Amid pervasive workforce shortages and a growing demand for services, Optum Behavioral Health is working to reimagine the way behavioral health care is delivered. CEO Katherine Hobbs Knutson, who joined the company about a year ago, is leading the charge.
“That divide between … what exists in the field versus what people actually have access to is a wide gap that I want to … narrow that so that we can start to make a dent in this real epidemic that we have in our society,” Hobbs Knutson said.
She made those comments last month during the Going Digital: Behavioral Health Tech Summit 2021, a virtual event put on by a group of behavioral health entrepreneurs, investors, technologists and designers.
A psychiatrist by training, Hobbs Knutson has been working in the payer space for about 10 years now, and she joined Optum Behavioral Care in 2020.
The company is focused on improving behavioral health care access and quality, while also measuring outcomes and rewarding the providers who deliver them. It’s part of Optum, which is the fastest growing business under the multinational managed healthcare and insurance company UnitedHealth Group (NYSE: UNH).
“There’s oftentimes a mismatch between what the patient needs and what’s available in their local community, and so that’s what we really want to address … through a lot of these more innovative methods of delivering care,” Hobbs Knutson said. “We want to really build out that full spectrum of mental health and substance use [disorder] care delivery nationally.”
Partnerships, technology and integrated care are essential to making it happen, she said.
Integrated care involves blending behavioral health care treatment with general or specialty medical services, allowing professionals such as primary care physicians (PCPs) to treat patients with lower-level behavioral health needs during routine medical appointments.
The practice makes it easier and more convenient for people to get behavioral health care, while also reducing the stigma that often comes with behavioral health treatment and freeing up overburdened behavioral health specialists.
“If you can take those [lower-level behavioral health] conditions and empower PCPs to address them, then you’ve got an opportunity to focus our specialists on that smaller population that has more severe and complex conditions,” Hobbs Knutson said. “It’s a more efficient, better use of our resources. Also, there are just more primary care providers available, so it helps us address these workforce shortages that we have.”
Empowering PCPs comes down to providing them with the extensive technical support and education, while also ensuring integrated care is possible from a payment perspective.
While coordinated care codes exist, they’re still “basically fee-for-service codes,” Hobbs Knutson said.
“Where we really want to go is toward a model where primary care providers are at global risk for a population for both physical and behavioral health services, and we’re putting in the right outcome measures to incentivize them to focus on … and invest in behavioral health,” she said, noting that ROI would help sustain the model over time. “That’s ultimately the payment model that we want to get to — but the collaborative care codes absolutely are an important first step.”
Outcomes would be an essential part of that potential payment model, which is why every provider Optum Behavioral Care works with uses measurement-based care, Hobbs Knutson said.
In behavioral health, most measures are self-reported, with providers frequently using tools such as the PHQ-9 and the GAD-7 to measure patients’ depression and anxiety, respectively. However, Hobbs Knutson noted her organization is trying to move more toward “true health outcome measures to the fullest extent possible.”
That requires providers to have robust electronic health records (EHRs) and IT systems able to regularly collect and report outcomes to payers, she explained.
Meanwhile, when it comes to the outcome measures necessary for value-based care, Hobbs Knutson said she often sees organizations get intimidated by the concept due to the fact that behavioral health outcome measures are imperfect and diagnosis-specific. However, providers are typically given an array of outcome measure tools to choose from, she said.
“The provider can choose which one is most relevant for their patients, and then what we as the payer are holding them accountable to is … one baseline and at least one follow up in the measurement period, with a consistent scale,” Hobbs Knutson said. “We reward improvement according to that scale.”
She noted that technology — which can be a workforce multiplier and access improver in behavioral health — also has the potential to improve outcome measurements down the line.
“I’m asking [patients] to think over the last two to four weeks, ‘How has your mood been?’ and … it’s very hard to think over two to four weeks,” she said. “So I get very excited about these more passive ways — using phones, using wearables — that we could be tracking these symptoms.”
Finally, she added that peer support and community health members are also important in revolutionizing behavioral health care delivery, noting that they are a less expensive, more relatable way to improve accessibility of behavioral health services.