Inform.

Challenge
Aetna was looking to provide comprehensive and effective behavioral health care for its members while also accounting for members’ overall well-being, including the time and resources needed to achieve and maintain optimal health. Traditional approaches often do not address the complexity of behavioral health issues, including factors such as social determinants of health.

Solution
Aetna introduced the Aetna 360 Behavioral Health approach in May 2019, partnering with select behavioral health and substance use disorder treatment facilities. Under the Aetna 360 Behavioral Health program, partnering facilities and members have a dedicated 360 Care Advocate as their single point of contact with Aetna’s Behavioral Health team. These advocates work closely with Aetna 360 designated facilities to understand members’ needs, collaborate directly with members and caregivers during and after discharge, and they are supported by a multidisciplinary team at Aetna, including medical, and Resources for Living. Instead of focusing on standard time limits, Aetna prioritizes holistic care, comprehensive support, resource access, and collaboration for members and their families.

Result
The approach led to improved care coordination, enhanced member support, and positive feedback from both members and facilities. Aetna’s success with this approach has led to its expansion, with more partnering facilities implementing Aetna 360 Behavioral Health. This expansion ensures that more members can benefit from the program’s comprehensive and compassionate care, ultimately leading to better mental health outcomes for members.

Challenge
The COVID-19 pandemic intensified risk factors for youth depression and suicide, leading to a National State of Emergency in Children’s Mental Health declared by top pediatric healthcare organizations. The isolation and loss experienced by youth, combined with societal factors, like social media, have exacerbated feelings of loneliness and stigma related to mental health challenges among youth.

Solution
Aetna, in consultation with the National Institute of Mental Health (NIMH), built a predictive model that can be used to make self-harm risk estimates and best support those in need. When Aetna’s youth members (ages 13-17) have a high-risk score, Aetna’s licensed clinical staff conducts direct outreach to those families to identify any evidence-based care, resources, and services – including specialized programs, provider connections, peer support, group support, and community services – that can reduce stressors and help sustain recovery for these adolescents and their families. Aetna’s clinicians also support these families by identifying broader resources needed to build and reinforce protective factors and address social determinants of health.

Result
Since the program launched in June of 2022, Aetna has conducted outreach to over 1,800 parents/caregivers of high-risk youth to provide resources, referrals, and support. 

Challenge
Suicide is a major public health crisis and a leading cause of death among people 10-24 years of age in the United States. Aetna has committed to reducing member suicide attempts by 20% by 2025 and prioritizing the important role primary care practices have in our members’ well-being. 

Solution
Through its partnership with the American Foundation for Suicide Prevention, Aetna is offering contracted pediatric providers the opportunity to enroll in the American Academy of Pediatrics ECHO (Extension for Community Healthcare Outcomes) learning collaborative for youth suicide prevention based on strategies described in the Blueprint for Youth Suicide Prevention. 

Result
This Aetna-sponsored program is cost-free to participating pediatric practices and offers complimentary CME and MOC credit. The 8-month program is delivered virtually via monthly one-hour zoom sessions with the opportunity to opt into an additional six one-hour quality improvement sessions. 

Challenge
There continues to be misconceptions and stigma around mental health and suicide along with the need to provide accessible support and psychoeducation for youth and young adults, parents/caregivers, and teachers.  

Solution
Aetna created programming and informational toolkits, specific to youth and parents/caregivers, designed to engage and help youth, young adults, and those who support them deal with the continued mental health impact of the pandemic and its potential associated risks to mental well-being. In addition, Aetna co-sponsored a High School Educator Guide with the JED Foundation. 

Result
Aetna developed several publicly available guidebooks and toolkits which are linked below. 

• • Young Adults
  • Parents/Caregivers
  • LGBTQ+ Parents/Caregivers
  • Jed High School Educator Guide (sponsored by CVS Health)

Challenge
Substance use disorder continues to cast a shadow over the well-being and quality of life of countless Californians. Recognizing the pressing need for intervention, the Anthem Blue Cross Foundation has taken a significant step forward to address this issue.

Solution
The Anthem Blue Cross Foundation awarded $1.2 million in substance use disorder grants to five California-based organizations, including the California Health Collaborative in Fresno for Maternal Wellness to create a Perinatal Substance Use Task Force. This organization is dedicated to helping local mothers facing substance use disorder challenges.

