ubh orientation and update l.
Skip this Video
Loading SlideShow in 5 Seconds..
UBH orientation and update PowerPoint Presentation
Download Presentation
UBH orientation and update

Loading in 2 Seconds...

play fullscreen
1 / 9

UBH orientation and update - PowerPoint PPT Presentation

  • Uploaded on

UBH orientation and update. James M. Slayton, M.D., M.B.A. Medical Director, United Behavioral Health June 16, 2009 June 18, 2009. UBH related topics. Goals of today’s discussion: Brief discussion of UBH level of care criteria Update on Wellness Assessment (ALERT)

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

UBH orientation and update

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
    Presentation Transcript
    1. UBH orientation and update James M. Slayton, M.D., M.B.A. Medical Director, United Behavioral Health June 16, 2009 June 18, 2009

    2. UBH related topics Goals of today’s discussion: • Brief discussion of UBH level of care criteria • Update on Wellness Assessment (ALERT) • Update on authorization process • Update on use of OTRs • Testing questions related to behavioral health versus non-behavioral health (medical diagnoses) • Network management related questions

    3. Scope of Business • Over 58 million individuals managed through UHC/OptumHealth, or through UHC partners • Numerous external health plans partners, such as Harvard Pilgrim Health Care • Numerous high visibility employer groups, such as IBM • History of acquisition of other health plans (e.g. Oxford, PacifiCare) • Individuals served in all 50 states • Expanding scope of business in northern New England • United Behavioral Health is historical identity for UHC related business

    4. Level of Care guidelines • Based on principle of “least restrictive treatment setting” that is safe and effective for the member • Four areas covered by level of care guidelines: • Mental health or psychiatric services (includes dual diagnosis) • Substance abuse services • Community Support services (typically apply more to public sector populations under management; may not be available in the benefit plan for commercially insured or self-insured employer group members) • Testing guidelines apply to psych testing and neuropsych testing • Level of care guidelines are underpinned by evidence based practice (supported through adoption of best practice guidelines, such as APA Eating Disorder guideline) • Level of care guidelines are updated annually • They can be downloaded or reviewed at www.ubhonline.com • Revisions receive input and approval by UBH national provider advisor panel

    5. Wellness Assessment update • Product of a revision of previous UBH Wellness Survey and PacifiCare ALERT assessment in 2007 • Based on seminal network by Michael Lambert and Jeb Brown in Utah, looking at functional impairment and improvement in function during the course of therapy • Derived from well-known and validated assessment scales such as SCL-90, SF-36, CAGE-AID, WHO Health and Productivity Questionnaire, Caregiver Strain Questionnaire, and Child/Adolescent Measurement Scale • Psychometric analysis conducted to review potential item overlap, scale validity, scale sensitivity across a range of symptom severity, and response option efficiency • Shorter than previous survey tools used by either company

    6. Wellness Assessment update (continued) • 2007 revision of Wellness Assessment paired with open authorization process for members (essentially, members get the annual benefit with the initial auth; authorization NOT tied to a given provider) • Request of care providers is to have at least 2 Wellness Assessments completed early in the episode of care • Final Wellness Assessment mailed to members for completion several months after initiation of the episode of care • Wellness Assessments sent to UBH via fax to file technology • Care advocates may reach out to clinicians by letter or phone if there is a potential increased risk profile, or if there is a risk of premature treatment drop-out • Data from Wellness Assessments is confidential, not shared with employer groups or any other parties. Members with additional concerns are encouraged to call UBH directly if they should have questions

    7. Authorization process and questions • Outpatient behavioral health care has always been a prior-authorization service. • Requests for retroactive authorization will be considered on a case by case basis, depending on potential “extenuating circumstances” • As noted previously, members receive the annual benefit in their initial authorization when they call in for a referral or to initiate treatment with an in-network provider already identified • It is still advisable for providers to call in to UBH if there is a question about current member eligibility or other aspects of the authorization • Outpatient Treatment Reviews are no longer utilized for in-network providers • For out-of-network providers, authorizations typically conducted with clinical care advocates up to 10 sessions at a time • Suggest that providers submitting OTRs by fax keep a record of their successful submission in the patient’s file (much more reliable than using US Mail, unless one requests a return receipt) • Given fax volume at UBH, recommend calling the receiving party to ensure that they are aware that fax was sent successfully (to avoid misdirected faxes)

    8. Testing Requests and questions • Psychological/Neuropsychological testing typically require prior authorization • Determination on whether it’s behavioral or medical determined by reviewing testing request • Assisting with treatment plan for a DSM-IV diagnosis typically viewed as behavioral • Unless related to a complex medical or neurological disorder • Level of Care guidelines followed in reviewing testing requests for approval • If there is a need for clarification about the testing request information, it is not uncommon for the UBH reviewer to reach out to the person submitting the request • Sometimes, members and loved ones may have “heightened expectations” in the testing unlocking something unique and critical about the proposed treatment • There may be an opportunity to “manage expectations” in terms of what to expect from testing • Generally, managed care organizations assume that the testing will be used to help guide treatment already underway, as opposed to being a stand-alone element not related to a current or proposed treatment • Generally, testing for educationally-based purposes is viewed as outside coverage provided by health plans, where the purpose of testing is should be based on active treatment of a medical or behavioral condition

    9. Information regarding the UBH network • Local UBH network manager is Wendy Smith, works out of Portland office (207-253-1017); wendy.smith@optumhealth.com • UBH network providers can be found at www.ubhonline.com • UBH network providers self-identify in terms of areas of expertise; e.g. psychological testing or neuropsychological testing; eating disorders, trauma, etc. • Sometimes, especially with testing requests, members or families will not be certain of what they are seeking; this may lead to an errant referral • If your identified areas of expertise are not complete as listed in our system (or are incorrectly loaded), please be in contact with Wendy Smith • If there are other problems with referrals you are receiving from UBH, please let us know • Thank you for the opportunity to work with you on behalf of our members!