In January, the CMS Innovation Center introduced a new Innovation in Behavioral Health model that seeks to use community-based behavioral health practices to provide integrated care that addresses people’s behavioral health, physical health and health-related social needs, such as housing, food, and transportation. Steve Miccio, CEO of People USA, says organizations like his peer-run mental health nonprofit will be key to making the model work.
In an interview with Healthcare Innovation, Miccio described how his Poughkeepsie, N.Y.-based organization’s services are developed and operated by people who have personally overcome mental health issues, addiction, or trauma, which makes a valuable addition and alternative to the traditional behavioral healthcare system. He said that People USA’s peer-led models significantly reduce hospital utilization, incarceration rates, and overall healthcare spending.
Healthcare Innovation: Can you describe a little about your organization’s structure and evolution?
Miccio: People USA is what's known as a peer-run organization. Everyone from me on down in the organization has lived experience of mental health and substance use. The whole idea of the organization was to provide advocacy services for people who were being released from the psychiatric centers in New York to help them cope in the community after being institutionalized for years.
Then we began hiring peers to greet people in a hospital emergency room. That was our first real dive into service delivery. I love the idea of us being the ones that people would see first instead of that traditional medical punitive care model. And it started working right away. It wasn't embraced by the hospital staff until they saw the magic of that engagement and then they asked, ‘why haven’t we done this forever’?
That was a good win for us, but it was just that one hospital. I couldn't get the other hospitals to join in. So in the meantime, we also developed respite houses for people who were getting to that level of crisis where they would go from home to crisis to hospital. We would be that intervening point where they wouldn't have to go to the hospital anymore. They can come to our house. It was like a bed and breakfast. They could stay for seven days for free and get 24-hour peer support if they need it, and they're getting educated on wellness, on how to look at their crisis differently, on what resources there are besides the traditional services. And it worked really well. We now have four respite houses, and the State of New York has licensed them. Based on our model, other states are following suit, so I'm working with other states as well. So it's it's an up-and-coming new service that is very effective in reducing the trauma of going to an emergency room in an inpatient setting. For the people that we're serving, over 90 percent don't go back to hospitals, and they have a better quality of life after working with us in our in our respite houses.
HCI: We hear about traditional hospitals and emergency rooms having people with behavioral health issues and not having any place available to send them. So is this part of the equation — offering them a place to go instead of a hospital?
Miccio: At first, I just wanted people to avoid the hospital because it's so traumatic. They're so overburdened with people in their emergency rooms. The staff are burned out, so the care is just not good. And police departments deal with the same issues where they'll bring someone to the hospital and in two hours that person is back on the street, having the same issues. I worked with a lot of people on building an integrated system where if we call you from the stabilization center, we want them in your services within 24 hours or less. And we've been successful. We have rehabs all over the country that will take folks within 24 hours. Mental health services are still the biggest challenge, but we're working with all providers, traditional, nontraditional, anywhere that we can get them the help they need. And I keep expanding my services because I keep seeing these gaps.
HCI: I saw on your website that you work with a lot of county departments of mental health. What are the challenges that they're facing most right now and have things gotten more intense over the last several years?
Miccio: They're facing the challenges of people in their communities having so many mental health issues. The substance use issues are growing exponentially. So they're embracing us more now. Things have gotten critical since COVID hit, especially with children. During the school year, 50 percent of our guests that come to the stabilization center are under 18. So we're seeing this youth crisis, right now that we're addressing the best we can. What we're finding is that we're providing such good care in our stabilization center that the kids are choosing to want to come back to the stabilization center instead of going to the clinic that we're referring them to because they feel that they're getting better care. We're not designed for that. So then I said, ‘Well, maybe we should open our own clinic to fill that space as well.’ There's a lot of money coming into this space now. But I'm calling it stupid money because we're not integrating like we should, not piecing it together cohesively. I'm trying to do the cohesive work.
HCI: Well, maybe that's a good time to segue into this alternative payment model that CMMI is developing because I think there's a focus on integrating behavioral health with other providers like primary care and social care. Do you think that your organization is the kind that will benefit from that kind of model becoming available?
Miccio: We absolutely will because we look at all the dimensions of wellness: financial and social and employment and faith-based. We work with everyone under those dimensions to say it's not just your mental health, it's not just your substance use, it's your quality of life. So how can we help you with your social determinants, your issues, your poverty, whatever it is you're dealing with? This will help that. But at the same time, you need the partners out there that are going to provide the additional care, because we're not the panacea. We can't do it all. I want to use the system the way it should be used. I think of it as more help is coming so that we can provide the care and empower people to be more self-determined for themselves to live a better quality of life.
HCI: Usually in those alternative payment models, there's a partnership or an accountable care organization bringing together the traditional healthcare system and other providers and doing the quality reporting to CMS. In your region do you have people you can work with on those things?
Miccio: We tend to be the leadership in that even when we're not the funding mechanism. We take the leadership and the responsibility of following the quality indicators the way they should be followed.
HCI: Anything else coming up in the next year as far as geographic expansion? It sounds like you're growing in a lot of different ways just to meet the this burgeoning demand?
Miccio: We're opening new stabilization centers, new respite houses, and mobile teams. I’m developing a whole school-based mobile team that will respond to the school immediately rather than having to pull a kid out of school. We're working more heavily with police departments on the challenges of the people that they're working with in the community.
HCI: I read that you also do consulting with other other organizations around the country about reducing readmissions or ED visits.
Miccio: Yes. Right now we're working in Idaho, where we developed four stabilization centers. We’re in Washington doing respite services. We’re in New Jersey doing stabilization and in Pennsylvania doing stabilization and respite and mobile teams there. So it's nice to be able to work with the states because they're the ones with the dollars. They're the ones that can really push things along, and that's our goal.
HCI: In those cases, do you stress to them having the the peer-based approach, too?
Miccio: Yes we do. We were doing a lot of curriculum development about the value of peers and gathering the data that shows the difference of when it's a peer engagement, how it can complement the traditional system, and help get better information from people so that they can get a better treatment plan put together for them. We have to be able to demonstrate the value and the positive outcomes that we're seeing from it. So I'm putting research into my own organization to extract that.
