Integrated care rising in popularity

See how integrated care improves access and contains costs.

There is a growing consensus among state Medicaid programs regarding the value of integrating behavioral health care and medical services.

The key drivers behind recent integration efforts include:

  • Increased recognition that physical conditions, mental health conditions and substance use issues are connected and often occur at the same time.
    Significant segments of Medicaid’s highest-cost members have both multiple chronic physical conditions and a mental illness, according to a study by the Center for Health Care Strategies, Inc.1
  • The Affordable Care Act of 2010 created an option for states to establish “Health Homes,” which operate under a “whole person” philosophy. They coordinate care for beneficiaries who have chronic conditions such as asthma, diabetes and mental health conditions.
  • Facing shrinking budgets and a growing population, Medicaid policy makers realize they need to coordinate physical, behavioral and substance use services to improve access to quality care and contain health care costs.

In recent years, states have partnered with external firms with Medicaid expertise to assist in developing and implementing integrated delivery systems. Optum®, for example, has worked closely with public entities on the following initiatives:

New Mexico

Optum has served for the past four years as the Statewide Entity for mental health and substance use services, managing all behavioral health services provided through the 17 state agencies that comprise the New Mexico Behavioral Health Collaborative.

By expanding the use of telemedicine — secure video conferencing between a patient and provider — for residents in rural areas with few behavioral health specialists, Optum has helped increase care coordination for those with physical and mental health conditions.

San Diego County, CA

Since October 1997, Optum has provided comprehensive administrative services for 425,000 Medicaid members in San Diego County.

Optum is working with the county to integrate care between the behavioral health provider network and the federally qualified health centers (FQHC) where many Optum members receive their medical care.

Nevada

Optum sister company, Behavioral Healthcare Options, provides behavioral health management services to 104,000 Medicaid members.

Those enrolled in the chronic condition management program are routinely screened for depression in the primary care setting. And, when appropriate, they are referred to behavioral health services.

Increasing numbers of states are embracing integrated care models in an effort to expand access for their Medicaid populations while achieving cost savings.

Washington and Idaho, for example, recently selected Optum as their partner based on its solid track record of coordinating medical and behavioral health services for Medicaid programs across the country.

Washington

The Washington State Health Care Authority designated Optum to serve as a Medicaid Health Home in four out of seven areas of the state. Optum is currently building capacity to serve approximately 10,000 Health Home enrollees in these areas.

This designation builds upon the foundation Optum has already developed in Pierce County, Washington. Since 2009, Optum has served the county as the Regional Support Network (RSN).

As the RSN, Optum coordinates mental health care for Medicaid beneficiaries (an eligible monthly population of approximately 135,500). An integrated approach is used to monitor and provide care for enrollees’ physical and mental health care needs.

This is done through a network of inpatient, outpatient and residential treatment providers, specialized mobile crisis teams and certified peer counselors who work with patients to make lifestyle changes.

Working to connect people with mental health conditions to community-based resources, Optum served 32 percent more people and reduced unnecessary hospitalizations by more than 32 percent, while saving the county an estimated $7.3 million cumulatively over three years.

With responsibilities for both Health Home and RSN support, Optum will further its emphasis on integration. Optum will coordinate care for all assigned Medicaid and Medicaid/Medicare beneficiaries who have chronic medical and/or serious and persistent mental illness.

Wellness coaches and licensed clinicians skilled in managing co-morbid chronic conditions and behavioral change methods will provide care coordination.

Idaho

On September 1, 2013, Optum began managing behavioral health services for adults and children enrolled in Medicaid through the Idaho Behavioral Health Plan.

Optum is administering outpatient community-based mental health and addiction disorder services to help people access the most effective treatment. The goal is to create a behavioral health system that is more coordinated and accountable.

To achieve this goal, Optum is expanding the local network of behavioral health providers and offering new services.

These include the use of peer support, services that help enrollees transition back to their communities following discharge from a hospital or other in-patient facility, and programs that support enrollees’ family members as they support their loved ones in recovery.

Additionally, Optum operates a free, 24-hour, seven-days-a-week mental health crisis hotline. The hotline provides support and provider referrals to individuals experiencing a mental health or substance use crisis.

In light of their constrained budgets, many Medicaid programs are working to further integrate physical, behavioral and substance use services to improve access and lower costs.

Optum is dedicated to working in partnership with public entities to implement accountable, outcome-driven results that help Medicaid programs make the most effective use of public funding.

 

References

  1. Richard G. Kronick, Melanie Bella and Todd P. Gilmer, Center for Health Care Strategies, Inc., “The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions” (October 2009), http://www.chcs.org/usr_doc/Faces_of_Medicaid_III.pdf.