Category 1 Project: 127376505 1.1
Project Option 1.13.1 - Develop and implement crisis stabilization services to address the
identified gaps in the current community crisis system.
Unique Project ID: 127376505 1.1
Performing Provider Name/TPI: Emergence Health Network/127376505
Project Description:
Emergence Health Network (“EHN”) proposes to develop an Extended Observation Unit
(“EOU”) as an alternative to inappropriate systems of care.
The EOU will serve as a stabilization and treatment location for individuals presenting in crisis
with behavioral health needs. Community stakeholders to include law enforcement, first
responders and other community providers will be educated regarding the service availability
in the EOU. By design, the EOU will be able to serve individuals that are of voluntary and
involuntary status, thereby avoiding the need to take these individuals to the local emergency
departments or inappropriate systems of care. Individuals that present at the EOU will
receive a medical screening and/or clearance. All non-emergent medical needs will be
addressed through an escalated medical clearance protocol. The EOU will have the
infrastructure to serve all of the individual’s bio psychosocial needs to include substance
abuse, non-medical detoxification, therapeutic interventions, medication maintenance and
stabilization.
The current behavioral health care system in El Paso, TX has limited options for appropriate
community based services and a shortage in acute/sub-acute inpatient beds. This results in
individuals receiving treatment in local emergency departments, the criminal justice system
and other systems of care. When individuals are treated in less desirable settings, the cost to
the community significantly increases.
Goals and Relationship to Regional Goals:
Implementation of this proposed project will provide an additional choice for appropriate
behavioral health crisis resolution. The EOU will alleviate the burden currently placed on local
emergency departments and first responders. Secondly, the EOU will be an avenue for law
enforcement to divert individuals in crisis to more appropriate settings.
Project Goals:
 Increase access to appropriate behavioral health services.
 Decrease utilization of inappropriate systems of care.
 Reduce the overall volume of individuals utilizing hospital emergency departments for
psychiatric care.
This project meets the following regional goals:
 Enhance and expand behavioral health services to increase access as well as provide
service alternatives to inappropriate systems of care.
EHN believes that early intervention and access to behavioral health services decreases the
utilization of inappropriate systems of care. When services are provided in appropriate
Category 1 Project: 127376505 1.1
settings, such as an EOU, the cost for services significantly decreases and cost-savings is
realized for all stakeholders.
Challenges:
The primary challenge for this project will be to engage treating physicians, law enforcement,
and other community stakeholders to utilize the EOU as an appropriate community based
service for individuals with behavioral health needs. EHN will overcome this challenge by
providing educational meetings to community stakeholders. EHN will collaborate with
community stakeholders to develop and implement processes related to the EOU.
5-Year Expected Outcome for Provider and Patients:
Emergence Health Network expects to see a reduction in the number of emergency room
visits utilized by individuals presenting in a psychiatric crisis. Expected outcomes will relate to
the project goals described above.
Starting Point/Baseline:
The EOU is a new initiative for the community; therefore a starting baseline will be
determined during the analysis of community needs for crisis services.
Rationale:
The EOU will assist the El Paso Community by diverting individuals away from the local
Emergency Departments and law enforcement contact to a more appropriate treatment
setting. Utilization of the EOU will result in an overall cost savings for the community.
Services provided in the EOU will include:





Prompt and comprehensive assessment of a behavioral health crisis
Rapid stabilization in a secure, protected, and safe environment
Crisis resolution
Linkage to appropriate aftercare services
Reduction of inpatient and law enforcement interventions
“Inappropriate holding of individuals with mental health needs in local emergency rooms”
(Regional Strategic Health Framework Needs Assessment Report 2011) was identified as an
area requiring improvement. It was identified that individuals with mental health needs are in
local emergency rooms for up to 172 hours awaiting appropriate services. On a monthly basis
there is an average of approximately 374 individuals waiting in an emergency department for
behavioral health care. Of those 374 individuals and average of 164 are admitted into an
inpatient psychiatric facility. In addition, on a monthly basis there is an average of 300
individuals in the El Paso County Detention Facility identified with behavioral health needs.
Implementation of this proposed project will provide an additional choice for appropriate
behavioral health crisis resolution, alleviate the burden currently placed on local emergency
departments and first responders and be an avenue for law enforcement to divert individuals
in crisis to more appropriate settings.
