Strengthening communities by building integrated systems of care
Today’s Medicaid environment is undergoing unprecedented change, and state and county directors are challenged by meeting the demands of tremendous membership expansion, as well as current trends toward stronger medical-behavioral integration and migration from fee-for-service to managed care arrangements.
Optum is an expert in helping communities meet these challenges. As the country’s largest managed behavioral health organization, our partners benefit from our economies of scale, our unmatched clinical bench, and our deep experience in serving all Medicaid populations, including TANF, ABD, low income, frail elderly, and dual eligibles. We offer more than just advanced full-risk mental health and substance use disorder services. We offer full partnership with you and your community to create integrated systems of care that help you meet the CMS Triple Aim objectives by:
- Ensuring the best care possible while lowering costs
- Integrating solutions that improve the overall care experience for everyone
- Empowering providers to achieve the best outcomes
- Empowering and engaging individuals to live their best life
Better care. Lower costs. Focused on your goals.
Working with states and counties, consumers, providers, and other stakeholders, Optum has developed collaborative local systems of care to improve individual health and recovery while maximizing program funds.
We start by analyzing the population to identify areas of clinical risk, treatment variation, and gaps in care. Then we collaborate on a tailored solution to address those areas, leveraging our clinical services, local community resources, specialized programs such as peer support and telespsychiatry, and provider ratings and performance-based contracts. These collaborative partnerships have been proven to:
- Expand access to community services that support recovery and wellness
- Simplify the health care experience for consumers and families
- Reduce administrative burdens for providers
- Improve the quality of care across the system, including adherence to evidence-based practices
Making a real difference in communities across the country
Learn more about how Optum:
- Saved Pierce County, Washington over $7 million through reduced hospitalization while serving 32% more people
- Reduced recidivism and length of stay in jail by 80% in Salt Lake County, Utah
- Diverted 54.2% of residential treatment admissions of Tennessee youth to more appropriate community services
- Prevented post-treatment addiction relapse for over half of the participants in a unique peer support program in New York City
- Improved care for high-need, high-cost Medicaid fee-for-service beneficiaries as part of New York’s Chronic Illness Demonstration Project (4-min. video)
Optum is ICD-9 compliant with concurrent accreditation with NCQA and URAC for behavioral health management.
Our commitment to person-centered, recovery-oriented care
Our foundational approach to helping people drives all aspects of our mental health and substance abuse programs.
We know that the best care, is person-centered care. That’s why we strive to incorporate these core principles into our relationships with each person we serve:
- Honoring individuals by focusing on their personal strengths and goals (as opposed to just the symptoms) to help them achieve recovery
- Taking a whole-person health approach that addresses their physical and mental health while considering the person’s living environment (housing and work status) and access to community supports
- Meeting individuals where they are by helping them access information, tools and services they need to achieve and maintain their well-being
- Leveraging proven recovery and resiliency principles into the consumer experience by:
- Instilling a sense of hope that recovery is possible
- Enabling people to set goals that are personally meaningful and motivating to them
- Ensuring they are empowered and engaged in their own recovery, especially with the support of our highly effective certified Peer Support Specialists
We bridge fragmented delivery systems with integrated solutions
We eliminate barriers between medical, behavioral and social services by integrating necessary technology, services, and supports around the needs of the consumer population, including:
- Telepsychiatry services to improve access to care
- Mobile medical clinic for mental health agencies
- Cross-access to electronic health records
- Psychotropic pharmacy review and intervention
- Aligned incentives and performance-based contracting around whole-person care
Optum has been selected as the lead entity for integrated health homes for four areas in Washington and two state plan programs in Kansas — coordinating care for all assigned Medicaid and Medicaid/Medicare beneficiaries who have chronic medical and/or serious and persistent mental illness.
We encourage and reward provider performance
Optum’s performance-based contracts in New Mexico improved clinical metrics by 35-55%
We create true collaborative partnerships with providers with the goal of helping them deliver the best possible care and rewarding positive results. Our sophisticated performance measurement and rating system gauges clinical outcomes of behavioral network providers. We make these ratings transparent and provide comparative performance feedback to help providers enhance their practice. We also offer performance-based contracts and other incentives that reward providers for increased collaboration, outcome-based results, and improved cost-effectiveness.
We empower your population on their journey to recovery
We help people achieve their wellness goals in ways that work most effectively for them. Our programs offer:
- Training programs to build coping skills that support resiliency and well-being, including wellness and recovery action planning (WRAP)
- Access to local supports such as peer-based warm lines and crisis response centers, and consumer-run respite services, to help reduce panic, fear and isolation
- Self-guided tools and resources to keep people engaged in their own recovery, including local support groups, whole-health resource guides, and “how-to” kits co-developed with SAMHSA
Community Collaboration in Action
Optum partners with those closest to the consumer — peer and family support programs, community-based organizations and advocacy groups — to enhance local systems of mental health and substance abuse care.
- We’ve established a powerful Consumer Advisory Board of nationally recognized front-line supporters and consumer advocate leaders (including NAMI, MHA, DBSA, and others) to validate our person-centered approach
- We’ve partnered with the National Council for Behavioral Health to train providers to apply our recovery and resiliency care approach in their practice
- We’ve created a workgroup of national clinical professionals and consumer-run organization representatives to successfully establish level-of-care criteria for peer support services to guide treatment planning, care management, and evaluation of outcomes
- Optum worked with the National Association of State Mental Health Program Directors and the Carter Center to architect “Pillars of Peer Support” discussions to educate states on the benefits of applying to CMS for Medicaid reimbursement for peer services