Result
Through the grant, the California Health Collaborative for Maternal Wellness in Fresno, CA, has made significant strides in providing essential care and support to mothers who have limited access to resources or may be facing daunting barriers to recovery. The impact of their work resonates not just with the mothers they assist, but ripples through communities, fostering hope, health, and a brighter future.

Challenge
The United States was facing as of 2020 a dire opioid crisis, with over 107,600 Americans dying from drug overdoses in a year, and more than 75% of these deaths were attributed to opioids. The urgent challenge was to find effective treatment options for individuals with opioid use disorder (OUD). Despite the availability of FDA-approved medications for opioid use disorder (MOUD), they were underutilized. Many inpatient units relied on traditional withdrawal management protocols, putting patients at high risk for relapse, accidental overdose, and death due to decreased physical tolerance.

Solution
In 2018, Beacon Health Options (now Carelon Behavioral Health) and the Connecticut Behavioral Health Partnership (CT BHP) initiated the Changing Pathways program to promote MOUD, enhance outcomes for individuals with OUD, and save lives. The program’s three core elements included comprehensive education on treatment options, offering MOUD induction for interested individuals, and ensuring seamless aftercare for the continuation of MOUD. Peer specialists played a crucial role in the program, providing education and support both during the inpatient phase and up to 90 days after discharge. This peer-led approach aimed to establish trust and create a more personal connection with participants. In Changing Pathways, participants started MOUD during a withdrawal management episode and were discharged on a stable dose. The program facilitated their connection with community providers to continue MOUD treatment and follow a recovery plan.

Result
Changing Pathways successfully transformed practices, emphasized the importance of MOUD education, and implemented life-saving strategies that increased MOUD adherence, thereby making substantial strides in combating the opioid epidemic. Participant engagement with MOUD increased by 32%, ensuring more individuals with OUD received this critical treatment. There was a 12% reduction in readmissions to inpatient facilities within 30 days compared to traditional withdrawal management. Participants who remained MOUD adherent experienced significant reductions in the average number of behavioral health emergency department visits (54%), inpatient days (39.7%), and withdrawal management episodes (55.8%) in the 90 days following discharge. MOUD adherence in the 90 days following discharge led to a 74% reduction in overdoses, significantly improving the safety and well-being of program participants.

Challenge
The charitable arm of health insurance provider, Elevance Health, saw the need to bridge the gap in health equity for individuals affected by mental health and substance use disorders.

Solution
Elevance Health Foundation provided a grant in the amount of $650,000 to Faces & Voices of Recovery to launch a digital app, The RecoveryNet. This app is designed to help facilitate connections and resource exchanges with others in the field from across the country and provide support through peer recovery specialists—individuals who are in recovery and use their own life experiences in ways that benefit others who facing similar experiences.

Result
The RecoveryNet app is a trusted companion on the road to recovery. With its wealth of resources at users’ fingertips, the app acts as a compass, helping individuals navigate the complex terrain of substance use disorders confidently and identify care for substance use disorders to prevent future relapses.

Challenge
The United States faces a severe shortage of mental health professionals, with nearly half of the population living in areas lacking sufficient access to therapists and clinicians. This scarcity of mental health providers exacerbates the growing mental health crisis, leaving many individuals without the care they need.

Solution
Kaiser Permanente recognized the need for collaboration and has taken significant steps to bridge the gap between immediate crisis response and ongoing mental health care. They have actively worked with state officials to coordinate follow-up appointments for members who contact the 988 Suicide & Crisis Lifeline or their local crisis line. Additionally, they’ve increased the number of behavioral health consultants in primary care, acknowledging that crisis response and clinical care are interconnected and cannot function in isolation.

Result
The successful rollout of the 988 Suicide & Crisis Lifeline demonstrates how policy improvements can enhance integrated crisis care. The 988 Suicide & Crisis Lifeline has opened new doors for mental health support, and it is essential that these doors lead to a compassionate and connected network ready to provide assistance whenever needed.

Challenge
People living with severe mental health conditions such as schizophrenia and bipolar disorder often rely on medication to stave off difficult symptoms, including suicidal thoughts and psychosis. But side effects and other barriers can make sticking with a drug regimen challenging. Recognizing these challenges, Kaiser Permanente in Northern California identified the need for an innovative approach to enhance patient care, particularly for those with severe mental health conditions.

