Optum Behavioral Care CEO: Integrated Coverage, Improved Access Are Essential for Next-Gen Payment Models

Access to behavioral health services is a major issue, as more than a third of Americans live in areas lacking providers.

Yet a significant problem also has to do with how those services are provided to consumers. Changing that will help drive the next generation of payment for behavioral health services, industry insiders believe.

“The providers that we do have often are used inefficiently,” Katherine Hobbs Knutson, SVP of UnitedHealth Group (NYSE: UNH) and CEO of Optum Behavioral Care, said during a health equity panel last Friday at the 2022 Wharton Health Care Business Conference.

Knutson is concerned that individuals with certain behavioral conditions are not being routed to a provider equipped to handle particular care needs.

“Oftentimes, you’ll have people with pretty mild conditions actually seeing a psychiatrist who [is] essentially the most highly trained and most intensive resource,” she said. “Whereas people with schizophrenia who really need that level of care are unable to access care.”

Knutson acknowledged that behavioral health access is further hampered by a lack of coordination between the behavioral side and medical side of insurance plans – whether they be commercial or government-sponsored.

“One of the major issues with payment today is that traditionally, the payment is separated [with] physical health on one side [and] behavioral health on the other side through the use of behavioral health carve-out companies,” she said. “That split contributes to a split care delivery system and it leads to lack of coordination and poor access to care.”

Knutson said that Optum is working to address the issue by providing a more integrated form of coverage for its members. The integrated approach, she says, can help providers with goals of achieving value-based care.

“How can we get clinically and cost effective services to [vulnerable populations] and address all those barriers to them actually accessing care, so that we can actually get them healthier and then perform better in these value-based contracting models?” Kuntson posited at one point during the panel. “I’m super excited about this. This is really sort of next generation payment for behavioral health care.”

Knutson added that behavioral health access can be improved by “reverse integration,” where primary care providers are embedded within a behavioral health care team of an individual with mild to moderate behavioral health conditions.

“[I]t takes a very holistic view of the health and the social needs of this patient population,” she added.

One way to increase access is through the use of technology. Since the pandemic, Optum has seen telehealth usage increase 130%, with the rate even higher for Medicaid participants.

Nora Dennis, who is the lead medical director of behavioral health and health equity for Blue Cross Blue Shield of North Carolina (Blue Cross NC), also participated on the panel and addressed the importance of analytics in the creation of value-based care models.

“We all have a theoretical commitment to equity,” she said. “But we actually need to make that material, we need to make that concrete. And we need there to be accountability using data to stratify the population.”

Dennis said that Blue Cross NC has been looking at providing rewards for payees that hit upon value-based targets.

“One of the things that we are really looking at is that as we create these contracts, can we also integrate either guarantees or bonuses that specifically hold providers or vendors accountable for reducing disparities within that population,” she said.

Dennis said that the industry move toward value-based care would only be good as the improvement in health outcomes of all patients, regardless of background.

“We don’t want improvements in quality in one subset of the population if that is actually going to widen the existing disparity,” she said. “You have to address the health of the entire population in order to truly be driving value.”