At Optum, we are committed to clinical excellence with a focus on quality, access and evidence-based practice. We recognize that it is the efforts of the Optum clinical network that give Optum members the best opportunity to achieve their quest to live healthier lives. As a result, our priority is creating relationships with network clinicians and facilities that ensure appropriate, time-effective, clinical treatment. With this goal in mind, we have developed the ALERT® model, a consumer-directed, outcomes-based and cost-effective approach to making treatment decisions.
ALERT stands for Algorithms for Effective Reporting and Treatment. The model incorporates member responses to a validated tool, the one-page Wellness Assessment (WA), along with claims data. Both WA and claims information are analyzed through a set of algorithms, or decision rules, to identify potential targeted clinical risks. Care Advocates use letters and/or phone calls to inform you in the event that a member you are seeing is identified with any targeted risk factors. This allows us to work together and focus primarily on those members with the greatest potential for benefit from such collaboration. We safeguard confidentiality throughout our management of care.
The Wellness Assessment (WA)
Optum utilizes a one-page WA which contains items which measure behavioral health symptom severity, functional impairment and self-efficacy. Items are included to screen for substance abuse risk and medical co-morbidity.
The one-page WA, completed at more than a single point in treatment, offers more immediate feedback on changes in health status and functioning that may inform further treatment planning, including level of care changes or coordination with medical professionals. (See The Science section of this site for additional information regarding the Wellness Assessment.)
Level of Care Guidelines
The Optum Level of Care Guidelines are intended to promote optimal clinical outcomes and consistency in the authorization of benefits by Care Advocacy and medical staff.
Identification of an appropriate Level of Care (LOC) takes into consideration the following:
- A comprehensive bio-psychosocial assessment of the member's condition, including an assessment of the member's current functioning
- Assignment of a DSM diagnosis that is predicated on the findings of the assessment
- The development of an individualized treatment plan that is based on the assessment and is suitable for addressing the member's current condition
Optum believes there must be a reasonable expectation that the member’s presenting problems will improve within a reasonable period of time when essential and appropriate services are provided in a chosen level of care and the member agrees to the treatment plan. The Level of Care Guidelines augment, but do not replace, sound clinical judgment. While there is a wide range of viewpoints regarding the use of levels of care, services should be essential and appropriate and reflect empirically validated approaches.