Category 1 Project: 127376505 1.1
Project Components:
Through the EOU, EHN proposes to meet the following project components:
a) Convene community stakeholders who can support the development of crisis
stabilization services to conduct a gap analysis of the current community crisis system
and develop a specific action plan that identifies specific crisis stabilization services to
address identified gaps (e.g. for example, one community with high rates of
incarceration and/or ED visits for intoxicated patients may need a sobering unit while
another community with high rates of hospitalizations for mild exacerbations mental
illness that could be treated in community setting may need crisis residential
programs). EHN will host meetings with all affected and interested stakeholders to
include County Commissioner’s Court, El Paso Judicial System, Public Defender’s
Office, District Attorney’s Office, El Paso Sherriff’s Office, County Attorney’s Office, El
Paso Police Department, all local emergency departments, private and public inpatient
psychiatric facilities, outpatient behavioral health providers and the El Paso Homeless
Coalition. The purpose of the committees will be to discuss appropriate crisis
stabilization services, analyze the current crisis continuum of care and assess the
behavioral health needs of individuals currently receiving crisis services in the
community. Outcomes shall include establishing Memorandum of Understandings,
Business Associate Agreements, and plans and protocols for implementation of the
EOU. The committee will reconvene on a regular basis to assess the impact of the
implementation of the EOU on the community.
b) Analyze the current system of crisis stabilization services available in the community
including capacity of each service, current utilization patterns, eligibility criteria and
discharge criteria for each service. EHN will conduct a mapping and gap analysis of the
current continuum of care for crisis services. The written plan will include current
utilization patterns, eligibility criteria for each service array.
c) Assess the behavioral health needs of patients currently receiving crisis services in
the jails, EDs, or psychiatric hospitals. Determine the types and volume of services
needed to resolve crises in community-based settings. Then conduct a gap analysis
that will result in a data-driven plan to develop specific community-based crisis
stabilization alternatives that will meet the behavioral health needs of the patients
(e.g. a minor emergency stabilization site for first responders to utilize as an alternative
to costly and time consuming Emergency Department settings). EHN will conduct a
mapping and gap analysis of the current continuum of care for crisis services. The
analysis will assess individuals receiving crisis services in jails, EDs, psychiatric
hospitals, and other access points.
e) Review the intervention(s) impact on access to and quality of behavioral health crisis
stabilization services and identify “lessons learned,” opportunities to scale all or part of
the intervention(s) to a broader patient population, and identify key challenges
associated with expansion of the intervention(s), including special considerations for
safety-net populations. On a monthly basis, EHN will monitor impact on access and
quality of services through data collection. Key community stakeholders will
Category 1 Project: 127376505 1.1
participate in the meetings to assist in identifying “lessons learned” and
implementation of interventions as challenges are identified. EHN is the designated
Mental Health/IDD Authority therefore will serve as the community safety-net.
EHN has chosen not to implement the following project components:
d) Explore potential crisis alternative service models and determine acceptable and
feasible models for implementation. EHN has chosen to implement an EOU as the
service model for this project.
Unique community need identification numbers the project addresses:
 CN.3 – Behavioral Health
How the project represents a new initiative or significantly enhances an existing delivery
system reform initiative:
Currently, an EOU does not exist in El Paso County. The initiative will improve access to
appropriate community based behavioral health care.
No other federal funding is being utilized for this initiative.
Related Category 3 Outcome Measures:
OD-9 Right Care, Right Setting:
IT 9.2 ED appropriate utilization
 Reduce Emergency Department visits for target conditions
o Behavioral Health/Substance Abuse
Reasons/rationale for selecting the outcome measures:
The expected outcome is that there will be a reduction in the utilization of emergency
departments and criminal justice system as individuals will receive the needed care in the
EOU. EHN selected the outcome measures to address “inappropriate holding of individuals
with mental health needs in local emergency rooms” (Regional Strategic Health Framework
Needs Assessment Report 2011).
The Extended Observation Unit is a diversionary service which will reduce the cost associated
with unnecessary inpatient hospitalizations. In a randomized trial study conducted on the
short –term acute residential treatment for veterans, co-authors (Hawthorne, Green, Gilmer,
Garcia, Hough, Lee, Hammond, & Lohr, 2005) stated, “In this randomized trial, START—an
alternative to inpatient treatment was less costly, yielded higher levels of satisfaction with
services, and produced similar outcomes to those achieved with hospital treatment. The
results of this study provide support for a certified and accredited hospital alternative
treatment model that is suitable for adults who need voluntary acute psychiatric care and
who meet age and medical criteria. These results add to the accumulated body of research
supporting non–hospital-based acute psychiatric alternatives”. In this study, the mean cost for
the START participants showed a 65% decrease in cost as opposed to the individuals who were
treated in an inpatient hospital setting.
Category 1 Project: 127376505 1.1
Relationship to other Projects: The EOU project is related to the Crisis Respite Unit (Project
#2.1), Crisis Stabilization for IDD population (Project #2.2) and Expand Behavioral Health
Providers (Project #1.2). The proposed projects offer additional crisis stabilization alternatives
for the community. The Expand Behavioral Health Providers project will ensure access to
appropriate care in community settings.
Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative:
No other providers in the RHP are establishing an EOU. EHN will participate in scheduled
meetings with other providers in the RHP to promote collaborative learning around shared,
similar projects, or other projects impacting the community.
Project Valuation: Valuation of the EOU was based on average cost and length of stay related
to individuals that require inpatient hospitalization, individuals served by local emergency
departments, and individuals incarcerated.
Category 1 Project: 127376505 1.1
Category 1 Project: 127376505 1.1
127376505 1.1
Related Category 3
Outcome
Measure(s):
1.13.1
1.13.1.A.B.C.D.E
Emergence Health Network
IT-9.2
127376505 3.1
EXTENDED OBSERVATION UNIT
127376505
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1 (P-1)
Conduct stakeholder meetings
among consumers, family
members, law
enforcement, medical staff and
social workers from EDs and
psychiatric hospitals, EMS,
and relevant community
behavioral health services
providers.
Metric 1 (P-1.1): Number of
meetings and participants.
Year 3
(10/1/2013 – 9/30/2014)
Milestone 5 (P-6)
Evaluate and continuously
improve crisis services.
Year 4
(10/1/2014 – 9/30/2015)
Milestone 7 (I-12): Utilization
of appropriate crisis
alternatives
Year 5
(10/1/2015 – 9/30/2016)
Milestone 8 (I-12): Utilization
of appropriate crisis
alternatives
Metric 1 (P-6.1): Project
planning and implementation
documentation demonstrates
plan, do, study, act quality
improvement cycles.
Metric 1 (I-12.1):% increase in
utilization of appropriate crisis
alternatives.
Metric 1 (I-12.1):% increase in
utilization of appropriate crisis
alternatives.
Goal: TBD
Goal: TBD
Goal: Evaluate and improve
crisis services.
Data Source: Claims,
encounter, and clinical record
data.
Data Source: Claims,
encounter, and clinical record
data.
Baseline/Goal: Establish a
baseline of quarterly
admissions
Data Source: Project reports
include examples of how realtime data is used for rapidcycle improvement to guide
continuous quality
improvement
Milestone 7 Estimated
Incentive Payment: $5,001,708
Milestone 8 Estimated
Incentive Payment: $5,805,462
Data Source: Attendance lists
Milestone 1 Estimated
Incentive Payment (maximum
amount): $1,214,321
Milestone 5: Estimated
Incentive Payment (maximum
amount): $2,068,181
Milestone 6 (I-12): Utilization
Category 1 Project: 127376505 1.1
127376505 1.1
Related Category 3
Outcome
Measure(s):
1.13.1
1.13.1.A.B.C.D.E
Emergence Health Network
IT-9.2
127376505 3.1
Year 2
(10/1/2012 – 9/30/2013)
Milestone 2 (P-2)
Conduct mapping and gap
analysis of current crisis
system.
Metric 1 (P-2.1): Produce a
written analysis of community
needs for crisis services.
Baseline/Goal: Identify
community needs for crisis
services.
Data Source: Written plan
Milestone 2: Estimated
Incentive Payment (maximum
amount): $1,214,321
Milestone 3 (P-4)
Hire and train staff to
implement identified crisis
stabilization services.
Year 3
(10/1/2013 – 9/30/2014)
of appropriate crisis
alternatives
Metric 1 (I-12.1):% increase in
utilization of appropriate crisis
alternatives.
Goal: TBD
Data Source: Claims,
encounter, and clinical record
data.
Milestone 6 Estimated
Incentive Payment: $2,068,181
EXTENDED OBSERVATION UNIT
127376505
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Category 1 Project: 127376505 1.1
127376505 1.1
Related Category 3
Outcome
Measure(s):
1.13.1
1.13.1.A.B.C.D.E
Emergence Health Network
IT-9.2
127376505 3.1
Year 2
(10/1/2012 – 9/30/2013)
Metric 1 (P-4.1): Number of
staff hired and trained.
Baseline/Goal: Hire and train
staff.
Data Source: Training curricula
Milestone 3: Estimated
Incentive Payment (maximum
amount): $1,214,321
Milestone 4 (P-5)
Develop administration of
operational protocols and
clinical guidelines for crisis
services.
Metric 4 (P-5.1): Completion of
policies and procedures.
Baseline/Goal: Complete
operational protocols and
clinical guidelines.
Year 3
(10/1/2013 – 9/30/2014)
EXTENDED OBSERVATION UNIT
127376505
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Category 1 Project: 127376505 1.1
127376505 1.1
Related Category 3
Outcome
Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Data Source: Internal policy
and procedures documents
and operations manual.
