UnitedHealthcare, Inc.

Burnout is quickly becoming a health crisis for providers and patients, according to the American Medical Association. A Mayo Clinic study highlighted alarming trends in physician burnout: 62% of physicians had at least one symptom of burnout in 2021 compared to 39% during the prior year, and organizations across the country have seen little improvement since. Amidst a nationwide provider shortage, understanding burnout and developing effective, achievable solutions are key to helping clinicians have more time to do what they do best – provide clinical care for their patients. Reasons for burnout Several factors contribute to provider burnout: ever-increasing administrative tasks, electronic medical record documentation, too little time per patient, as well as the needs of patients between visits. Providers shoulder most of the responsibility for direct patient care as well as visit documentation and typically operate in silos. There is often not enough coordination and collaboration among siloed clinicians regarding patients in their care, despite their best intentions. The nuances of treating mental health can exacerbate burnout, too. Due to competing clinical demands, primary care providers often do not have enough time, resources, or mental health domain expertise. To get the best outcomes, primary care providers need to: screen for mental health issues like depression and anxiety; educate patients about the rationale for treatment with medication and evidence-based psychotherapy approaches; and monitor symptoms and side effects; all of which takes extra time. This is virtually impossible in the typical 15-to-20-minute primary care visit. Psychiatric collaborative care improves health outcomes The psychiatric collaborative care model offers an opportunity to mitigate burnout by reducing the burden placed on primary care providers (PCPs) and more effectively supporting their patients with behavioral health needs. In psychiatric collaborative care, clinicians work in unison – from the psychiatrist to the PCP to a care manager – and they partner to assess the efficacy of a patient’s care plan. In real time, they can make adjustments to address evolving patient needs. In particular, psychiatric collaborative care creates a strong support system for clinicians as they manage their patients’ complex behavioral health issues; the addition of a psychiatrist’s expert input is key to the collaboration. Moreover, regular outreach to the patient by the behavioral health clinician – monitoring symptoms and side effects, measuring depression and anxiety levels, and providing evidence-based psychotherapy, coaching and health activation support – provides a level of support that extends the reach far beyond what primary care providers could do in traditional practice, i.e., “usual care.” Further, such a psychiatric collaborative care model can help alleviate clinician burnout by having regular touch points to provide support and answer questions, which would otherwise fall solely on the PCP. Of note, the most advanced collaborative care programs allow for expedient, ongoing access to psychiatrists, alleviating standard administrative burdens associated with psychiatric consultation requests. Tools to support psychiatric collaborative care Effective psychiatric collaborative care models can really help primary care groups and improve patient health outcomes. However, primary care groups should evaluate programs before adopting to make sure the selected model will help alleviate provider burnout while supporting collaborative care efforts. Features of effective psychiatric collaborative care programs: Impact analysis: the program should identify patients who are most likely to benefit from the collaborative care program. Evidence-based interventions: these should include evidence-based psychotherapy, clinical decision support tools, and real-time interactions with psychiatrists and care managers. Frequent reviews: updates provided to the primary care provider on a regular basis – think weekly, not monthly – so the care team can adjust the plan as needed. No patient excluded: regular case review evaluates all patients, even those who do not show up; the collaborative care team helps the primary care provider by supporting patients in engaging in their care. Support move to value-based care With the push to value-based care already underway within the nation’s largest payers , such as UnitedHealthcare Group, Humana, and CVS/Aetna – primary care groups need programs that help them succeed in value-based care arrangements. Compared to fee-for-service arrangements, value-based care models incentivize PCPs to spend more time with their patients. Specifically, value-based care offers clinicians compensation based on performance and demonstrated patient health outcomes. As such, value-based care can include longer appointment times, more frequent visits, and smaller panels, with an emphasis on prevention and lifestyle changes to improve health. With primary care practices positioned as the quarterback to coordinate all aspects of care, including mental health care, they stand to gain with the new value-based model, especially when leveraging a results-driven psychiatric collaborative care model to address their patient’s mental health needs. Patients and clinicians benefit When properly supported in offering psychiatric collaborative care, primary care groups can expect to see a reduction in their burnout rates. Success will appear both in quantifiable return on investment for PCPs and improved health outcomes for the patients they serve. Clinicians owe it to themselves and their patients to implement the psychiatric collaborative care model.

