Implementing Recovery, Resilience, Wellness And Wellbeing Into Our Work

At OptumHealth

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Sue Bergeson Slides

The Expanding Peer Workforce – Evidence, Delivery and Outcomes

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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

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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 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.

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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.

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Components of the Whole-Health Peer Specialist Program

• Assessment of the need for this service

• Criteria for admission to the program

– 60 years of age or older

– Two hospitalizations in the prior year

– Diagnosed with both a mental health issue and a general health issue

• Willingness to develop a relationship with our Whole-Health Peer Specialist (WHPS)

• Contract established with an elder care provider to administer the program

– Provider in conjunction with Optum search and locate the Peer Specialist for this project

– Referrals were offered to provider by Optum

• A specially trained advocate who has actually experienced mental illness as well as having a physical health issue

• Training includes standard Peer Specialist Training as well as an additional component to deal with the physical health issues

• Understands the impact such illness can have on a person’s physical and emotional well-being

• Does not diagnose or treat any medical issues

• Does help a mental health consumer who is dealing with physical health conditions develop recovery goals

• Offers support in following the care and wellness treatment plan created by the consumer and the treating clinician

Peer Whole-Health Specialist

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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

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Future Areas of Growth

• Whole Health – Coaches, Educators

• Recovery and Wellness Coaches

• ERs

• Respite

• Post Hospitalization follow up

• Quality Auditors, Care Coordinators

• State Exchanges “…Operating a toll-free hotline for consumer support, providing grant funding to entities called “Navigators” for consumer assistance, and conducting outreach and education to consumers regarding Exchanges”

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“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 Affairs612-632-2998 612-632-2963 Susan.Bergeson@optum.com Peter.Ashenden@optum.com

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