To conquer the $3 trillion and rapidly rising healthcare costs annually, the secret is getting out in front of it. And that’s what Optum does by design. At its foundation, Optum is all about finding solutions to problems early before they turn into bigger issues. It’s a leading information and technology-enabled health services organization that transcends across all areas of healthcare. And one of the fastest growing areas of its business, population health, is transforming health care through some of the largest employers in America by focusing on innovation around employee health management. Seth Serxner is Chief Health Officer and Senior Vice President of population health at Optum. Population health services include patient advocacy support, case and chronic condition management services, benefit analytics to help lower costs, and near and dear to the heart of Serxner, the integration of innovative behavioral health management capabilities to treat mind and body for better patient outcomes. Serxner shares the key areas of innovation in which Optum is focused, what they’re looking for from partners, and key opportunities and advice for interested entrepreneurs.
Highlights:
KM: I’m aware that behavioral and mental health is a critical focus for Optum. In what ways are you leading in innovation around these areas?
SS: Yes, we have quite an involved strategy around behavioral health, which includes mental health and substance use disorders. It involves medical and behavioral integration, where we're looking at patients more holistically. For example, if a patient has heart disease, we know that many in this position have comorbidities including depression. But typically, treatment is divided into silos. You might have a clinical team including a doctor and a nurse. Maybe you’ll get referred to a mental health practitioner, maybe not. But what we are doing is looking at each patient more holistically and creating entire care teams across practices to seamlessly share information and better evaluate and treat patients.
KM: I bet the Opioid epidemic is top of mind when it comes to behavioral and mental health strategies for Optum.
SS: We're doing significant amount of work around the opioid epidemic and overall addiction. Optum, as you may know, has one of the third largest PBMs (pharmacy benefit managers) in the country - OptumRx, serving 65 million members and filling more than one billion scripts. Through implementing tools such as advanced data analytics, prior authorization requirements, and fraud monitoring strategies, OptumRx has achieved a significant degree of success through its Opioid Risk Management Program. This comprehensive approach to addressing the opioid epidemic focuses on reducing inappropriate prescribing, dispensing and consumption of prescription opioids – while delivering quality care. For example, health plans and employer clients who have adopted the program saw significant reductions in opioid prescriptions and average daily opioid dosing, facilitating greater compliance by physicians and other prescribers with opioid prescribing standards set by the CDC.
What about at the rehab level?
SS: Yes, we are also involved at the treatment level. One of the things we know is that oftentimes people are attracted to going to treatment providers they might see ads for on TV late at night with pictures of far-away beaches and palm trees and luxury facilities and they say, “Come to our Facility.” They’re often called “destination” rehab facilities that use sophisticated marketing tactics and emphasize the resort-like setting rather than the quality of treatment. This can look very appealing to someone who is struggling with addiction and unsure where or how to get help. But there are pitfalls to seeking treatment at an out-of-network facility that may not adhere to the latest evidence-based best practices that are proven to deliver the best outcomes for the patient. So our focus is on helping people with opioid use disorder (OUD) access medication-assisted treatment (MAT) because it’s the most effective intervention. MAT is the gold standard for OUD care and combines behavioral therapies with FDA-approved medications that help ease withdrawal symptoms and reduce cravings. This approach to OUD allows individuals to get treatment in their local community where they live and work, and develop skills needed for long-term recovery so there’s less risk of relapse.
KM: And how to do you work with employers when it comes to managing mental and behavioral health? Does Optum get involved at that level?
SS: We are trying to work on destigmatizing the whole behavioral health space. And this is a really interesting space because it has to do with deep and long-held beliefs that people have about seeking care for problems with mental health and substance use, and the stigma accompanies a feeling by many of being singled out for different kinds of jobs. So, we are really trying to take that stigma away and trying to help people use the many, many services that most employers have but employees often don't take advantage of and need.
KM: So where do you feel that you're missing something that you wish you had when it comes to executing on your strategy?
