Behavioral and Medical Health
A community approach. Custom solutions. And a breadth of service.
State and County agencies and divisions, including Medicaid, Behavioral Health, and other allied entities nationwide count on Optum’s experience in transforming systems of care and supporting individuals, families and the providers who serve them. From low-income children and families enrolled in TANF and CHIP programs, to the most vulnerable adults experiencing multiple chronic conditions, including severe mental illness, our expertise and tools improve both health outcomes and quality of care while managing costs.
Optum works with states and counties to build and deliver effective medical and behavioral care services in all types of Medicaid environments, including full/shared risk and ASO models, supporting fee-for-service schedules and transitions to managed care, as well as establishing integrated medical-behavioral health homes for persons with complex conditions including mental illness. We combine innovation with proven, collaborative approaches to help you reduce costs, improve population health and well-being, and enhance the members’ care experience.
We collaborate with all stakeholders to speed the flow of relevant information, streamline processes, simplify administration and manage costs for everyone — beneficiaries, providers, government agencies and community partners.
- Cost-effective community-based alternatives — including peer- and family-driven services — that reduce the use of more intensive levels of care and create lasting new system capacity
- Customized clinical, claims, braided funding, and reporting systems that reduce costs and improve accountability and transparency
- Expertise and innovative programs to help states and counties address their most challenging populations, including long-term care; aged, blind and disabled; dual eligibles, criminal justice; substance use disorders; and developmental disabilities
- Enhanced analytics to identify individuals at risk
- Timely, relevant information, helping providers improve clinical practices
- Tailored education and support—in person, online, via mobile apps, and on the phone — aiding individuals and families as they pursue their own goals for health and well-being
- Serving 6.7 million members of Medicare and Medicaid in 40 states
- Enacting performance-based provider payment reform in 21 states
- Established telepsychiatry networks in rural areas of 13 states
- Accreditation for behavioral health management
Services to enhance behavioral health outcomes
We offer expertise and innovative mental health and substance use disorder programs to address the needs of your specific population, including those in long-term care; the aged, blind and disabled; dual eligibles; criminal justice; substance use disorders; and developmental disabilities. We offer enhanced analytics and sophisticated tools that can identify individuals at risk by providing a whole-person view of your population — taking into consideration not only psychosocial factors, but other aspects of an individual’s life that can support their well-being (e.g., housing, work status, and access to community supports). Optum’s expert clinicians and administrators with direct Medicaid experience can help your programs deliver measurable population health improvement in the areas that drive the most costs.
Medical services designed to reduce risks and improve outcomes associated with complex conditions
Optum’s health care solutions ensure evidence-based, cost-effective care for complex medical conditions to simultaneously improve outcomes and quality of life and reduce costs.
- High-risk care management, including local care coordination and advocacy, for beneficiaries with co-morbid medical and behavioral conditions
- Specialized behavioral health care management and network development, including collaborative local development of community alternatives to higher levels of care
- Care management programs built specifically to support the pre- and post-care needs of Medicaid members facing transplants and high-risk pregnancies
- Access to our Centers of Excellence networks for transplants, cancer, kidney failure, sickle-cell anemia, and other complex conditions, enabling members to receive care from top-performing facilities at discounted rates
Medical-behavioral integration at the local level
We work with the medical community to deliver whole-person care in innovative ways:
- Telepsychiatry services to improve access to care
- Mobile medical clinic for mental health agencies
- Access to electronic health records
- Psychotropic pharmacy review and intervention
- Aligned incentives and performance-based contracting around whole-person care
- Customized solutions for local-level integrated health homes
- Prevention and wellness programs in both behavioral and medical health