In the space of a decade, most consumers with complex needs are enrolled in some type of managed care plan. This is 15% of Medicaid consumers with an intellectual and developmental disabilities (see I/DD & Managed Care – What Are The Early Lessons For Providers?), and 40% of consumers who are dually eligible for Medicaid and Medicare are in some type of managed care plan (see Planning For The Changing Dual Eligible Market Opportunity). This has been a big shift for executives of health plans and provider organizations.
How provider organization executives can partner with health plans to manage these new demands was at the center of my conversation with Michael J. Hammond, MSM, Vice President of Product and Partnership Development, Optum Behavioral Health. Optum’s integrated care solutions for complex consumer populations have been top of mind in recent years, thanks to a series of investments, including Optum’s latest ventures in: new Virtual Visits (see Consumer Engagement = Performance); Genoa Healthcare pharmacy (see OptumRx Acquires Genoa Healthcare); Mindstrong Health technology to track and analyze how smartphone users engage in behavioral health care (see Optum Backs Mindstrong Health To Develop Smartphone Data Mining Technology); and a number of value-based partnerships (see Developing A Value-Based Partnership: The Optum Case Study). The overall effect of these investments is creating a system with comprehensive care management in a way that addresses the triple aim: improves the experience of care; improves the health of populations; and reduces the overall cost of care.
Mr. Hammond explained that for all consumers, including those with severe mental illness, Optum is re-examining and re-tooling its care management approaches. He said:
We want to take a more comprehensive look at how we are identifying these individuals, how we begin to determine their needs, and to incorporate the core capabilities that enable a strategy. We are re-examining our local care ecosystem and chronic condition management. This includes imbedded technology, clinical expertise, and how we engage consumers, which results in integrated care engagement for the individuals. We call it Whole Person Care. We are applying our proprietary algorithms and analytics ‒which we call OptumIQ ‒ to determine and deliver the right level of care for each individual. This identification helps guide our interventions with providers during treatment and transitions of care. It is also important to examine the effectiveness of approaches and ensure the latest evidence confirms that the interventions continue to make a positive impact on health outcomes.
What are the keys for any provider organization management team looking to position itself to support this strategy? The answer according to Mr. Hammond is consumer engagement, population management, and value-based reimbursement (VBR)—with a heavy dose of strategic alliances and technology. He explained:
You can also have best-in-class programs, but if you can’t engage the member effectively, you will never get the chance to demonstrate the importance of the program to their improved health. A care management approach for complex populations needs to view people holistically with a focus on enhancing quality of life; it should seek positive outcomes through collaboration across the spectrum; and it should provide the right services by the right provider at the right time. It all starts with the individual at the center.
We constantly work with provider organizations to look at ways we can better engage our members, through various approaches and tools like value-based reimbursement (VBR), and identifying a core population. What are the most effective ways to engage individuals in their care? We look at contacts face-to-face, telephonic , and meeting the member where they are for those programs that don’t have high engagement. To do this, provider organizations need to make sure they have updated technology to better integrate with managed care systems and share information. They need to consider alliances when they are looking at significant investment costs.
His final advice? Provider organization executive teams should take the time to invest in managed care readiness tools to evaluate their current capabilities, as well as capabilities needed, to work in a managed care environment. He noted:
Provider organizations need to develop their own business cases to tell us, and to remind themselves, what the value of their services are, to build competencies and to forge partnerships with managed care organizations (MCOs). And they need to think big around strategic collaboration. Identifying the right populations, improving access and availability of services, and tracking performance at the levels necessary to support a VBR relationship with management care continues to be a prime stumbling block for many organizations. For provider organizations looking to demonstrate their value to MCOs, the ability to improve access to care will continue to be a clear differentiator and one that will increasingly be decided based on the ability to understand and adopt the necessary technology.
For more on developments at Optum, check out our recent coverage—Optum To Manage Non-Clinical Functions For John Muir Health In San Francisco Area, UnitedHealthcare Launches Bundled Payments For Maternity Care, Veterans Affairs Awards 3 Community Care Regional Contracts To OptumServe, and Veterans Affairs Awards Telephone Lifestyle Coaching Services Contract To Optum.
For a deeper dive into Optum’s approach to complex populations such as intellectual and developmental disabilities, foster care, and behavioral health, join me on September 11 in Gettysburg, Pennsylvania, where Mr. Hammond will deliver his keynote, The Future of Medicaid Managed Care: Building a Comprehensive Care Solution for the Complex Consumer Population.