The ever increasing influence/control of our profession by the mostly for-profit insurance industry will only be enhanced by the developments of the Affordable Care Act (ACA- Obama Care.) A high percentage of our fellow professionals now rely a great deal on either public or non-profit employment or insurance contracting and reimbursement—as do our clients. The ACA will be providing many more people with at least some degree of mental health coverage. The pool of private pay clients is likely to be reduced and the demand for services increased. At the same time, the mostly unrestrained for-profit insurance bureaucracy will make therapeutic services more difficult to provide and burdened with over administration. AAMFT must enhance alliances with other state and national organizations to act as an effective voice for clinicians, clients/consumers and society to enhance services and reduce bureaucratic restrictions.
Related to this is developing and having an understanding and an impact on what the therapeutic landscape will look like in the near, mid and long range future. Will we all have to work for large groups --private, public or non-profit-- in order to be able to meet the systems’ policy and funding structures ? What will be the fate of the individual, mostly out-of-pocket private practice ? We need to prepare ourselves to have influence on the future and to participate in it.
As a more specific example--With funding streams attached to more Integrated/Accountable Care Systems will even small group practices be able to provide the administrative services needed for documentation, Global Budgeting, Evidenced Based Best Practice, demonstrated Outcomes, etc. Will we, like most physicians, have to develop administrative entities to negotiate and interact with various funding and regulatory organizations? Or, alternatively, what can we do to promote Practice Based Best Evidence and the ability of the individual practitioner to survive in the environment and develop therapeutic structures—not bureaucratic ones?
Universal Health Care:
It’s clear that the U.S. has the least efficient and, in many measurements, among the least effective health system in the “developed” world (and beyond.) What is not clear is exactly the structure of Mental Health systems in other countries. Taking the above concerns into account, we must learn from and about them and promote and adapt useful ideas and structures into our policy proposals and goals. (A project I have already initiated.)
It is well known that the Wellstone-Domenici Parity Act (2008) calls for parity with medical services for mental health and substance abuse services. What is less understood is that it also calls for reimbursement parity. This means it is incumbent on the field’s leadership to “examine fee structures to be sure that insurers are reimbursing at rates comparable to medical and surgical benefits” (National Council for Community Behavioral Healthcare-- 2010)