Implementing Recovery, Resilience, Wellness And Wellbeing Into Our Work At OptumHealth The Expanding Peer Workforce – Evidence, Delivery and Outcomes Sue Bergeson Slides Confidential property of Optum. Do not distribute or reproduce without express permission from Optum. 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. 3 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. 4 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. 5 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. 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. 8 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. 9 “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. 10 Thank You Sue Bergeson, VP Consumer Affairs 612-632-2998 Susan.Bergeson@optum.com © 2013 Optum. All Rights Reserved. Peter Ashenden, Director Consumer Affairs 612-632-2963 Peter.Ashenden@optum.com