This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The first time Linda Denton knocked on his door, the man with bipolar disorder wouldn't answer, even though he needed his medication.
The second day, he recognized the Valley Mental Health nurse's voice and let her in. He was then hospitalized because he was "out of control."
"If they don't come back, I get a little concerned," Denton, nursing supervisor at one of Valley's clinics, said recently. She went looking for him after he missed an appointment and a concerned relative called Valley. "They could hurt themselves or someone else."
In the past six months, Valley staff members have called dozens of patients or visited their homes after they stopped going in for treatment. Valley has also paid for billboard advertisements and radio and TV commercials to remind people its doors are open.
Since OptumHealth took over Salt Lake County's Medicaid contract from Valley on July 1, Valley has lost 500 clients, leaving around 7,500. While Valley no longer administers the $50 million in Medicaid behavioral health funds, it does provide mental health services under contracts with Optum.
But some clients may have been confused — thinking Valley was out of business. And other clients may have found treatment elsewhere, after Optum expanded the number of providers by more than 100.
Neither Optum, Valley or Salt Lake County can say for sure what has happened to the missing patients. They are still looking over data to see if the growth in referrals to other providers makes up the difference.
"We're a little nervous about where some of our clients have gone," Tim Whalen, director of the county's behavioral health system, said recently.
However, officials say there have been no suicides of Medicaid patients since July, and they haven't seen a spike in hospitalizations or arrests of the mentally ill.
What is more clear is that Valley will likely need to return money to Optum because it hasn't provided as many services to patients as was anticipated. Optum prepaid Valley an undisclosed amount in July based on how much care it anticipated Valley would provide. Valley CEO Debra Falvo said the organization was not providing enough services to justify the prepaid amount.
From July 1 to Nov. 1, the company laid off 23 employees — in addition to the 100 people it let go earlier in the year. It put one of its 36 buildings up for sale, hired a new leader who will take charge by March and reduced its program for seniors, though Falvo said the program cut was due to low federal payments, not changes under Optum.
The verdict is out on how things are going six months into the major shift in how Salt Lake County residents covered by Medicaid get mental health treatment.
"Maybe it's a little bit too soon to say good or bad idea," Whalen said.
There were widespread fears that treatment overseen by a for-profit company — Optum is a subsidiary of UnitedHealth Group — would get worse.
"They've been good citizens so far," said Ross Van Vranken, executive director of the University Neuropsychiatric Institute (UNI), which treats hospitalized patients on Medicaid. "It's still early, but so far so good."
He said the "real acid test" will be the next six months — the busy time of year in psychiatry.
So far, Optum has met the county's goal to reduce the length of hospitalizations at UNI and two other hospitals it contracts with — Pioneer Valley Hospital and Salt Lake Behavioral Health. From July through October, the average length of stay dropped from 101/2 days last year to nearly seven days.
Optum had an incentive to shorten stays — a $100,000 annual bonus. It's also met other goals that will lead to another $100,000 incentive: timely access to care for patients and timely payments to providers. Contractors outside of Valley — such as The Children's Center and Silverado Counseling Services — are even being paid more than what Valley paid when it was in charge of the Medicaid contract, according to Whalen.
Van Vranken said the reduction in hospital stays isn't due to Optum cutting treatment short, as was feared would happen.
"Doctors are more efficient or [patients] are stable enough to go," he said.
Brian L. Currie, the county's quality assurance coordinator, said Optum has denied hospital services 46 times since July. Eight denials were appealed to the county, which sided with Optum each time.
"In each case, Optum was very generous," Currie said. "The referring facility didn't make their case."
The county is also praising Optum and Valley for working together to set up a new system to shuttle county jail inmates to a Valley clinic to get their medications and seek counseling. The pilot program, to be started soon, will require judges to create specific release times for mentally ill inmates so that Valley can transport them to their appointments.
Now, inmates are released at any hour. While they have prescriptions and counseling appointments, many don't make it to the clinic.
Not getting timely treatment "puts them in jeopardy," said Rebecca Brown, coordinator of Valley's alternatives to incarceration program. "If we can attach them to treatment and maintain their medications ... they are more likely not to reoffend."
The county and Optum are also working on ways medical doctors at Intermountain Healthcare and Molina Healthcare clinics can treat their Medicaid patients' mental disorders along with their physical health. That wasn't possible when Valley was in charge, Whalen said.
Optum and Valley officials said they will reconcile their books next month, revealing the amount of money Valley may have to return. Those dollars will be reinvested in mental health services, Whalen said. Optum's top priority is a crisis center to help people avoid hospitalization. Valley plans to bid to provide that service. hmay@sltrib.com