1.13.1
1.13.1.A.B.C.D.E
Emergence Health Network
IT-9.2
127376505 3.1
Year 3
(10/1/2013 – 9/30/2014)
EXTENDED OBSERVATION UNIT
127376505
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Milestone 4: Estimated
Incentive Payment (maximum
amount): $1,214,321
Year 2 Estimated Milestone
Year 3 Estimated Milestone
Year 4 Estimated Milestone
Year 5 Estimated Milestone
Bundle Amount: (add incentive Bundle Amount: $4,136,362
Bundle Amount: $5,001,708
Bundle Amount: $5,805,462
payments amounts from each
milestone): $4,857,284
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add milestone bundle amounts over Years 2-5): $19,800,816
Category 3 Project: 127376505 3.1
Related Category 1 Project: 127376505 1.1
Title of Outcome Measure (Improvement Target): IT-9.2 ED appropriate utilization
Unique RHP outcome identification number(s): 127376505 3.1
Outcome Measure Description:
IT-9.2 ED appropriate utilization
 Reduce Emergency Department visits for target conditions
o Behavioral Health/Substance Abuse
Process Milestones:
 DY2:
o P-1 - Project planning - engage stakeholders, identify current capacity and
needed resources, determine timelines and document implementation
plans
o P-2 - Establish baseline rates
Outcome Improvement Targets for each year:



DY3:
o IT-9.2 ED appropriate utilization
 Reduce Emergency Department visits for target conditions
 Behavioral Health/Substance Abuse
DY4:
o IT-9.2 ED appropriate utilization
 Reduce Emergency Department visits for target conditions
 Behavioral Health/Substance Abuse
DY5
o IT-9.2 ED appropriate utilization
 Reduce Emergency Department visits for target conditions
 Behavioral Health/Substance Abuse
Rationale:
Process milestones – P-1 and P-2 were chosen to measure and monitor emergency
department utilization. In order to report accurate data and establish baselines, P-2 must be
approached in DY2.
The improvement target was chosen based on the timeframe allowed to put in place the
proper resources and processes needed to collect data. The outcome measure being
addressed is affected by community education and willingness to use the service array.
Outcome Measure Valuation: Valuation of the EOU was based on average cost and length of
stay related to individuals that require inpatient hospitalization, individuals served by local
emergency departments, and individuals incarcerated.
Category 3 Project: 127376505 3.1
Related Category 1 Project: 127376505 1.1
Category 3 Project: 127376505 3.1
Related Category 1 Project: 127376505 1.1
127376505.3.1
9.IT.9.2
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
Emergence Health Network
Related Category 1 or 2
Projects::
Starting Point/Baseline:
Year 2
(10/1/2012 – 9/30/2013)
Process Milestone 1 P-1:
Project planning-engage
stakeholders, identify current
capacity and needed resources,
determine timelines and
document implementation
plans
Data Source: Plans and
agendas
Process Milestone 1 Estimated
Incentive Payment (maximum
amount): $0
Process Milestone 2 P-2:
Establish baseline rates
Data Source: Baseline data
Process Milestone 2 Estimated
Incentive Payment: $0
127376505
127376505.1.1
Year 3
(10/1/2013 – 9/30/2014)
Outcome Improvement Target
1 IT-9.2: ED appropriate
utilization
Improvement Target: TBD
Data Source: ED Data
TBD
Year 4
(10/1/2014 – 9/30/2015)
Outcome Improvement Target
2 IT-9.2: ED appropriate
utilization
Improvement Target: TBD
Data Source: ED Data
Year 5
(10/1/2015 – 9/30/2016)
Outcome Improvement Target
3 IT-9.2: ED appropriate
utilization
Improvement Target: TBD
Data Source: ED Data
Outcome Improvement Target
1 Estimated Incentive
Payment: $459,596
Outcome Improvement Target
2 Estimated Incentive
Payment: $555,745
Outcome Improvement Target
3 Estimated Incentive
Payment: $1,451,366
Category 3 Project: 127376505 3.1
Related Category 1 Project: 127376505 1.1
127376505.3.1
9.IT.9.2
Emergence Health Network
OD‐9 Right Care, Right Setting
IT‐9.2 ED appropriate utilization
127376505
Related Category 1 or 2
127376505.1.1
Projects::
Starting Point/Baseline:
TBD
Year 2
Year 3
Year 4
Year 5
(10/1/2012 – 9/30/2013)
(10/1/2013 – 9/30/2014)
(10/1/2014 – 9/30/2015)
(10/1/2015 – 9/30/2016)
Year 2 Estimated Outcome
Year 3 Estimated Outcome
Year 4 Estimated Outcome
Year 5 Estimated Outcome
Amount: (add incentive
Amount: $459,596
Amount: $555,745
Amount: $1,451,366
payments amounts from each
milestone/outcome
improvement target): $0
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD (add outcome amounts over DYs 2-5): $2,466,707