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Agenda Item 6a, Attachment 3Optum Behavioral Healthfor CalPERS MembersDr. Jeff MeyerhoffSr. National Medical Director, Optum Behavioral HealthDr. Dennis HsiehDecember 17, 2019Sr. Medical Director, United Retiree SolutionsProprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthAgenda1. Improving access Addressing stigma PCP collaboration on Behavioral Health Network access Treatment milestones2. Guiding high-impact, integrated care3. Addressing the social determinants of health4. Compliance with mental health parity laws5. CalPERS benefit utilization and prevalence2Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthOur national campaign to combat stigmaPartnersCurrent2020 Coping After Suicide American Foundation for Suicide Prevention Give an Hour Mental Health America Psych Hub Mental Health First Aid(National Council for Behavioral Health) ShatterProof Mental Health Innovations Stamp Out Stigma (ABHW) The Trevor Project University of Maryland3Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthWe help remove stigma as a barrierby increasing awareness about Mental Health and Substance UseFor CalPERS Members andRetireesFor CalPERSo Help CalPERS leadership take action on mental healthawarenesso Provide guidance to help members understand,navigate, and use behavioral health benefitso Manage co-morbid medical and behavioral conditionso Maximize use of CalPERS behavioral health benefitso Reduce discrimination and stigma in the workplaceo Develop a culture focused on wellbeing to positivelyimpact member engagement, satisfaction and retentiono Provide early identification and intervention beforemental health or substance use worsenso Engage members in mental health wellness programso Engage with and provide support at any point on thebehavioral health continuumo Integrate mental health as part of physical wellnessprogramso Frame mental health as a natural extension of physicalhealth4Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthPCP collaboration on Behavioral Health1. Provider resources and member reports2. UnitedHealthcare program screenings3. Social Determinants of Health (SDoH)5Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthImproving access to Behavioral Health careEXTENSIVEBEHAVIORALHEALTH NETWORK208,900 EXPRESS ACCESSNETWORKVIRTUALVISITS5,300 The industry standard fortreatment is 14 days for aroutine appointment.16,000 PROVIDERS NATIONALLYIncludes targeted local-levelMEDICARE NETWORK of78,900 14vsSPECIALTYNETWORKScontracted providersacross all 50 states²5G E NO A PA RT NE RS HI P4,800 Express Access providersoffer appointment timeswithin 5 days.3,000 100 Psychiatristsand APRNs3CMHC sites inover 35 states46Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.Medication-AssistedTreatment locations4,500 Applied BehavioralAnalysis practices17,900 Autism SpectrumDisorder clinicians
Optum Behavioral HealthImproving access to Behavioral Health care2019 California network growth over two years(November 2017 to November 2019)Behavioral NetworkSUD FacilitiesMATExpress Access*Virtual VisitsABA practices 22% 49% 30% 49% 174% 33%201720192017201920172019201720182017* Denoting growth from 2017 to 2018; unable to report 2019 counts at this time.7Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.201920172019
Optum Behavioral HealthImproving access through Treatment MilestonesTreatment Milestones are a Lengthof Stay within which most patients Case Study: Adult Bipolar Inpatient Lengthof Stay Distribution15% have a similardiagnosis, ageand Level of CarePercent of Cases have completedtreatment, or steppeddown to a lowerintensity Level of Care10%5%0%161116Length-of-Stay (Days)Treatment Milestones establish the point atwhich we re-evaluate clinical cases that mayneed enhanced support. Unnecessaryconcurrent reviews8Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Actionableconcurrent reviews
Optum Behavioral HealthGuiding high-impact, integrated careWe usesophisticatedanalytics toguide individualsinto care andalong the pathto recovery,includingidentifying thoseat acyHighneed,High-costEmerging riskAdvancedanalyticsClinical &pharmacy dataBehavioral &medical claimsAt-riskUM to CMhandoffLow riskDischarge9Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.Enrollment tospecialized supportprogramsMember &providerguidance
Optum Behavioral HealthResults our own medical-behavioral Comorbidity StudySimply having a medical comorbidity (the 14%) did not automatically indicatecomplicated clinical factors requiring costly case management and resources14%of populationwithcomorbiditiesSeverity,prevalence typeand combination ofconditions matter25%of those withcomorbiditySource: Azocar F, Bargman EP, Smolskis JM, Great TD. Enhanced methodology for estimating integrated medical-behavioral costs. Optum internal report. January 2017.10Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.80%80%of the costimpact
