Providers Say Optum Not Fulfilling $10.5 Million-a-month State Contract

Jan. 31--BOISE -- State lawmakers grilled representatives of the company overseeing the state's low-income mental health program Thursday, after being told of a slew of problems providers have battled for months had been resolved.

Last week, mental health and substance abuse social workers begged lawmakers to address the issues they've faced since last fall, when Optum took the reins of the state's Medicaid-based outpatient behavioral health system. The biggest complaint was the company's lag time in authorizing services that social workers must first acquire before treating a new client.

While speaking Thursday to the House and Senate Health and Welfare committees, Optum officials said they reduced the response times to less than three minutes, down from the seven-hour wait time providers complained about just six days prior.

"And response times were down to two seconds in the last two days," said Craig Herman, senior vice president of Optum, a for-profit subsidiary of UnitedHealth Group, which also includes health insurance giant UnitedHealthcare.

"If everything is good, then why are we here?" asked state Rep. Douglas Hancey, R-Rexburg.

Herman said the company hadn't anticipated the volume or the complexity of the prior-authorization calls. The company has added more employees to answer calls and streamlined its review process over the past week, Herman said.

Lawmakers expressed doubt that the shorter wait times would remain sustainable over time.

"I guess I need to know you're doing everything you can be doing so you're not just pushing the problem down the road," said state Sen. Jim Gurthrie, R-McCammon. "That you're not superficially hitting these response times."

Becky diVittorio, executive director of Optum Idaho, said their new strategy was streamlined but still adequately addressed the client's needs.

When asked how often they deny claims, and thereby saving the state money, diVittorio said both their denial and partial denial claims were low.

The Idaho Department of Health and Welfare is paying Optum $10.5 million each month as part of a cost-cutting privatization initiative, said director Dick Armstrong.

Optum's contract promises that wait times will be two minutes or less, Armstrong said. If those times are not met, the company will face penalties.

"We are the agency responsible for this," Armstrong said. "We should have been more aggressive seeking solutions."

The meetings were emotional for the providers watching in the audience. Holding back tears, Cindy O'Brien, owner of a private provider in northern Idaho, said she didn't trust Optum.

"I have filed complaints with Optum 34 times," she said. "I have gotten responses to three of them."

Magic Valley providers also expressed the same struggles working with Optum.

Dealing with Optum is like battling a "monster," said Jennie Fullmer, co-owner of the Twin Falls-based Crosspointe Family Services. As one of the Magic Valley's largest behavioral health clinics with 1,500 clients, Crosspointe has to deal with Optum daily.

Optum's authorization process is "ridiculous," and a waste of money, Fullmer said.

Moreover, Fullmer said her staff is often on hold for hours a day trying to get through to an Optum clinician. They have never been on hold "shorter than two and a half hours," she said.

Despite their best efforts and the staff banding together to shoulder the load of the new system, patients have complained that they get a busy signal when they call Crosspointe, she said.

"Our overhead has increased just because when you pay someone to stay on hold all day long to monitor these calls there's an increased cost and things that would normally get done have shifted to other employees," she said.

Nyla Jensen, also a co-owner of Crosspointe, said Optum takes four to six weeks to process and pay an approved claim. Before, it took about a week, she said.

She said that delay is preventing some smaller behavioral and mental health clinics from paying their bills. Crosspointe had to take out a loan just be able to pay their staff on time, Jensen said.

During Thursday's meetings, diVittorio said Optum has fulfilled its contract agreement of paying 90 percent of claims in 30 days.

"You have my commitment that what we provide to Idaho is sustainable and we will support advancement to the state's vision of recovery of care," she said.

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