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How states can serve members more holistically

Lori Halpern and Dennis Vaughan discuss interoperability, helping communities respond to the growing mental health crisis, and new ways of delivering care.

In this article

Lori Halpern:

Hi, I'm Lori Halpern, head of government solutions, business development for Optum Behavioral Health.

Dennis Vaughan:

And I'm Dennis Vaughan, chief executive officer for Optum State Government Solutions. State government leaders everywhere are focused on whole person care. They're seeking innovative and efficient ways to bring together all the services and supports people need to stay healthy in their lives and in their communities. So we're here to share examples of some of the critical building blocks that we've helped to put in place across numerous states to help them scale improvements and to serve their constituents more holistically.

Lori Halpern:

Dennis, that's no easy feat. I think the first and most fundamental challenge is improving outcomes in the community, and that includes physical and behavioral health outcomes. COVID-19 created intense economic pressures on state governments, but the pandemic also continues to drive an enormous demand for health services, particularly, around mental health and substance use disorders. Recent federal action has provided funding to address these issues but scaling quickly to meet the demand is the challenge for today. We work with a state expanding the behavioral health services they offer. There are more than 372,000 Medicaid members, including a variety of non-Medicaid services to help fill treatment gaps.

Dennis Vaughan:

Connecting the medical and behavioral needs is critical to your point, Lori, it's important to recognize that clinical care contributes only about 20% to health outcomes. Determinants such as physical environment, social and economic factors, as well as health behavior play a far greater role in overall health outcomes. We've worked with the state developing and operating a truly enterprise-wide analytic system. Today, 21 agencies in this state are using the insights to develop programs targeting specific needs for communities. They've tackled lead contamination and poor water quality, for example. Insights from this enterprise analytic system are helping staff focus their efforts and empowering their decision-making to adapt programs and policies to improve the health of people in their community.

Lori Halpern:

We are seeing efforts at the state level to integrate physical and behavioral health related information and care delivery to provide a comprehensive approach to an individual's care needs. We partnered with one local government agency to use this approach, to create an evidence-based treatment model for people with serious mental illness and substance use disorders. They have reduced their total healthcare spend by nearly 50% while improving the resources available for ongoing resiliency and recovery. This example demonstrates how we partner with government agencies to improve access, fill treatment gaps for the uninsured and underinsured and use integrated information to help transform care delivery.

Dennis Vaughan:

And with a more modern connected system, states can make full use of the recent advances in virtual and in-home care. Lori, this has been a great chat. Thank you for sharing your insights on how states are reimagining the care continuum to help bend the cost curve, to scale quality, and most importantly, to ensure that individuals who rely on public healthcare get equitable access to the care and support services they need.

Connected, whole-person care through interoperability

When individuals have more access to their health data, they can take better control of their health.

Dennis Vaughan:

Today, states are working to meet the interoperability and patient access rule by giving consumers access to their health data through third party apps, and that's just the beginning. Optum is supporting 60 million people with our patient access solution through nine payers. This solution includes secured to access management for mobile applications. Just think what's possible when a person can use an app to address their unique health needs. This can really put people in control of their care and overall health.

Lori Halpern:

That's a great point. Interoperability is foundational to creating a more holistic picture of an individual's health and health needs. Individuals with Medicaid coverage are starting to see the benefits of connected, whole person care. This includes their behavioral health as well as their physical health.

Helping prevent and respond to behavioral health crises

Crisis prevention and response programs connect individuals to behavioral health care when it's needed most.

Lori Halpern:

Communities need to be able to respond to crisis at both a large and individual scale. COVID 19 is causing great mental health and emotional harm and continues to drive a spike in demand for behavioral health services. The need for care increased and certain populations remain critically unserved or underserved. Our crisis prevention and response programs integrate with the community to connect individuals to behavioral healthcare when it is most needed. These create more digital doorways for individuals to connect to the healthcare services they need on their own terms and schedule. This is also helping address some of the inequities in the system.

New ways of delivering care

Difficult times demand flexibility and new ways to connect members to the critical services they need.

Dennis Vaughan:

COVID-19 accelerated the adoption of digital healthcare and set a new standard for delivering virtual care almost anywhere. Another state we're working with is improving outcomes of people needing long-term services and support. We assess our level of care needs so the state can connect them to critical services. Our clinicians typically conduct the interviews in person, but when COVID hit, Optum teams responded by rapidly pivoting to a new video call engagement approach. This shift was necessary to keep people connected to critical health services, and it did something more. It filled a critical need for the individuals and their families by providing a visual connection to each other during this rough time.