Optum Behavioral HealthOur Focused Initiatives for MBIEnsuring members with co-occurring conditions connect with the right supportIdentificationCoaching & SupportTreatmentData & ReportingScreenings, Referrals &MBI AlgorithmAbleToLevels of CareOperational Insight &Client Reporting Depression screenings andclinical judgement during medicalcondition management Digital platform for short-term,virtual cognitive behavioraltreatmentReferrals to clinical programs andtreatment (e.g., EAP, AbleTo,OBH) Data-driven identification andoutreach pilot with FI populationusing MBI ID/Strat application Focus on stress, anxiety anddepression high cost medical Coordination with care teamsData-driven ID/outreach tomembers who have comorbidmedical and behavioral conditions Outpatient referrals Virtual Visits (telemental health) Evidence-based substance usetreatment Higher levels are care whennecessary11Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Client reporting– MBI BH Screening &Referral Dashboard– LifeSolutions OutcomesDashboard Operational leading indicators Performance monitoring andimprovement processes Retrospective impact analysis
Optum Behavioral HealthAddressing the Social Determinants of Health (SDoH)Identification andstratificationConnection Algorithms that include emerging riskprofiles with SDoH inputs Letters outreaching high needs membersoffering support from Care Advocates Direct referrals to Care Advocates forhigh needs members to include flagsfor SDoH concerns Automated alerts to Care Advocates thatflag members with SDoH concerns Automated UM process will identifymember SDoH at facility admission Clinical Transformation to improveidentification and transition to casemanagement while members are in thehospitalSupports Evidence-informed work flows and jobaids direct Care Advocates to ask andassist members with SDoH Family Support Program uses similarevidence – informed workflows Optum Community Connector searchengine for community social andfinancial services12Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthCompliance with Mental Health Parity laws Hands on Collaborative Partnerswith UnitedHealthcare to:o Support both quantitative andnon-quantitative treatmentlimitation (QTL and NQTL)testing.o Assess product design annuallyfor compliance using NQTL Tool.NQTL assessment toolSupports the collection and alignment of key medical andbehavioral plan NQTL data for the purposes of: Identifying non-compliant elements of the existing plan designs Providing information regarding potential plan changes so that acost estimate can be established for new designso Provide DisclosureDocumentation required underFederal Parity. Comply with California-specificguidelines, including Departmentof Managed Health Care (DMHC)parity surveys13Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Optum Behavioral HealthCalPERS Benefit Utilization and Prevalence (calendar year 2018)Top 5 mental health diagnosesMEDICARE ADVANTAGE PPO(GROUP RETIREE)BY COSTBY PREVALENCECalPERSOPTUMBOOK OFBUSINESSBASIC HMO(COMMERCIAL)BY PREVALENCEBY COST1. Depressive Disorders2. Trauma and Stressor RelatedDisorders3. Anxiety Disorders4. Bipolar and Related Disorders5. Schizophrenia Spectrum andOther Psychotic Disorders1. Depressive Disorders2. Bipolar and Related Disorders3. Schizophrenia Spectrum andOther Psychotic Disorders4. Trauma and Stressor RelatedDisorders5. Anxiety Disorders1. Depressive Disorders2. Trauma and Stressor-RelatedDisorders3. Anxiety Disorders4. Neurodevelopment Disorders5. Bipolar and Related Disorders1. Depressive Disorders2. Neurodevelopment Disorders3. Substance-Related and AddictiveDisorders4. Bipolar and Related Disorders5. Anxiety Disorders1. Depressive Disorders2. Trauma and Stressor RelatedDisorders3. Anxiety Disorders4. Bipolar and Related Disorders5. Schizophrenia Spectrum andOther Psychotic Disorders1. Depressive Disorders2. Bipolar and Related Disorders3. Schizophrenia Spectrum andOther Psychotic Disorders4. Trauma and Stressor RelatedDisorders5. Anxiety Disorders1. Depressive Disorders2. Anxiety Disorders3. Trauma and Stressor-RelatedDisorders4. Neurodevelopment Disorders –Attention - Deficit Disorders5. Bipolar and Related Disorders1. Depressive Disorders2. Neurodevelopment Disorders Autism3. Substance-Related and AddictiveDisorders - Alcohol4. Bipolar and Related Disorders5. Anxiety Disorders14Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group. Dr. Jeff Meyerhoff Sr. National Medical Director, Optum Behavioral Health. Dr. Dennis Hsieh. Sr. Medical Director, United Retiree Solutions. Optum Behavioral Health . for CalPERS Members. December 17, 2019. Agenda Item .
