Executive Member Spotlight: UPMC Health Plan

An earlier version of this article was published in the January 2021 issue of PCC's Executive Member Update, the monthly newsletter for PCC members. Below is an expanded version of the article.

The UPMC Health Plan is a longtime member of the PCC, having joined in June 2010. The “UPMC” in its name comes from its owner, the University of Pittsburgh Medical Center. UPMC is an integrated delivery and finance system. The UPMC Insurance Services Division (ISD), which includes the UPMC Health Plan, serves more than 4 million members, and the plan encompasses more than 140 hospitals and more than 29,000 physicians throughout Pennsylvania and parts of Ohio, West Virginia and Maryland. The UPMC Health Services Division encompasses over 40 hospitals and 4,900 employed physicians, primarily in western and central Pennsylvania. UPMC Health Plan’s work to integrate primary care and behavioral health is one of many synergies between our two organizations.

Addressing mental health and substance use in primary care is a key focus of the UPMC Health Plan. UPMC incentivizes primary care practices for depression screening through both direct payments and value-based incentive strategies, making primary care-based depression screening routine. UPMC has launched several strategies to engage members in behavioral health care following a positive screen. RxWell, a digital behavioral health application (app) that provides techniques to manage stress, depression and anxiety symptoms, is available to all UPMC Health Plan members. When a primary care provider discusses RxWell with members, they can often prescribe it immediately through the electronic medical record (EMR). The member instantly receives a text message, which prompts them to download the app, all before they leave the physician’s office. In addition to RxWell, primary care clinicians are also supported by UPMC Health Plan’s Prescription for Wellness program. When a provider identifies a need for a Prescription for Wellness referral for a behavioral health issue or condition, they use the EMR to send a prompt to UPMC Health Plan health coaches to engage the member in programs to address behavioral health needs. Members can also be referred to community-based behavioral health care, when indicated; and most members also have a UPMC Employee Assistance Plan option which provides other behavioral health supports and services.

UPMC has also worked closely with primary care clinicians to enhance access to substance-use treatment and to support medication-assisted treatment in primary care settings. The UPMC Center for High-Value Healthcare (which supports ISD research initiatives) is implementing a Substance Abuse and Mental Health Services Administration (SAMHSA) award, in collaboration with the Pennsylvania Department of Drug and Alcohol Programs, to increase access to medication for opioid use disorders (MOUD) in four rural, high-need counties in Pennsylvania. Utilizing an integrated hub-and-spoke model, this initiative is designed to support a more coordinated continuum of care for individuals with opioid use disorders (OUD). This work has more than doubled the number of primary care clinicians who have obtained their waiver to prescribe buprenorphine, a medication approved by the Food and Drug Administration, to treat opioid use disorder in participating counties. After obtaining their waiver, providers receive ongoing support by connecting with addiction medicine clinicians to identify individuals in need of MOUD services and receive guidance on incorporating substance-use disorder (SUD) treatment into their current practice. Clinicians at all levels can also participate in online training for Screening, Brief Intervention, and Referral to Treatment (SBIRT), an evidence-based approach that allows clinicians to quickly assess the severity of substance use and identify an appropriate level of treatment. Through the course of the project, nearly 400 practitioners have been trained on SBIRT and motivational interviewing, a counseling method that helps individuals to uncover internal motivation needed to change behavior and resolve ambivalence toward making healthier choices.

To continue this important work, UPMC was recently awarded funding from the Health Resources Services Administration (HRSA) to expand and enhance prevention, treatment, and recovery services for individuals with SUD in two additional rural Pennsylvania counties. Over the next three years, the project aims to increase the number of primary care clinicians who can identify and treat SUD/OUD to accommodate for the lack of current treatment clinicians in the area and will use lessons learned from strategies employed in the SAMHSA-funded effort. Similarly, UPMC is partnering with the Allegheny County Health Department on an addiction treatment effort, funded by a grant from the Centers for Disease Control and Prevention, to support the development of strategies to monitor clinician and patient quality metrics related to addiction treatment in primary care. UPMC Health Plan has also developed approaches to connect individuals to peers to support engagement and long-term retention in substance-use treatment services. Analyses of claims and pharmacy data has informed the development and delivery of clinical education to recognize and treat OUD and employ risk-mitigation strategies for opioid prescribing.

The UPMC Health Plan’s sister behavioral health managed care organization, Community Care Behavioral Health Organization, also part of the UPMC ISD, developed the Behavioral Health Home Plus (BHHP) model, delivered in community mental health provider (CMHP) sites, to provide holistic health and wellness support to individuals with behavioral health conditions. Created in collaboration with members, providers, government agencies, and other advocates, the BHHP is a cost-effective model that facilitates and coordinates access to medical care, community-based social services, and behavioral health care for people with complex medical, behavioral health, and substance-use disorders. CMHPs train staff (primarily case managers) in engagement and coaching strategies so they can support members in the development of wellness goals to help manage their conditions. On-site wellness nurses, another key component of the model​, provide physical health guidance and support to case managers and enhance member engagement in primary care and other physical health systems of care​—bringing a focus on physical health and wellness into a behavioral health setting. This work complements most integration efforts that are oriented toward bringing behavioral health into primary care.

The BHHP model was evaluated using funds from the Patient Centered Outcomes Research Institute (PCORI) in a five-year study titled Using Wellness Coaches and Extra Support to Improve the Health and Wellness of Adults with Serious Mental Illness. Researchers and stakeholders from UPMC and other collaborating organizations tested two versions of BHHP in CMHP settings. Eleven CMHPs were randomly assigned to implement one of these two BHH models. In both models, wellness coaches worked with members to help them set health and wellness goals, work with their doctors, get needed care, and supported the development of a robust wellness culture focusing on disease management and prevention at participating sites. The difference between the models is that one included an on-site wellness nurse and the other model did not have a wellness nurse and focused more on providing members with techniques and resources to self-manage their conditions and healthcare experiences. Both approaches were successful in increasing members’ use of primary and specialty care, involvement in care, and mental health-related quality of life. The BHHP model has also been implemented with children receiving behavioral health services in community and residential treatment facilities and in programs serving adults with opioid use disorder. 

Publications related to quality and cost findings from UPMCs BHHP evaluation can be found at Impact of Behavioral Heath Homes on Cost and Utilization Outcomes and A Payer-Guided Approach to Widespread Diffusion of Behavioral Health Homes in Real-World Settings. More information is also available at this PCC webinar from July 2018.

UPMC views behavioral and physical health integration in both primary care and specialty settings as integral to its success and looks forward to continuing its work with the PCC. In addition, UPMC leaders are contributing their experiences and learning in PCC’s Roundtable, part of a current PCC project titled Increasing Uptake of Shared Decision Making in Behavioral Health. The roundtable will determine strategies to engage members and clinicians in shared decision-making (SDM) and will identify barriers and facilitators to the use of behavioral health-related SDM, especially among vulnerable and underserved populations.

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