SS: This mental health and substance use space is not as populated as the physical health space. We do see quite a bit in the resilience and mindfulness area. We're also seeing some very interesting applications around behavioral when it comes to communications. For example, one vendor in particular, through a noninvasive approach to the cell phone, is trying to understand how you use your cell phone: how often do you touch it, how often do you stay on it, where are you searching? This vendor is analyzing those patterns to see if these behaviors can be recognized as potential precursors to a relapse or a problem. Then, the user is alerted with a reminder saying something like, "Hey, it looks like something's going on. Take a breath, ease back," whatever it might be. There are very interesting applications like that one that I think could have a significant impact by leveraging what people do in their daily lives already, particularly when it comes to touching their cell phones a lot. And I think we could do more there.
KM: What about opportunities for innovation around support systems, whether it’s caregivers or peers?
SS: I think creating some kind of digital assistance to help caregivers stay on track and remind them that they’re not alone. We certainly could use more of that. I think what you find is people need more social and peer support from others going through similar situations to themselves. In fact, I just spent some time talking with folks about caregiver support. We forget that while it's very challenging for the individual going through these mental health issues, their family, friends, community are also going through it, and we oftentimes don't have support for them. Even more, they're the ones who are trying to navigate the system on behalf of the patient. So, I think there's a lot of opportunity in the caregiver space as well as the patient space when it comes to behavioral, mental health and substance use that requires more attention. I think more specifically, not necessarily just caregiver support but overall peer support, because it's nice to have people around you who want to be around peers who are going through it or have gone through it in the past. But care is probably, in some cases, a little misleading as a term. That social support network is critical and they serve many, many roles. Just navigating the system can be a challenge for any support team. For example, when it comes to special needs families, we have a lot of work we are doing to make things easier. Many employers are very interested in our enhanced benefits around autism in the full spectrum and other issues around special needs kids as well as adults and the social support network, whether it’s family, peers or general caregivers. It's a lot to deal with, it's a lot to understand how to navigate the system, and it's a lot to understand all the payments, the best practices and treatments. Are you getting them right? Is it okay to ask the questions? All of that weighs heavily on them and carries an extra burden of having some sort of stigma. So, I think there’s a real opportunity there to truly innovate and have an impact.
KM: If you could wave your wand and magically have some ultimate solution to any problem, particularly for mental and behavior health, appear before your eyes, what would that look like?
SS: I've been thinking quite a bit about this and hopefully it will spark some ideas in the people who are reading this. It’s around health literacy and the ability of people to understand the health system and healthcare information as well as the ability to navigate the system appropriately. What we know is that only one in 10 people are proficient in health literacy, and it gets even more difficult when someone is in an emotional state or in physical pain. It’s vital to help people increase their knowledge, confidence and skills in navigating the system and getting the answers they need, whether it’s a mental health system or a physical health system, especially in the mental health area because of the stigma-closed environment. So, what we are exploring is the use of video in what I call Health Literacy 2.0. I like the idea of quick, relevant, even peer-taught or trusted expert-taught video messages that are easily consumable and fit my phone and way of life. I think that would be a really interesting approach to education and something we are exploring in the near future. They wouldn’t be hour-long clips, but instead short YouTube-like or TED Talk clips that cut right to the point with relevant explanations. They could be videos that help navigate the system, explain jargon and acronyms and even offer stories that lend support to let people know they’re not alone. I feel like a lot of the services out there are still too technical and need to be more in tune with consumer and consumer language – plain and simple. I also think there needs to be a whole cultural element addressing social determinants which are not being addressed in many solutions I’ve seen so far.
KM: What are some of those determinants that you think would be great for video?
SS: Well, as I said, with cultural diversity, it goes beyond language, it is an understanding of what the different perceptions are, especially when talking about mental health. In some cultures, it's a big no-no to talk about your feelings, talk about your personal issues. You have to approach it understanding a person's cultural context if you really want to have them open up. We think we can do that with peer-to-peer videos or with experts specializing in those areas. When it comes to cultural diversity, we need to create videos that explain things in a more relatable way. We want to make sure that cultural piece is explored and reflected accurately through Health Literacy 2.0. We are open to ideas and we have to also figure out the economics piece. Many people can’t afford healthcare, right? So, let's acknowledge that financial wellbeing is one of the biggest issues out there today. And it's a major factor in so much of how people behave and what they feel like. They think, “I can't afford a psychologist. I can't afford going to one of these places. I can't afford taking off work. I've got other things to do. I'll just get through it." Those are human factors that we sometimes forget. We have to figure out how to reach them with video or other ways.