Boulder Care, a virtual provider for substance use disorder, is extending its treatment to adolescents in partnership with UnitedHealthcare Community Plan, the company told MedCity News exclusively. Portland, Oregon-based Boulder Care works with payers and treats people with opioid use disorder and alcohol use disorder. Its app provides access to a team of care providers and peer recovery coaching. Boulder Care’s addiction specialists can also prescribe buprenorphine, a medication that treats opioid use disorder. Starting in the second quarter of 2024, the company’s telehealth and medication management services will become available to eligible teens covered by UnitedHealthcare Community Plan, a Medicaid plan. Boulder Care is starting by serving adolescents in Washington and will be partnering with pediatric primary care and community-based organizations, including schools. The startup is also bringing on consulting experts in pediatrics and case managers with experience helping this population. In addition, to support its adolescent patients, Boulder is hiring peers who are between the ages of 18 and 35 and have lived experience with addiction. Stephanie Strong, CEO and founder of Boulder Care, said that telemedicine is an effective way to treat adolescents with substance use disorder as it is more affordable and allows them to continue living their lives. “We can reach many people at once without disrupting their day-to-day lives,” Strong said in an interview. “This is particularly important for Medicaid patients who don’t really have the luxury of flexibility in their schedules as well as being low income.” The arrangement with UnitedHealthcare Community Plan is a value-based contract with a focus on outcomes like patient engagement, retention and social factors, including housing and employment, according to Strong. Boulder Care’s expansion into adolescent treatment comes at a dire time. In 2022, an average of 22 teens aged 14 to 18 died in the U.S. each week from drug overdoses. In the same year, 38 youths in Washington died from an opioid-related overdose, about triple the number in 2019, according to The Seattle Times. Of the 38 deaths, 37 were tied to synthetic opioids, such as fentanyl. “As a parent and someone who is really close to the community in this work, it’s deeply troubling how young opioid use disorder and addiction is impacting our country. … We really need to not just focus on overdose and reversing overdose at the moment, but on overall prevention, education and practical ways of helping people get treatment and solving all the social needs that may make someone more prone to addictive disease,” Strong urged. Strong said she ultimately hopes to scale its adolescent services to more health plans and more states in the future and “break the generational cycle of addiction.” “We know that these traumas ripple into future generations. By helping people early in life and wrapping around entire families, our goal is to create a healthier future for our country in the midst of this worsening crisis,” Strong stated. Other companies that offer virtual addiction services include Bicycle Health and Ophelia, while other behavioral health companies that support adolescents include Equip Health and Brightline.

UnitedHealthcare said its expanded footprint on the Affordable Care Act exchanges will make its plans available to 60% of the eligible population. UnitedHealthcare is expanding its footprint on the Affordable Care Act (ACA) exchanges to four new states in 2024, the insurance giant announced Tuesday. The new states are New Jersey, New Mexico, South Carolina and Wisconsin, bringing its total footprint to 26 states. Over the past four years, the company has significantly grown its reach on the marketplaces from 177 counties across 11 states to 1,032 counties in 26 states for 2024. It also offers ACA plans in Alabama, Arizona, Colorado, Florida, Georgia, Illinois, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Nevada, New York, North Carolina, Ohio, Oklahoma, Tennessee, Texas, Virginia and Washington. UHC said the expanded footprint will make its plans available to 60% of the eligible population. “It is as important as ever for everyone to have access to quality health care coverage,” said Marcus Robinson, CEO of UnitedHealthcare Individual and Family Plans, in the release. “We are honored for the opportunity to serve more people in 2024 with affordable, convenient plans and to help expand equitable access to care.” Thanks to expanded subsidies and other flexibilities rolled out during the COVID-19 pandemic, enrollment in ACA exchange plans has reached record highs. More than 16 million people signed up for coverage in the 2023 open enrollment window, according to data from the Centers for Medicare & Medicaid Services. Increasing stability also lured previously skittish insurers to either return to the exchanges or expand their footprints. UnitedHealthcare said that many people qualify for plans with $0 premiums and that 90% of its ACA exchange plan members qualify for a subsidy that brings down the cost of coverage. Plans offered this year include $0 copayments for primary care visits and virtual urgent care as well as prescription costs as low as $5 at more than 40,000 in-network pharmacies, UHC said. New Copay Focus plans include $0 deductibles for medical care and predictable copayments for key services. Plan options also include adult dental and vision coverage, a potential $100 reward for completing health and wellness tasks and free access to digital fitness classes. Open enrollment begins Nov. 1 and continues through Jan. 15, 2024.