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Increasingly, health systems are integrating behavioral health and primary care services as a way to improve outcomes and reduce costs.

As part of this effort, health systems are focused on identifying the most effective treatment approaches to help people overcome mental health or substance use disorders.

Growing evidence and acceptance shows that a recovery-oriented approach to behavioral health care is an important part of health care delivery. This approach engages the individual as an active participant in his or her own treatment.

This approach also engages those closest to the consumer as partners — through peer and family support programs, community-based organizations and advocacy groups.

By exercising best practices of promoting wellness and preventing illness, informed and engaged consumers can dramatically improve outcomes and reduce costs.

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What is “recovery?”

Recovery is a process of change through which individuals living with a mental health or substance use disorder improve their health and wellness, live a self-directed life and strive to reach their full potential.

When someone has achieved recovery, he or she is living a healthy, purposeful life that includes meaningful activities and relationships that offer support and hope.

Whereas the medical model of treatment tends to focus on symptoms, illness and individual deficiencies, the recovery model focuses on strengths, shared power and personal achievement.

Simply put, the recovery paradigm empowers those who live with mental health or substance use conditions to recognize they can live purposeful lives.

Another important aspect of recovery-oriented treatment programs is the emphasis on family involvement. These programs help family members understand the process of recovery and how to become active supporters of their loved one’s efforts.

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Focus on recovery in public health systems

In recent years, counties and states throughout the country have partnered with external firms with Medicaid expertise to assist in developing and implementing recovery-oriented behavioral health systems of care.

Optum®, for example, has helped several public health systems successfully transform their mental health and substance use treatment programs to focus on helping people achieve long-term recovery.

In communities throughout the country, Optum has partnered with local stakeholders to develop recovery-oriented behavioral health programs that address the needs of each population and increase access to care, while helping public agencies maximize limited resources.

  • Transforming care through peer support: Peer services are an integral part of a recovery-oriented approach to behavioral health care. A peer is an individual who has managed his or her own behavioral health issue and is in recovery.

    Peers are trained to help people currently dealing with a mental health or substance use issue by providing support, encouragement and links to community resources.

    Optum has helped bring peer support services into systems in New Mexico, New York, Tennessee, Utah and Washington State, resulting in better adherence to follow-up treatment, fewer unnecessary re-hospitalizations and significant cost savings for local governments.
  • Helping high-risk members avoid re-hospitalization and live independently in their communities: The Optum Field Care Advocate (FCA) teams operate in 11 states and provide support for high-risk members with behavioral health conditions, including Medicaid beneficiaries.

    The FCA team is made up of independently licensed social workers and mental health clinicians who work to engage with consumers and connect them to treatment, tools and community resources in a community setting.

    The advocates work with both members and providers to help overcome barriers to treatment and recovery, such as access to transportation and housing.

  • Jail diversion and alternatives to incarceration programs: Many communities have experienced an increase in the number of offenders with mental health or substance use issues booked into local jails.

    Many of these offenders churn through the criminal justice system multiple times and experience numerous incarcerations. As a result, many local jail systems are overwhelmed and face increased operating costs.

    In collaboration with local governments, Optum has helped implement programs designed to reduce the time people with mental health or substance use issues spend in jail. These programs redirect people from the criminal justice system to community-based care.

    • Since 2009, Optum has served as the Regional Support Network (RSN) for Pierce County in Washington State. The RSN coordinates mental health care for approximately 134,500 Medicaid beneficiaries each month.

      In 2012, Optum worked with public health and law enforcement leaders to establish the Community Re-Entry program. This program reduces the time people with mental health issues spend in jail by redirecting them to appropriate treatment and community support services.

      The program also helps reduce and prevent future run-ins with law enforcement by helping these individuals get assistance once released, including help finding housing, assistance with applying for benefits, and family and child care services.

    • In Salt Lake County, UT, Optum manages mental health and substance use services for approximately 100,000 Medicaid beneficiaries.

      It’s estimated that nearly 60 percent of people in a county jail have a mental illness. The ability to coordinate care and link people to services is integral to keeping them out of the criminal justice system and to supporting their successful recovery.

      The county has collaborated with Optum to establish programs that quickly identify adults with serious mental illness who are booked into a county jail.

      Optum staff then work with a local provider, the court and the legal system to transition those people to mental health services more quickly and reduce incidents of re-incarceration.

      These programs engage people in mental health or substance use treatment services, thus reducing their likelihood of recidivism and improving their chances of achieving recovery.

As Medicaid programs face continuing fiscal pressures and increased demand for behavioral health services, implementing a recovery-oriented system of care is an important step in developing a care delivery system that results in improved outcomes and reduced costs.

 

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