KM: The number one thing I’ve learned in my journalistic journey is that you have to reach people where they are and guide them where you want them to be on your site. So, how do you reach them and get them to watch your videos versus going to WebMD, Healthline, or other sites where you don’t necessarily support the information presented?
SS: This is where we apply artificial intelligence. We do have many places where people come to our website or our app, and let’s say they're searching for a provider. They type in, "specialist, psychologist," – and a personalized recommendation pops up. This is where we use data to provide the content the person is looking for and put it in front of them. We do this across the entire health care system, but I think for mental, behavioral health and substance use it really makes a lot of sense. Even more, we have special EAP’s, or employee assistance programs, which include an employee assistance website. And with that, there are a lot of personalization opportunities. The more information an employee puts in the better we can customize what we put in front of them. We already know their family, their medical claims and we can do modeling around a person’s demographics and other factors so that we can anticipate, to the best of our ability, what they’re looking for and how we can help. That’s what people want. And that’s why we want to take it to the next level and really start to supply relevant information in even more consumable ways, including a video stream, so they can really absorb the knowledge.
KM: Are you working with internal innovators or external entrepreneurs who are innovating in these areas?
SS: We have a whole continuum. We have product teams that are always innovating our existing products and services and they're very in tune to market and employer demand as well as overall trends. Also, both Optum and United Healthcare have venture groups. Optum has a significant Optum Ventures, where we invest in startups and ideas that we think have promise. And then, of course, we get many entrepreneurs that reach out to us who are interested in working with us and want to be associated with our platforms, programs, services and would like access to our membership.
KM: Do you check in with the folks on your venture arm and say, "Hey, what do you have coming in that could benefit me?" Or "Here are our needs. Can you find startups in these particular areas?"
SS: Yes, there's a very systematic process to all of that. We do keep each other informed on investments and opportunities. I even send entrepreneurs who approach me to them and vice versa. Did you know we have an internal innovation team as well? Sometimes when people are asking me, "Hey, you know, we'd love to share with you our new product or service," I will oftentimes forward that to our innovation team and I'll say, "Hey, you know, what do you think? Is this of interest? Do you want to talk?" In fact, in my last meeting with an entrepreneur in December, I saw he had a really interesting idea. I forwarded it on, and now they're in contact with not only our innovation team but now our ventures group. So, there's quite a funnel.
KM: Sounds like an effective system. But just how easy is it for you to find exactly what you are looking for and how quickly does the system allow you to implement a great find?
SS: Well, the trick is that I'm an anxious person. I have that quick-to-market entrepreneurial spirit. But at the same time, I think the latest numbers show that Optum alone touches more than 90-million people. So, while I want to be quick, quality is incredibly important to me. We can’t make a mistake at this scale of impact. We have a lot of lives at stake. We do a lot of testing first, and we ensure every idea gets a thorough review and integration with all of the data systems, with all of the legal systems, clinical teams and operational teams. It’s a very involved process.
KM: What’s your best advice for entrepreneurs who believe they have the next big thing whether it’s in clinical, rehab, video, around cultural diversity or economics, or anything else, and they want to approach you with their ideas?
SS: Yes. It’s around measurement and value. I think it's really important to make sure that you're very clear on the value you deliver, whether it’s a clinical, behavioral, cost or quality of life outcome. Draw a very clear line to what your product does and what it delivers. Because oftentimes that's pretty fuzzy and we're going to want to be able to measure that and document it, and the clearer that line is the clearer your pitch will be.
KM: Can you give a quick example of something that works?
SS: Back to what we talked about before with the Opioid epidemic and part of what we're doing with some protocols around scripts. We've seen the number of inappropriate scripts delivered drop by a significant amount. Our goal was to see fewer multiple scripts and at high doses. We set that as a target, and we delivered on it. It’s how we do business internal and what we expect from our partners. Deliver on what you want to do, whether it's recidivism, whether it's back to work, whether it's self-reported issues. Be very clear on your metric, other than measuring the number of people on your site or using your app.
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Seth Serxner is the chief health officer and senior vice president of population health at Optum. He has more than 25 years of experience in health and productivity management and has published more than 40 articles and chapters.