When a potential targeted risk is identified through either the Wellness Assessment (WA) or claims information, a letter may be sent to you from United Behavioral Health (Optum) to inform you, the treating clinician, of an identified issue that may affect outpatient treatment. In some circumstances, a Care Advocate will call you to conduct a Clinical Review. Various Optum algorithms are used to identify potential risks that could affect outpatient treatment. Presented below are examples of potential risks identified by ALERT.
- Complications at the workplace resulting from missed days of work or reduced productivity
- Level of functioning may negatively affect coping skills, social and daily life activities
- Use of substances may need to be addressed to explore the impact on coping skills, social and legal functioning and overall health
- Medical conditions which could have co-existing behavioral health implications either as a result of the experience of the medical condition (i.e., depressive symptoms with End Stage Renal Disease) or of medical origin (i.e., depressive symptoms associated with Thyroid Disorder)
- Self reporting of minimal behavioral health symptoms
When you receive a letter, please review your interventions to determine that they are aligned with the minimal expectations of Optum specific to the clinical presentation of the member. Steps that may be taken include:
- Confirm or rule out the identified potential risk
- Re-affirm that the member meets the Level of Care Guidelines for Outpatient Treatment, thereby taking into consideration that their needs can be met on an outpatient basis rather than at a higher level of care
- Consider the Level of Care Guidelines that may be appropriate for the member in the event that the member may need to step up or down in level of care. Consult a Care Advocate for assistance regarding benefit eligibility for potential services
- Consult Best Practices that may be applicable for your intervention
- Consult the Supplemental and Measurable Guidelines, if clinically applicable
- Check that treatment interventions address potential and confirmed risks
A licensed clinician is available to collaborate with you if needed. See letter for contact information and availability.