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.)
Parity:
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)
