implementing programs that support recovery, resilience, and wellness into our work at optumhealth
TRANSCRIPT
Implementing Programs That Support Recovery, Resilience, And
Wellness Into Our Work At OptumHealth
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 2
Sue Bergeson Slides
The Expanding Peer Workforce – Evidence, Delivery and Outcomes
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 3
Peers As OptumHealth Staff
• At the Corporate level– Bring recovery and resiliency
orientation
– Provide the lived experience perspective on policies and procedures
– Focus on engagement
– Offer innovation
– Implement programs and services
• At the Local Level– Community relations
– Quality measurement
– Hospital discharge
– Care management
– Training in recovery, resiliency; person centered approaches
– Innovation, programs and services
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 4
Peers Contracted as Providers of Services
• Empowering Consumers, Family Members, And The Community
● MHFA ● QPR ● NAMI Family To Family
• Navigators
• Employed Through Living Room Or Crisis Respite Programs
• Peers as Whole Health Coaches (Physical/Mental Health)
• Peers in the ER
• Peer And Family Coaching Programs
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Engages members to support their move to recovery
Addiction Recovery Coaches
Peer Engagement
Coaches
Peer Bridger
Peer Whole-Health Coach
Connect with members who are at risk based on diagnosis or medication usage to empower the member through engagement tools and resources
Designed for members with 2+ hospital stays in one year, provides support coaching, community linkage and empowerment (developed by NYAPRS)
Supports both mental and physical health engagement and recovery
Family Peer Coach
(in process)
Supports families with a child having with a behavioral health or substance abuse issue
OptumHealth’s Peer
Coaching programs are
designed to connect
peers with individuals and
families to empower
recovery. There are
currently four models
with a fifth in process.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 6
Does it Work?
• Peer Link/Bridger
• Yale Optum Research:
– enrollees in the WI PeerLink program showed a significant decrease of 71% in average # of acute inpatient days per month
– enrollees in the TN PeerLink program showed a significant decrease of 90% in average # of acute inpatient days per month
• Optum TX 70% reduction in hospital days
• Optum Pierce: 125 people, 79.2% reduction in hospital admission year over year $550,215 in savings.
• NYAPRS data:71% percent of the people the Peer Bridgers worked with were able to stay out of the hospital in 2009.
• Recovery Innovations: 56% reduction in hospital readmission rates.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 7
Lessons Learned
• Need To Have A Basic Training To Ensure Standard Skills Are In Place As CPS Training Varies From State To State
• Contracting With And Paying Peers Is Incredibly Complicated In Our Systems– Credentialing – Provider Contracting Status– Public Versus Commercial Coverage (Benefit Design)– Level Of Care Guidelines– Authorization Process– Changing Eligibility– Claims Payment (H0038 )
• Statement Of Work Helps Clarify Expectations
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 88
“Who then can so softly bind up the wound of another as he who has felt the same wound himself?”
“Who then can so softly bind up the wound of another as he who has felt the same wound himself?”
Thomas Jefferson
• Thank You• Sue Bergeson, VP Consumer Affairs Peter Ashenden, Director Consumer Affairs
• [email protected]@optum.com
• © 2013 Optum. All Rights Reserved.