OptumHealth introduced itself at Behavioral Health Day at the Legislature.
Health care providers across New Mexico are concerned the state's decision to contract with a new corporation will undo much of the progress achieved since Gov. Bill Richardson's 2004 restructuring of the behavioral health system.
In late January 2009, OptumHealth, a subsidiary of health care giant UnitedHealth Group, won the statewide contract to manage mental health care services. If all goes according to plan, it will take over July 1. Many of New Mexico's individual care providers now tell SFR they would prefer that ValueOptions, which has managed the system since its inception, remains in place.
For its part, ValueOptions is formally challenging the contract.
Dr. Donald Naranjo, executive director of the Albuquerque mental health and substance abuse treatment center Pathways Inc., has no gripes with OptumHealth, per se. Rather, he says, "All I know is that a major system change like this is extremely disruptive at a program level…In terms of the impact on the statewide system, I would really have my doubts that anyone could say it's a positive thing."
In interviews with SFR, more than a dozen health care providers spoke highly of ValueOptions, describing an entity that suffered growing pains at the beginning of its contract but evolved into a responsive health care organization.
"It took ValueOptions the better part of a year and a half to get all the cobwebs out of their systems and start paying folks on a regular basis," Naranjo says. "Things weren't perfect, but they were willing to talk and get things changed. Now we're going to go through another whole upheaval again. "
In 2004, New Mexico began the unprecedented 10-year process of consolidating the various mental health services offered by 15 state agencies into a single entity: the Interagency Behavioral Health Purchasing Collaborative (BHC), which spends its money collectively through a private-sector managed care organization.
At the outset, ValueOptions picked up the contract to manage over $1 billion for more than 80,000 New Mexicans.
Linda Roebuck, CEO of BHC, tells SFR that simply renewing ValueOptions' contract was not an option; BHC is obligated to conduct a competitive bidding process every four years.
ValueOptions Vice President of Public Affairs Steve Anderson argues there was no real competition between the three companies in the bidding process: OptumHealth, ValueOptions and Magellan Health Services.
According to BHC's scoring summary, evaluators scored ValueOptions' and Magellan's technical proposals and oral presentations low enough to disqualify them from further consideration.
ValueOptions is challenging the findings with a formal protest and request for a stay, and is currently preparing a supplementary protest based on new documents released by the BHC.
"We believe we've done outstanding work for the people of New Mexico," Anderson says. "How is it that ValueOptions, which has such a wealth of experience and qualifications, could score so low in some of these areas?"
Roebuck would not comment on issues related to the ValueOptions protest. However, BHC Deputy CEO Bill Belzner says this year's contract differs significantly from the one ValueOptions won in 2004.
"The first time around, we didn't know exactly what we wanted from the entity," Belzner tells SFR. "This time we do.
We honed in and got very precise about expectation and how we will measure accountability. "
Lisa Murillo, case manager for Border Area Health in Silver City, tells SFR she was surprised OptumHealth won the contract.
"I think it's probably going to be difficult times ahead," Murillo says. "We spent a lot of money in our company to upgrade our systems to meet what ValueOptions wanted…Am I going to be able to work in that system? Are they going to have the same programs?"
Kevin Berry, clinical director for Peak Treatment Foster Care in Santa Teresa, tells SFR he thinks the state should consider eight-year contracts for the sake of continuity.
"ValueOptions has definitely made huge changes in the system and I think it would be very detrimental to change that," Berry tells SFR. "The state hasn't provided information to providers and consumers about really why they made this decision and really about the company itself. I think it would be a mistake to move forward without more information."
Health providers from around the state echo Berry's sentiment. They all have questions: Murillo wants to know about software compatibility, while Margaret Merrill, executive director of the Oso Vista Ranch Project, wants to know whether OptumHealth will staff its rural offices with Native Americans.
OptumHealth CEO Sandy Forquer says answers are on the way: The company is planning a statewide series of meet-and-greets for the third week of March.
"We have a large team here and we are 100 percent dedicated to executing an excellent transition," Forquer says. "We are meeting with lots of people and listening to what they have to tell us. We are a very mission-driven group and we really believe what's going on here in New Mexico is the greatest social experiment in the United States."
As for the technical and cultural issues: Each regional office will have four full-time tech support employees and another regional office will be dedicated to Native Americans; the company also will employ a "cultural competency manager."
"We've been doing a lot of rumor control lately," Roebuck says. "We owe the people who are experiencing this change the best information that we can give them so they're not getting stirred up by rumors."
Chief among those rumors is that OptumHealth's parent, UnitedHealth Group, has a history of manipulating reimbursement rates.
"I don't know anything about Optum, nothing whatsoever, and I'm not hearing good things," Veronica Rodriguez, chief operating officer of Esperanza Guidance Services in Las Cruces, says.
UnitedHealth Group settled two class-action lawsuits in January for a total of $400 million. Although United did not acknowledge guilt, it paid out after being sued by the New York Attorney General's Office and the American Medical Association for allegedly rigging reimbursement rates. In its protest, ValueOptions argues these suits should have been considered against OptumHealth during the bidding process.
Forquer will not comment on the lawsuits except to point out they did not involve Optum. Roebuck says she can't comment on why the suits were not considered in the bidding process because of ValueOptions' ongoing protest.
"Let me just say, as the person that's mostly in charge of the transition effort, I really believe that we will not skip a beat when we hit July 1," Belzner says. "Providers will get paid, services will be delivered,
we will even see new initiatives begin to
hit communities…I personally do not believe that we will experience any of the catastrophic issues that providers and consumers and others are concerned about."
And some providers say they, too, hope for the best.
"We were very supportive [of ValueOptions] and hoped they would continue, but that didn't happen," Dr. Yolanda Briscoe, executive director of the addiction treatment center Santa Fe Recovery, says. "There's always fear around change. We happen to work from a position of faith, not fear…If this is what the state has decided is best for New Mexico, then we'll get on board and try to do the best we can to be supportive of the new organization."
