl, MSW, MBA President, Princeton House Behavioral Health Senior Vice President, Princeton Healthcare System Marguerite Pedley, Ph.D. Vice President, Inpatient Services Princeton House Behavioral Health

2 Princeton House Behavioral Health (PHBH) is a division of Princeton Healthcare System. With seven sites located throughout New Jersey, we are a leading provider of behavioral healthcare in the state. Offering a full spectrum of behavioral health and addition services, PHBH is committed to delivering high quality, compassionate care that is recognized for excellence in treatment.

3 PHBH Inpatient Services provides treatment for adults with addictions, psychiatric disorders, or co-occurring mental health and substance use disorders at our 110-bed inpatient campus in Princeton, NJ. We are licensed by the State under the University Medical Center of Princeton (UMCP) General Acute Care Hospital license but are physically located off campus. 89 ( 81%) of our beds are voluntary. This includes: General Psychiatric Program, Dual Diagnosis, Medical Detox, Young Adult Substance Abuse, Adult Addiction Recovery 21 (19%) of beds are licensed as short term, involuntary beds making PHBH one of the largest general acute care hospital providers of short-term involuntary care in the state. An ECT Suite providing IP & OP care is adjacent to the IP campus.

4 PHBH Outpatient Services offers acute partial hospital and intensive outpatient services to children, adolescents and adults with addiction, psychiatric, or co-occurring disorders in six distinct locations throughout New Jersey. Within the domains of Acute PH and IOP services, specialty tracks include Women’s & Men’s Programs, Trauma & Addiction, Emotional Eating, a program for teen girls and similar specialty services. The focus is acute outpatient care. Traditional outpatient services are not provided by PHBH.

5 Psychiatry Services at University Medical Center of Princeton (UMCP) include a range of programs and services distinct from those offered at PHBH’s 110-bed inpatient campus. These include: Center for Eating Disorders Care 22-bed Inpatient treatment unit (child/adolescent/adult) Outpatient Partial Hospitalization program Behavioral Health ED 6 bed discrete unit located within the Medical ED Consultation & Liaison (C&L) Service to 250 bed medical center

6 Growth in services over time

7 Patient Satisfaction (Inpatient)

8 Creating a culture that values…Patient Satisfaction… INDICATOR TARGET JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 2016 YTD 2015 Patient Experience (Press Ganey) Overall Score 89.5 or (90%) 88.2 (83%) 90.1 (95%) 92.0 (98%) 91.5 (96%) 90.9 (95%) 89.9 (94%) 89.1 (89%) 89.3 (92%) 90.1 (93%) 89.5 (93%) Physician Section Score 89.6 or (90%) 87.8 (79%) 90.4 (89%) 94.3 (99%) 91.3 (92%) 94.2 (99%) 93.3 (99%) 90.4 (87%) 89.0 (86%) 91.3 (91%) 89.6 (86%) "Likelihood of Recommending" Question Score 94.0 or (90%) 92.0 (84%) 93.3 (89%) 95.3 (98%) 95.3 (97%) 95.7 (99%) 89.8 (79%) 93.3 (90%) 92.9 (89%) 93.5 (91%) (93%) Overall Impression of Hospital 92.7 or (90%) (94%) (98%) (99%) (99%) (82%) 92.4 (88%) 91.8 (89%) 93.3 (93%) 92.7 (93%) Overall Rating of Care Given 93.0 or (90%) (87%) 94.5 (96%) 95.8 (99%) 95.1 (99%) 96.3 (99%) 92.5 (86%) 93.1 (92%) 93.4 (92%) 94.2 (94%) 93.0 (90%)

9 Fairness and equity for our patientsPatient Safety… Examples: Staff Satisfaction… >62% of PHBH employees fall into the top two categories (“Advocates” and “Have Bought In”) in PHCS Employee Engagement surveys Employee-of-the-Quarter program remains strong (highly valued) Fairness and equity for our patients We maintain longer lengths of stay and have fewer denials than our peers. Committed to parity internally and also externally (NAPHS, NJHA, etc.) Confinement statistics: 2015 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016YTD Restraint (Total #) 17 3 2 4 1 12 Restraint (rate per 1000 patient days) 0.5 1.0 0.8 1.4 0.4 0.7 0.0 0.6 Seclusion (Total #) Seclusion (rate per 1000 patient days) Medication Errors (rate per 1000 pt days) 1.6 1.0 2.6 3.1 2.5 0.7 1.1 0.4

10 Access to Care 10% of PHBH total staff (600 FTEs) are involved in Admissions, Registration, Patient Financial Counseling, Utilization Management or Collections in all of our settings. These are our employees, not employees of the medical center allocated to help support Princeton House. There are separate Directors of Utilization Management & Auditing for Inpatient Services and Outpatient Services each with a full complement of staff supporting registration and revenue cycle functions. Vice President , Outpatient Services Vice President , Inpatient Services Patient Financial Services Dept: Dedicated PHBH Supervisor Dedicated PHBH Follow Up Representatives Director of OP UM & Auditing Director of IP UM & Auditing UM Reviewers at each site - North Brunswick - Princeton - Hamilton - Moorestown - Eatontown OP Medical Records Specialists IP UM Staff: - Senior UM Reviewer - UM Reviewers - Certification Specialist - Registration Auditor - Medical Records Assembler/Analyst - Medical Records Coder (PT) Managed Care/ Contracting Dept.

11 PHBH uses a shared database across the continuumPHBH uses a shared database across the continuum. This shared database is our UM clearinghouse. Our Reviewers have access to clinical, benefit and historical denial information. This allows us to not only track authorization information but also, workflow, caseloads and payer trends. The system is regularly adjusted to track and report data based on our needs. This database is used by: IP and OP Admissions IP and OP UM & Registration staff Patient Financial Services Contracting Our UM Directors are regarded as key leaders within the Princeton House Behavioral Health management team. They are included in all major PHBH management and clinical meetings as full participants and decision-makers.

12 The UM Directors take the lead in our interface with MCOs.We partner with MCOs and other payors to share data and discuss outcomes collaboratively. While we emphasize collaboration and partnership, denials are not accepted as inevitable. The culture at PHBH is to question and respectfully challenge when we disagree. Our UM directors are regarded throughout the broader healthcare system as a valuable resource for providing technical assistance. Beyond PHCS, they have served as technical experts to the New Jersey Hospital Association’s Behavioral Health Constituency Group as well as NAPHS member organizations.

13 Related key points: Employed physician modelPHBH has 60 employed medical staff across our continuum of care. It is understood and supported by the provider panel that MD reviews are an essential element of ensuring equity and quality of care for our patients. Providers view the UM Directors and their respective employees as important problem solvers. Their consultation and guidance makes the providers’ workflow easier. Our culture of respectful questioning extends into the regulatory arena. We are not uncomfortable challenging a surveyor’s interpretation if warranted. Strive to respectfully challenge what doesn’t fit with our mission, to continue to be an agent for change.

14 Outcomes: Bad Debt <3% for the last three yearsMaintain a profitable operation and are a valued contributor to the Princeton Healthcare System. Culture of patient first (as reflected in our patient satisfaction scores, low seclusion/restraint rate, among others)