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Seeking startups with evidence their product is effective
UnitedHealth Group is among the top three healthcare companies in the world, with revenue of $201 billion in 2018. It is a labyrinth of divisions that include UnitedHealthcare, its insurance arm, and Optum, its services arm, which focuses on physician networks, as well as products and services to deliver to the 49.7 million members insured by UnitedHealthcare.
Who to talk to and how to integrate your startup into this massive corporation are questions many have. Tim Blevins is the SVP of Behavioral Health at UnitedHealth Group Optum.
Tim is in charge of products within this group that's focused on enhancing and expanding Optum's mental health and behavioral health services and selling them to employers.
- Optum has 40 employer customers that buy managed behavioral services (but whose members are not insured by UnitedHealthcare)
- Behavioral health is booming due to a confluence of events, including mental health parity, the shortage of prescribers of psychotropic medications, high deductible health plans and numerous others
- Products and services must have proven measurements because employers already have 20-30 solutions on their shelves already
- Startups should think about how their products fit into the UHG's and employers' broader ecosystem
BF: What is your role at UHG Optum Behavioral Services?
TB: UnitedHealth Group entity is the holding company. Underneath, UnitedHealthcare is the traditional health insurance arm, which sells insurance to employers and government entities. At its core, it's a traditional insurance company purchasing insurance benefits and providing coverage to eligible members through a plan. Within that, there are three major components: The two public sector components are Medicaid and Medicare. The other division is employer-sponsored and individual plans. I am responsible for providing mental health and substance abuse benefits to that third division. I do this through Optum, which is the service arm for UnitedHealth Group. So my counterparts at UnitedHealthcare are focused on (medical) claims, sales, actuarial data while I provide a range of services specific to behavioral health, including, but not limited to clinical and provider-networks. My teams handle the provider network, clinical programs, the products and digital assets that enhance behavioral and mental health services.
BF: And your division inside Optum also sells these managed services to employers that are not working with UnitedHealthcare, correct?
TB: Yes. We go to employers directly that may have a limited or no relationships with UnitedHealthcare. I have more than 40 employer customers who purchase managed behavioral services (network, product, care management, clinical) from our group, such as the state of Ohio or State of Tennessee.
BF: How is UHG Optum's behavioral health services different from what's offered by the established insurers, like Anthem and Aetna?
TB: I was previously at Aetna, Blue Cross and Aetna. All of those have behavioral health benefits and services fully embedded in their broader medical insurance company. Aetna Behavioral Health provides employee assistance programs and core services for anyone who is a member of Aetna. Other than EAP, these insurers don't typically offer direct-to-consumer or direct to employer products outside of their own insurance members. Optum operates more like a PBM (pharmacy benefit manager) for behavioral in that we sell to the insurance provider and UHC is my biggest customer. [A PBM is a third-party administrator of prescription drugs]. You can think of this as on a continuum. On the far left, there are companies like Magellan Insurance, ComPsych and Beacon Health Options [which is being acquired by Anthem] that provide employee assistance programs and managed behavioral health services. We stand alone like them. On the far right are the integrated ones - Anthem, Cigna, Aetna and we operate similarly for United HealthCare.
BF: Why has behavioral health become a massive area of concern for employers?
TB: This is a question I get a lot, along with 'How did it evolve so quickly?' The truth is that many of the problems employers are dealing with today, they dealt with 30 years ago. Employers were trying to manage psychiatric costs. Thus was born the managed behavioral healthcare industry. There were a small handful of companies - such as Magellan, Beacon and United Behavioral Health (now Optum) -- doing a good job keeping unit costs low. But then came the Mental Health Parity and Addiction Equity Act (2008), [which requires health plans to provide the same level of benefits for mental health and substance use as they do for medical benefits.] Soon we were seeing a shortage of psychiatrists. Then came high-deductible plans that made purchasing behavioral services expensive. Then there was the opioid crisis that created demand for more products and services. So there were just several forces that converged around the same time, in ways anyone could have predicted. The stage has been set quite beautifully to bring in new innovative technologies and capabilities that are intended to create more and better access to care.
BF: There are a number of new companies addressing this space. How can they work with your group?
TB: The three most important areas are No. 1 - evidence. Does the supplier know that what they're doing is effective? They have to explain in very clear, objective quantitative terms that they've been able to prove that their product works. What is the value to the end user, whether it's the patient, health plan or employer? Often, it takes time to have products verified and published, therefore at the least, they have to have a measurement strategy that we can see if achieved can be evidence that the product does work. No. 2 - business model. An organization can get themselves into trouble if one day they are direct-to-consumer and then they pivot to sell to employers then shifts focus to sell through a different channel. Direct-to-consumer is proving to be a bit challenging for some. And direct to employers can be challenging as well. Employers already have many solutions on their shelves that tackle diabetes, wellness, and now mental health. It’s hard for an employer to wrap their heads around all this. So being nimble enough, but also picking a strategy and sticking to it is my advice. No. 3 - integrable. How easily can this product be integrated into the broader ecosystem?
BF: How many behavioral / mental health startups do you work with?
TB: It's hard to say. We do work with different groups for mindfulness, cognitive behavioral therapy, autism and substance use. Then we have employers that want us to contract with a certain vendor they're working with. We've evaluated hundreds of companies. But we only have formal agreements in place with more than a handful. We work with Talkspace and AbleTo. We have our own digital company Sanvello. In some ways, it's easier for vendors to be adopted by the companies that integrated the medical claims side (insurance) with the services. For instance, in order for AbleTo to work with our customers, we'd have to get medical claims data from non-UHC members as well as the pharma data, which we can't always get, though we intend to do so in the near term. Then sometimes we have other administrative requirements that are state by state since AbleTo prefers some member costs are waived as an incentive to get sign-ups.
BF: What new innovations are you looking to integrate?
TB: It's not a secret that Optum Ventures invested in AbleTo. We acquired Pacifica, which is now Sanvello. Then we have a partnership with Talkspace. Those three have progressed nicely. This is all heavy lifting however. For behavioral, more than 15 percent of people will need care, but it’s not unusual for less than 5 percent to actually receive care. Each of these take an extended period of time to amass the level of data needed to analyze the outcomes. That's why evidence is so critical. We would explore a full range of services and products: those with unique needs such as children/teens, comorbidities, Substance Use Disorder as well as those who would serve a large swath of members if there would be an impact.
BF: How have these new innovations helped patients?
TB: First of all, all of these innovations have to be rooted firmly in an overall access to care improvement strategy. It’s not generally helpful to employers, members or health plans if the are purely “stand alone”. They have to show that worker productivity has improved, or people are adherent to their medications. They have to show improvements in clinical quality improvement, cost and utilization.
BF: You talked about the challenges integrating a new vendor service/product across UnitedHealthcare. Are there startups helping to make integration easier?
TB: What we’re seeing in terms of new innovations is that the behavioral side is about 5-8 yrs behind what's happening on the medical side. [Medical refers to people with typical claims for events, such as doctor's visits, having a baby, diabetes care, etc. vs behavioral services.] We do see navigators and aggregators, such as Buoy Health, which can help navigate people to services within their health plan. Behavioral will then follow directionally. Navigating where to go and education on how to use behavioral services are critical.
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