Implementing Recovery, Resilience,
Wellness And Wellbeing Into Our Work
At OptumHealth
The Expanding Peer Workforce –
Evidence, Delivery and Outcomes
Sue Bergeson Slides
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2
Peers As OptumHealth Staff
• At the Corporate level
• At the Local Level
– Bring recovery and resiliency
orientation
– Provide the lived experience
perspective on policies and
procedures
– Focus on engagement
– Offer innovation
– Implement programs and
services
–
–
–
–
–
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.
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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
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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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.
Peer
Bridger
Designed for
members with 2+
hospital stays in one
year, provides
support coaching,
community linkage
and empowerment
(developed by
NYAPRS)
Peer WholeHealth Coach
Supports both mental
and physical health
engagement and
recovery
Addiction
Recovery
Coaches
Peer
Engagement
Coaches
Family Peer
Coach
Engages members
to support their move
to recovery
Connect with members
who are at risk based
on diagnosis or
medication usage to
empower the member
through engagement
tools and resources
Supports families with
a child having with a
behavioral health or
substance abuse
issue
(in process)
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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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.
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
6
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
Peer Whole-Health Specialist
• 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
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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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
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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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”
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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“Who then can so
softly bind up the
wound of another as
he who has felt the
same wound
himself?”
 Thomas Jefferson
Confidential property of Optum. Do not distribute or reproduce without express permission from Optum.
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Thank You
Sue Bergeson, VP Consumer Affairs
612-632-2998
[email protected]
© 2013 Optum. All Rights Reserved.
Peter Ashenden, Director Consumer Affairs
612-632-2963
[email protected]
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Peter Ashenden - Mental Health America