Last week, Deborah Adler, the Senior Vice President, Network Strategy, at Optum Behavioral Health, provided an update on some key elements of Optum’s network development strategy in her keynote at the mhca fall conference, “Industry Network Trends.” My big takeaway was the concept of the “configured” network and its implications for both consumers and the managers of provider organizations.
But first, some context on the evolution of Optum’s network. I think Optum is leading the pack in the transition of its network to value-based reimbursement (VBR). Ms. Adler reported that about 16% of their current behavioral health spend was in some form of alternate payment methodology (APM). And, when asked, said that in the years ahead, she would like to see that number in the 50% range. However, she highlighted that many factors—including the fact that many provider organizations have a small volume of consumers with United and other payers—will make this a challenging yet worthwhile endeavor to achieve. The VBR models in the Optum network are varied from pay-for-performance fee-for-service arrangements, to bundled rates for selective conditions, to capitation for health home/care coordination arrangements.
Ms. Adler said that the bundled rate initiatives have been in place three years and will be a big focus going forward. The current bundled rate payments are largely focused on community-based medication-assisted addiction treatment, which they have used to create a preferred network of addiction treatment programs (their “centers of excellence”). Optum also has similar initiatives in place for eating disorders and will soon tackle transcranial magnetic stimulation (TMS) treatment as a potential bundled payment approach. To facilitate provider organization transition to alternative payments, they are doing readiness assessments with provider organizations to vet potential provider participants and offer technical assistance. They have created P4P pilot programs with selected provider organizations (including the CMHCs in Kansas and Missouri)—programs that she referred to as the “glide path” to shared savings relationships.
In addition to on-site services, the Optum telehealth initiative is growing. They now have a 3,800+ professional national telemental health network paid the same rates as on-site services—and are looking at increasing the rates to prescribers in the year ahead. Additionally, a planned new platform will have the capability to offer online appointment access services to Optum members.
As part of the discussion of preferred contracting within Optum’s network development, Ms. Adler gave some advice to the assembled executives. First, the importance of understanding the specific solutions that health plans are looking for when presenting services to health plan executives and being able to present the value proposition and likely cost-benefit of the proposed solution. She provided examples of Optum’s expanded work with AbleTo and Clean Slate as the evolution of a provider partnership relationship based on specific solutions and documentation of outcomes and savings.
So, finally to the configured network concept. When asked about the future of narrow networks at Optum, Ms. Adler’s response was that their focus wasn’t on narrowing networks, as much as configuring networks for consumers. This means identifying and contracting with “best outcome” provider organizations and programs, flagging provider organizations with rapid access to appointments, and waiving copayments and deductibles for “centers of excellence.”
It struck me that this is the future of provider/health plan relationships. First, provider organizations must become part of the health plan network – as an organization and their clinical team members. Then, they must move to some form of partnership around a gain-sharing relationship within the network. But going forward this is not enough. The new standard is to differentiate their performance in order to become recommended as high performers and included in emerging configured networks. A tall order for both the health plan and the provider organization.
For more, join us at The 2018 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 15th and 16th to learn from payers, including Ms. Adler, on the future of payer-provider partnerships in these sessions:
- Building Commercial Health Plan Partnerships: Magellan’s Model For Mental Health Management featuring Gus Giraldo, President, Commercial Markets, Magellan Healthcare
- Building Successful Value-Based Partnerships: How To Align Financial & Clinical Performance Goals featuring Misty Tu, M.D., Medical Director of Psychiatry and Behavioral Health, Blue Cross Blue Shield of Minnesota
- Developing A Value-Based Partnership: The Optum Case Study featuring Deborah Adler, SVP, Network Strategy, Optum Behavioral Health