Optum Behavioral CEO: We Must Expand the Behavioral Health Care Delivery System to Facilitate Value-Based Care

On average, people with behavioral health conditions cost payers about $875 more per member per month than those without behavioral health conditions. Yet, studies show that less than half of the patients who need behavioral health treatment actually receive it.

The health care system’s fee-for-service nature is one reason for that, as is the massive supply-demand mismatch in behavioral health. Behavioral stakeholders have often mused that addressing the former could help improve the latter; however, Katherine Knutson, the senior vice president at United Health Group and the CEO of Optum Behavioral Care, believes the issue is a little more complicated than that.

“The behavioral health system really is fragmented, and it’s difficult to access,” Knutson said Thursday. “So just putting in a payment methodology like an accountable care organization is not enough. We’ve also got to build out the behavioral health care delivery system and … do a better job of really understanding our population and honing in to get those treatment resources to the right population in an efficient manner.” 


Knutson made those comments during a recent webinar hosted by Rise, a community for healthcare professionals working to troubleshoot the challenges of accountable care and government health care reform. 

On the webinar, Knutson backed up her views with data from Health Affairs, pointing to a 2016 study the journal published about mental illness spending, utilization and quality measures associated with ACOs. 

With a few exceptions, researchers found that the ACOs studied didn’t drive down mental health spending, readmissions or rates of depression diagnoses. In fact, most metrics studied saw no change at all. 


Beyond changing the payment methodology, Knutson said there has to be more investment in behavioral health services, as well as a redeployment of primary care clinicians to address mild to moderate behavioral health conditions.

“Many conditions, like depression or ADHD, can be managed very effectively in primary care,” she said. “And if we did a better job of helping primary care providers to manage these conditions, then we could potentially reserve the limited supply of specialists … to address the populations that have more severe and complex conditions.”

Knutson said the “vast majority” of behavioral health conditions fall in the mild to moderate category and can be appropriately handled in primary care, whether by existing clinicians or by adopting a collaborative care model.

On top of that, she denounced the way behavioral health providers are paid, which is usually on a fee-for-service basis, meaning they can usually only treat patients face-to-face or using telehealth.

“Fee-for-service rates often don’t scale appropriately, depending on the patient complexity,” Knutson said. “So oftentimes, payers are paying the same amount for treatment of ADHD as a medication visit for schizophrenia, and the work involved in those two is quite different.”

Additionally, fee-for-service doesn’t account for interventions between visits — such as phone calls to see how patients are doing on new medication, for example — which Knutson calls among the most impactful in patient care. 

“That phone call is often the difference between a person staying in treatment … and never coming back,” she said. “But that telephone call … isn’t paid for in that current fee-for-service environment, and so, honestly, many providers really can’t do that.”

As such, she said there’s a “major opportunity” to invest more in outpatient behavioral health care.

“If we could give people better access to those treatments in the outpatient setting, we should be able to see not only … an improvement in the behavioral outcomes and a reduction in the spend for behavioral health, but also improvement in management of co-occurring medical conditions and a corresponding reduction in the total cost of care. So this is the whole financial value-proposition for behavioral health.”

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