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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 in the Residential Treatment Quality Initiative include the following.


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




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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