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ABHW Member Company Spotlight – OptumHealth

Over the course of the year, ABHW will be spotlighting member companies for the Perspectives section of the website. Interviews conducted with ABHW’s members will highlight programs and initiatives they are offering; preparations underway for the implementation of the Patient Protection and Affordable Care Act (ACA); or other current topics of interest.
For this piece, ABHW obtained information about an initiative Optum has in Tennessee addressing high utilization of residential treatment by children and adolescents in the Medicaid program. OptumHealth, a part of Optum and an ABHW member, has 30-plus years of experience and is a provider of comprehensive mental health and substance abuse services. Their behavioral programs can be integrated with medical and health-specialty services to help ensure that behavioral issues are addressed anywhere they occur in the health care continuum.

Optum Tennessee: Helping Youths Remain in the Community while Supporting Their Recovery and Well-Being Background

In Tennessee, Optum™ is a subcontractor to our sister company UnitedHealthcare® Community & State (formerly AmeriChoice®), providing integrated management of medical and behavioral health services for over 550,000 members since April 2007. In 2009, Optum partnered with UnitedHealthcare Community & State on a health care quality initiative regarding high utilization of residential treatment by children and adolescents in the Tennessee Medicaid program. The goal of this initiative was to ensure youth who could receive the appropriate level of services in a community setting were not removed from their homes and needlessly admitted to residential treatment facilities.

Data provided to Optum from Mobile Crisis Teams suggest that when those providers evaluate members in the emergency room to determine if a behavioral health hospitalization is needed, there is a greater likelihood of admission than when the member is evaluated at home or in other community settings. The health plan identified this same phenomenon with residential treatment for children and adolescents. When a youth was presented to a residential treatment facility and was assessed by the clinical staff at that facility, there was a greater likelihood of recommendation for admission to that facility than if a referral was made without assessment at the facility.

In addition, the psychiatrists at these residential facilities were not involved in the initial assessment of these youth and had not evaluated their appropriateness for admission. There were many instances when a non-clinical person such as a probation officer, judge or family member recommended residential treatment. Individuals without clinical backgrounds may not be as aware of alternatives to residential treatment or may not know how to access community-based services that will enable a youth to remain at home.

Interventions

Interventions in the Residential Treatment Quality Initiative include the following.

Results

From May of 2009 through April of 2013, 2,412 in-home or community evaluations of youth referred for residential treatment were completed. 991 (41%) of these evaluations resulted in diversion from residential treatment, allowing the youth to remain in their homes with additional community-based services in place. As shown in Figure 1, there has been a year-over-year trend of increased diversion rates over this period of time as well. Only a small number (approximately 4% to 6%) of children and adolescents who were initially diverted were later admitted into a residential setting. This was due to a number of reasons, including increasing symptomatology that required a more intensive and structured level of treatment, or because of involvement with the State Child Welfare system, which often places children and adolescents in residential treatment as an alternative to having them become wards of the state.

Our successful approach to youth residential treatment diversion has been recognized by the Medicaid Health Plans of America Center for Best Practices in their 2012 Best Practices Compendium for Serious Mental Illness.

Figure 1

ABHW

Perspectives

CONSUMER TIPS: NAVIGATING YOUR PRIOR AUTHORIZATION.

Behavioral health is complex. Untreated behavioral health conditions, including both mental health and substance use disorders, have a significant impact on individuals, families, friends, and employers. Individuals with mental health conditions and/or substance use disorders need access to evidence-based services - the care that, based on scientific research, has been shown to...

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ABHW

Publications

June 26, 2017 ABHW Letter in Support of the Nomination of Elinore F. McCance-Katz, MD, PhD, for Assistant Secretary for Mental Health and Substance.

