New OPE report examines Idaho Behavioral Health Plan, Optum contract
The Joint Legislative Oversight Committee has released a new report today on the Idaho Behavioral Health Plan, including the three-year, $300 million contract with Optum Idaho. The performance evaluation report found that the move to the contract with Optum succeeded in switching to a managed-care model and reversed a trend in which the use of psycho-social rehabilitation, or PSR, ballooned ninefold, from $8.3 million in 2001 to $76.1 million in 2012. Spending just on PSR “at its peak was 65 percent of Medicaid’s outpatient spending,” said Office of Performance Evaluations Director Rakesh Mohan. “The department did not believe that this was the best use of Medicaid’s resources.”
PSR spending had hit $83.3 million in 2013, but had fallen to $44.1 million by 2015, according to the report. But investing the savings into community-based services has proven more difficult than planned, in part because of federal regulations.
The report also found that among service providers, there was confusion about just what the department intended in the new plan, and about which changes were due to the new plan and which were brought about by Optum’s choices.
Overall, spending is down under the new plan, evaluators found, though more people are actually receiving services. “The drop in rehabilitation is much larger than the increase in other services,” said OPE analyst Ryan Langrill. But, he said, “The main lesson of this plan is it is not enough to have a contract that adheres to purchasing regulations and a compliant contractor to have a successful program.” Success, he said, “additionally requires strong communication, well-developed program design and an understanding of the product the state is buying.”
The full report is online here; its recommendations include that the Department of Health & Welfare continue taking steps to build capacity and services in the community; that it formally evaluate the merit of including inpatient services in the behavioral health plan, which were specifically excluded in the initial design to focus on outpatient services; and that the department turn to “independent third-party expertise” to examine that.
In its response to the report, Optum noted that it's seen an 87 percent increase in the use of parenting skills through family therapy. "We are seeing a shift of outpatient services delivered to children," wrote Optum Idaho Executive Director Becky diVittorio. "This indicates more families are engaged in helping their loved ones reach recovery, and families are now taking a more active role in that journey." DiVittorio told lawmakers today, "We knew it would not be easy. True system change does not happen overnight."
State Health & Welfare Director Dick Armstrong, in his response to the report, wrote that H&W agrees with its conclusions. "The department's goal in implementing the IBHP was to create a cost-effective, evidence-based system of behavioral health care with a focus on recovery and resilience," he wrote. "While we have largely achieved that goal, we recognize that these changes have not been easy for certain providers and for some of the participants we serve." He added, "We are looking forward to implementing additional improvements, including new benefits, in the near future."
Rep. John Rusche, D-Lewiston, who’s participating in the meeting by phone, said, “PSR grew because we paid for it and didn’t manage it. … So … the plan was designed to reduce psychosocial rehabilitation, and Optum basically did what we asked.” McCleve responded, “That’s correct.” Rusche said he agreed that better communication could have kept the change from disrupting and angering providers.
