About one in six adults will experience a mental health illness and medical condition within a year ― and among those receiving Medicaid, the percentage is likely higher.1 Since medical and behavioral health conditions tend to overlap, research shows that the most effective way to treat this vulnerable and growing population is by integrating their care.2
An integrated approach to health care recognizes that an individual’s health is influenced by a combination of many complex factors. These go way beyond the biological and psychological components of illness, and include social, community, cultural, and other determinants of health and well-being. Strategies to improve health outcomes must be person-centered and support the engagement and activation of people to improve their own health and wellness. Provider systems and networks of care must also foster the coordination of care and integration of services.
Optum recognizes these challenges and works to develop health care solutions that address the comprehensive needs of individuals, their families, and the communities in which they live. In Tennessee, Optum has partnered with United Healthcare in their TennCare Medicaid program. Covering over 450,000 beneficiaries, this integrated health care program employs a comprehensive health risk assessment that accounts for a person’s medical and behavioral health needs ― plus social, family, and other environmental challenges ― in order to develop a single comprehensive treatment plan. This extensive approach to the whole person supports the integration of their health service needs, and all of the providers and health service resources involved in their care.
A major obstacle for effective and efficient health care treatment ― and especially for comorbid conditions ― is poor communication among clinicians.3 Integrated care enhances communication and collaboration not just among providers but also with community resources. In the TennCare program, Optum and UnitedHealthcare have developed a clinical team of physical and behavioral health care coordination staff, including peer specialists, to help coordinate the care of those covered by the plan. The care team is led by a designated clinical staff member who integrates both physical and behavioral health resources and promotes a whole-person approach to care and services. Members and their providers also have access to the care team 24/7 for immediate help with routine, urgent, and emergency physical and behavioral health needs including crisis intervention. All care coordination records are integrated into a single data system, and this supports improved coordination among team members. Additionally, the care team meets weekly to address the complex health care needs of covered beneficiaries.
In order to support the integration of care, Optum and UnitedHealthcare have developed networks of clinical services that promote the co-location of physical and behavioral health providers. In partnership with a national community mental health agency, they have supported the availability of behavioral health providers in a medical home system that is available to TennCare members. By providing behavioral health clinicians who are a part of the overall medical home team, timely screening, assessment and consultation services are available to the primary care providers and members. This promotes timely resolution of many behavioral health problems and effective referrals for others that require higher levels of service.
Optum also recognizes that many of their covered members with behavioral health conditions are most comfortable receiving their medical care in the settings where they receive their behavioral care. Therefore, primary care services have been integrated into some of the larger network behavioral health service settings. This team-based approach brings primary care clinical resources to the sites of behavioral health providers to support whole-person care. Optum and UnitedHealthcare’s care coordination staff are available to support this integration of care and help direct appropriate services as needed.
Improving health outcomes for TennCare members requires attention to a range of factors that are broader than just physical and behavioral health conditions. Social and community factors also influence an individual’s health and well-being. One example is the availability of stable housing. The TennCare program includes partnerships with supported housing providers to create stable community living supports. These alternatives are available to individuals with both physical and behavioral health needs who are transitioning from facility-based care back to the community. These supported community living resources are a cost-effective means to promote stability and improve community engagement and tenure. Peer services also help support the engagement and activation of covered members.
Through these integrated approaches to care and community services, the TennCare program has been able to demonstrate improved health outcomes and reduced care costs. Effective partnerships with providers have resulted in a 12% statewide reduction in service utilization.4 In behavioral health there has been a concurrent reduction in psychiatric readmissions of 8.3%.5 The coordination of care has also demonstrated better follow-up after hospitalization, as evidenced by a 42% increase in follow-up with providers within 7 days, and a 32% improvement in follow up after 30 days.6 Improved housing alternatives have also resulted in reduced costs and improved community tenure.
Optum and UnitedHealthcare have demonstrated in the TennCare program that the integration of care for physical and behavioral health conditions must include the coordination of care across all levels of the system and a commitment to whole-person care. This integrated approach improves quality of care while reducing unnecessary service use and overall health care costs.
Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.
- Adelmann PK. “Mental and Substance Use Disorders among Medicaid Recipients: Prevalence Estimates from Two National Surveys.” Administration and Policy in Mental Health, vol. 31, no. 2, 2003.
- Butler M, Kane R, McAlpine D, Kathol RG, Fu SS, Hagedorn H, Wilt TJ. Integration of Mental Health/Substance Abuse and Primary Care. Minneapolis: Minnesota Evidence-Based Practice Center, 2009.
- Institute of Medicine (U.S.). Committee on Crossing the Quality Chasm. Adaptation to Mental Health and Addictive Disorders. Improving the Quality of Health Care for Mental and Substance Use Conditions. Washington: 2006.
- Results from Optum’s analysis of inpatient admission reports from TennCare for FY2011 to FY2012. Cost savings is based on a daily average TennCare unit cost of $525. Results include reductions in psychiatric readmission rates in West Tennessee during the same period.
- Results from Optum’s analysis of state quarterly psychiatric readmission reports for the West Tennessee region, from FY2011 to FY2012 (psychiatric readmissions statewide decreased overall). Cost savings is based on a daily average TennCare unit cost of $525.
- Based on Optum’s comparison of HEDIS rates for the West Tennessee region from FY2009 to FY2012 (three-year period).