ABHW Letter to Chairman Hatch on Health Care Reform Process in the Senate (May 23, 2017)

ABHW Press Release: ABHW Issues Statement in Wake of House Passage of AHCA (May 4, 2017)

ABHW Letter to House Leadership on AHCA and MacArthur Amendment (May 2, 2017)

ABHW Press Release: ABHW to Chair Inaugural Payer-Provider Behavioral Health Management Summit (April 26, 2017)

ABHW Press Release: ABHW Recommends Improvements to Medicare Advantage Program (April 25, 2017)

ABHW Press Release: ABHW Welcomes White House Commission on Opioids (March 30, 2017)

ABHW Press Release to House Leadership Over AHCA Concerns (March 23, 2017)

ABHW Comment Letter to House Leadership on ACHA (March 22, 2017)

ABHW Press Release on Confirmation of New HHS Secretary Price and CMS Administrator Verma (March 17, 2017)

ABHW Comment Letter to Rep Murphy (March 10, 2017)

ABHW Comment Letter on Market Stabilization Prop Rule (March 8, 2017)

ABHW Press Release on SNPRM Part 2 Comment Letter (February 17, 2017)

ABHW SNPRM Comment Letter to SAMHSA on Confidentiality (February 17, 2017)

ABHW Summary of 42 CFR Part 2 Final Rule and SNPRM (February 1, 2017)

ABHW Paper - Behavioral Health Organizations Current and Future Approaches to Addressing the U.S. Opioid Crisis (May 2016)

ABHW Comments on the notice of proposed rulemaking on Medication Assisted Treatment for Opioid Use Disorders (May 27, 2016)

ABHW and Diverse List of Health Care Stakeholders Letter to House Leadership calling attention to the importance of amending 42 CFR Part 2 (May 10, 2016)

ABHW Interview on 42 CFR Part 2 (April 27, 2016)

ABHW Editorial on 42 CFR Part 2 (April 11, 2016)

ABHW Press Release: ABHW and Diverse List of Health Care Stakeholders want HIPAA Standard to Apply to Substance Use Records (April 11, 2016)

ABHW and Diverse List of Health Care Stakeholders Comments: on the notice of proposed rulemaking on the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2 (April 11, 2016)

ABHW Comments: on the notice of proposed rulemaking on the Confidentiality of Substance Use Disorder Patient Records, 42 CFR Part 2 (April 11, 2016)

ABHW Press Release: ABHW Supports Changes to Outdated Substance Use Disorder Privacy Regulation (February 5, 2016)

ABHW Paper: on 42 CFR Part 2 - Now is the Time to Strengthen Protection of Substance Use Records by Revisiting the Substance Use Privacy Law (December 21, 2015)

ABHW Press Release: on 42 CFR Part 2 - All ABHW Wants for Christmas are Changes to the Substance Use Privacy Law (December 21, 2015)

ABHW Paper: on Healthcare Integration in the Era of the Affordable Care Act (August 5, 2015)

ABHW Press Release: ABHW Released Report Demonstrating Critical Role Managed Behavioral Healthcare Organizations Play in the Integration of Behavioral and Physical Health (August 5, 2015)

ABHW Press Release: on the Institute of Medicine (IOM) report on Psychosocial Interventions for Mental and Substance Use Disorders (July 14, 2015)

ABHW Comments on SAMHSA’s Peer Core Competencies: ABHW is pleased to see a comprehensive list of essential core competencies required by peer providers. (May 21, 2015)

ABHW Press Statement: ABHW Mourns Loss of Robin Williams (August 12, 2014)

Stamp Out Stigma highlighted in Behavioral Healthcare, MBHOs Launch Anti-Stigma Campaign for MI and SUD (May 22, 2014)

ABHW Press Release: ABHW Applauds Reps. Peters and Miller for Introducing National Mental Health No Stigma Week Resolution (May 14, 2014)

ABHW Press Release: ABHW Launches Stamp Out Stigma Campaign to Reach 1 Million People in 2014 (April 2, 2014)

Final Parity Rule Provides New Guidance for ABHW Members – The Association for Behavioral Health and Wellness (ABHW) issued the following statement today in response to the release of the final Mental Health Parity and Addiction Equity Act (MHPAEA) regulations this morning. (November 8, 2013)

ABHW letter to the Senate Finance Committee in response to the Committee’s request for information from the mental health community on how to improve the mental health system in the United States (September 30, 2013)

ABHW Press Release: ABHW President and CEO Participates in Historic White House Conference on Mental Health, Applauds National Dialogue (June 3, 2013)


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