1. Integrating Health Systems – MAHP Summer Conference
Ken Anderson VP, Business Development

2. OPTUM is part of UnitedHealth Group
Ranked 14th of the Fortune 500
Health Services
Helping to make the health care system work better for everyone.
Health care coverage and benefits
Helping people live healthier lives.

3. Health is more than the absence of disease
Whole-person care incorporates all aspects of the health care system by harmonizing and integrating areas of clinical specialization to achieve the personal health and wellness goals of the individual
Physical
Social
Behavioral
Optimal health
Job
Specialty BH Care
Primary Care
Emerging Tech.
Urgent
Care
Health
Plan
Clinical
Data
Social Supports
Pharm.
Individual Values
EAP
E.R.
Claims
Optimal health and well-being
Whole-person care
Whole-person care focuses on how the physical, behavioral, and social elements of a person are interconnected to maintain health
When one part is not working well, it is believed to affect the whole person
Holistic approaches focus on the whole person rather than just on the illness or part of the body that is not healthy
Person-centered care
An approach to “providing care that is respectful of and responsive to individual preferences, needs, and values, and ensuring that member values guide all clinical decisions”1
1. Institute of Medicine (US). Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

4. Optum’s point of view regarding integration
Expand and scale the whole-person and person-centered care model
To improve clinical decision making we need to focus on the physical, mental, and social elements of a person, and take into account their individual preferences, needs, values and culture
Recognize the value of behavior in health
Behaviors influence health and the decisions people make around health
Preserve the role of behavioral health specialization
Behavioral health specialization brings a unique and necessary perspective to whole-person health
Minimal collaboration
Basic collaboration
at a distance
Basic collaboration
on-site
Close collaboration
on-site with some
system integration
approaching
an integrated practice
Whole- person care (full collaboration in integrated practice)
Coordinated
Co-located
Integrated
Limited information
i.e., Louisiana (Bayou Health)
Multiple data sources
i.e., Texas, Washington, Florida
Interpreting and sharing meaningful information i.e., Ohio, Kansas
Source of care integration continuum: Heath B, Wise Romero P, and Reynolds K. A Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions, March 2013.

5. National Medicaid Medical and Behavioral Health Footprint
Pierce County
183.7K members
Blue: Medicaid through UHC Community & State
Orange: Behavioral prime to state
Washington
179.3K members
Montana
Maine
North Dakota MA
14K
members
Oregon
Minnesota VT
Idaho
255.8K
members
New York
473.9K
members NH
Wisconsin
139.9K members
South Dakota
Michigan
206.4K members RI
72K
members
Wyoming CT
California
Iowa PA
207.7K
members
Utah
Nebraska
Ohio
281.5K members
Nevada NJ
480.9K members CT
(Salt Lake County)
110.6K
members
Illinois
Indiana DE
55.3K members
(San Diego County)
613.2K
members
Colorado
West Virginia
Kansas
125.2K
members
Missouri
Virginia DC MD
224K members
Kentucky
North Carolina
New Mexico
ASO/FFS
Tennessee
635.9K members
Arizona
59.2K
members
New Mexico
84.1K
members
Oklahoma
South Carolina
Arkansas
Mississippi
130.2K
members
Georgia
Alabama
Texas
204.7K
members
Louisiana
317K
members
Alaska
Florida
340.7K
members
Hawaii
50.2K
members
Updated 3/14/16

6. STATES TO WATCH AND LEARN FROM
Tennessee – Long term integration. Looking to add IDD services to LTSS system (TX and RI also looking to integrate IDD services)
Kansas – Nearly 3 years of integration, includes IDD waiver services
Louisiana – Recently ended statewide BH carve - out. Evaluating LTSS and IDD systems
Iowa and Nebraska – Ended statewide BH carve-outs, IDD impacted
Arizona – Specialty health plans for people with SMI
Ohio – Announced a structured process to end BH carve-outs
Washington - Announced a structured process to end BH carve-outs
Washington, Texas and Florida – Specialty plans for kids in Foster Care
Ohio and Louisiana – Trying to figure out Medicaid Expansion specific to people coming out of prison/jail

7. Washington Health Care Innovation Plan
WA has 4-year State Innovation Model (SIM) grant
Drive value-based purchasing across the community, starting with the State as “first mover”
Improve health overall by building health communities and people through prevention and early mitigation of disease throughout the life course
Improve chronic illness care through better integration of care and social supports, particularly for individuals with physical and behavioral co- morbidities
7 Foundational Building Blocks
Regionalize transformation efforts
Create Accountable Communities of Health (9 are established)
Leverage and align state data capabilities
Provide practice transformation capabilities

8. Washington Health Care Innovation Plan (cont.)
Regionalize Transformation Efforts – Seven region straw man
Health Care Authority
Department of Social and Health Services
Department of Health
Department of Labor and Industries
Department of Early Learning
RSNs to BHOs – now there are 10
Early Adopter Status – Southwest WA Region
Practice Transformation and Support HUB RFP
Regional Health Connectors RFP
Mid-Adopters still being developed
Complete MCO contracting by 2020

9. Critical Issues --- Plan to Address these BH concerns
Local taxation processes, either as part of match or as special health care levies
Crisis Systems – they serve Medicaid and non-Medicaid (generally 50/50). How to keep the firehouse open and funded
Federal MH Block Grants and SAPT Grants – serve Medicaid and non- Medicaid individuals
CCBHC development
Initiatives to increase availability and access to affordable housing and improvements in employment for people with disabilities
There are still people without insurance, what is their safety net?

10. OPTUM is a leading health services company committed to helping make the health care system work better for everyone.
For more information, please contact:
Ken Anderson at or by phone at