Solution
Kaiser Permanente developed a telehealth program that gives people with serious mental health conditions direct access to psychiatric clinical pharmacists. Psychiatrists continue to oversee the care of their patients and partner with the clinical pharmacists, who act as care navigators. They establish ongoing relationships with patients through regular video and telephone appointments. This helps address the complex needs of those with serious mental health conditions. 

Result
While ongoing research evaluates the program’s impact, early indications suggest promising outcomes for patients in need of extra support. The program’s potential impact is significant, with a focus on decreasing health disparities and enabling patients with serious mental health conditions to live longer and healthier lives. 

Challenge
As of September 2021, Washington faced a significant gap in meeting the mental health care workforce demand, with only 16.8% of the need being addressed. The COVID-19 pandemic further heightened the demand for behavioral health services, emphasizing the urgency for innovative solutions to expand access and support for those dealing with behavioral health challenges, particularly among the youth population.

Solution
In response to the pressing need, The MolinaCares Accord, in collaboration with Molina Healthcare of Washington, unveiled a $77,000 grant to SPARK, an organization committed to establishing a career pathway for youth to become certified peer counselors in Washington. The grant to SPARK specifically focuses on the identification, outreach, training, and placement of youth peer support. By empowering young adults who have overcome mental health challenges to become certified peer counselors, SPARK addresses the shortage in the mental health workforce and fosters a compassionate care environment. 

Result
The grant from MolinaCares is anticipated to significantly increase the number of youth peer counselors in the community. By providing support to the SPARK program, MolinaCares aims to create a more effective and compassionate care environment for Washingtonians living with behavioral health challenges. The program aligns with MolinaAccord’s mission to strengthen the youth peer support workforce and create a supportive environment for all youth seeking behavioral health support.

Challenge
Virginia faced significant health care disparities, including high rates of obesity, heart disease, and diabetes, with certain regions suffering from poor health outcomes due to limited access and funding for essential programs. Ensuring every citizen had access to the necessary health resources was a pressing concern.

Solution
The MolinaCares Accord, in partnership with Molina Healthcare of Virgina, launched Vision for Virginia initiative, investing over $1 million to support 30+ organizations focused on access to care, health-related social needs, behavioral health, food security, and maternal and child health of underserved populations across Virginia.

Result
The Vision for Virginia initiative by the MolinaCares Accord expanded access to essential healthcare services, promoted child development and literacy, created opportunities for disadvantaged youth, supported vulnerable groups, assisted families and youth, addressed social determinants of health, and promoted healthier eating habits. Notably, it provided vital support to single mothers returning to school, emphasizing the initiative’s holistic approach to improving community health and well-being. Through strategic investments, this initiative made a positive impact on Virginia’s residents and underscored the significance of corporate social responsibility in healthcare, ultimately strengthening the fabric of the communities it served.

Learn more about the Vision for Virginia initiative by Molina Healthcare here.

Challenge
Optum Behavioral Health, like many healthcare organizations, grappled with time-consuming clinical review processes that often left both providers and patients frustrated. Delays in verifying patient eligibility, assessing symptoms, and obtaining treatment approvals were common pain points. The challenges included lengthy waiting times, slow approval processes, and learning intricacies of the existing system for providers.

Solution
Optum Behavioral Health introduced the Smart Technology Authorization Request (STAR) system to address these challenges. STAR offers a streamlined and efficient approach to clinical reviews, making it a game-changer in the healthcare industry. Key features of STAR include Eligibility and Benefits Verification, Efficient Data Collection, Guideline-Based Review, Real-Time Approvals, and Optum Care Advocate Support, User-Centric Development, User Training, and User Access.

Result
The implementation of STAR has yielded remarkable results for Optum Behavioral Health and its members’ health outcomes:

• Time Savings: The reduced hold times and streamlined processes have saved providers valuable time.
• Faster Approvals: More than 50 percent of cases are now approved in real time, ensuring quicker access to treatments.
• Resource Efficiency: STAR has decreased the time spent on clinical reviews by 30 percent, allowing staff to focus on more strategic tasks.
• User Adoption: The self-paced training video and easy access have made it simpler for providers to adopt STAR.
• Improved Patient Outcomes: Quicker reviews and approvals mean patients receive the necessary treatments faster, leading to better health outcomes.