For health plans, the use of technology is being driven, in part, by the need to improve convenient consumer access to services. At The 2016 OPEN MINDS California Management Best Practices Institute we learned how one health plan is putting technology into action to solve the consumer access problem. Deb Adler, Senior Vice President for Network Strategy at Optum Behavioral Health, talked about two consumer-facing tech initiatives at Optum – the expanded use of telemental health and the consumer portal-enabled “rapid access” program – in her opening keynote session, Using Technology To Improve Consumer Access: Optum California’s Investment In Telemental Health Initiatives.
The Optum news on telemental health is most interesting. Optum is paying for telemental health the same as in-person visits – all mental health services including evaluation, medication management, and therapy. The services are provided either site-to-site or through professional-to-consumer computer. Optum currently has about 1,000 telemental health provider organizations within their network – and hopes to grow this number to 3,000 by the end of 2016. Ms. Adler also mentioned their use of telemental health in emerging behavioral health/primary care integration initiatives. That is not surprising based on some return-on-investment (ROI) information she shared – the literature shows the greatest ROI in the use of telemental health is for consumers with comorbid medical conditions with an average savings of $9,000 per year for medical costs expenditure for individuals with certain co-morbid conditions (e.g., pain and depression).
There have been two challenges to their launch of these initiatives. First, Ms. Adler said the main logistical challenge was state licensure laws. But, stakeholder education was also on her list of challenges. Consumer education is needed, as consumer uptake is slow (but growing). And for employer and Medicaid plans, there is the traditional reliance on the geographical location of professionals as the measure of access. The challenge will be to replace that standard with actual consumer access times.
One tantalizing statement made by Ms. Adler was the opportunity to change the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) standard regarding follow-up to hospitalization, allowing telemental health visits to meet the standard. That would be a powerful system change – and one that would propel the use of telemental health.
Telehealth isn’t the only way to increase access to care. Ms. Adler also discussed the Express Access program, which is aimed at decreasing wait times for appointments. Under this program, provider organizations commit to providing all clients with an appointment within five business days of the client’s call (the typical standard is ten days). Provider organizations who commit to the Express Access program receive the Express Access logo in the Optum provider directory to help consumers recognize the clinical professionals with the best access. If a provider organization in the program gets two complaints about appointment wait times going over the five day requirement, then the provider is removed from the Express Access program.
These two programs highlight the access challenges that consumers are facing – and the innovations payers are developing to meet this challenge. The bottom line is that consumers want more convenience and better access to treatment, and payers want to give it to them. That leaves provider organizations to align their strategies with new payer initiatives, or risk being left behind. For more on consumer engagement, be sure to check out: Solving For Engagement With Technology, Less Consumer Education Demands More Consumer Engagement, Consumers Don’t Know What They Don’t Know, and What Health Plans Want: Technology That Engages Patients.
If you couldn’t join us in San Diego, stay tuned in the coming weeks as we continue our briefing coverage of the top 2016 OPEN MINDS California Best Practice Management Institute sessions. And for more on other ways that technology is helping to improve access to care, join us in November for The 2016 OPEN MINDS Technology & Informatics Institute, where senior associate and institute chair Sharon Hicks will present “Innovations In Consumer Technology: How To Use Tech To Increase Engagement & Improve Satisfaction.”