Providers still adjusting to Optum
It’s been a little less than a year since Optum Idaho took over part of the state’s Medicaid system, and local mental health care providers are still having a hard time adjusting.
Some providers said since Optum took over, some services for people with behavioral health problems have been reduced, but Optum said it isn’t approving less care. Executive director of Optum, Becky diVittorio, said Optum is simply shifting what care it allows. The company said it has actually exceeded the amount of care the state requires.
Meanwhile, licensed clinical social worker Brett Hampton works for Rehabilitative Health Services in Idaho Falls. Hampton said since Optum took over, he has had a difficult time adjusting to some of the changes the agency has made, like waiting for a service to be approved.
“In the past we would be able to inform the client at the time during the assessment that they would have certain services. Now we have to go through an authorization process that can take up to three to five days,” he said.
Hampton also said he has seen a reduction in community-based rehabilitation services, which is a form of counseling that has therapists go into the community with clients.
“There has been a reduction for CBRS hours for children and some adult. A lot of that has been driven to push those clients to individual and family therapy,” Hampton said.
Optum said evidence-based services for kids have actually increased, individual therapy is up 25 percent, and the number of children getting family therapy has tripled.
“We focus on getting people the help they need from services or treatments that are shown to be effective based on guidelines established by the mental health and medical communities. Some members who are receiving community rehabilitation services have been transitioned to evidence-based practices,” said diVittorio.
Evidence-based practices are determined by the behavioral health field to be known to work, Optum says. Hampton said if therapy is not working for his patients, he will then try to get CBRS as an enhanced service.
