Perspectives on Practice

When it comes to making changes to positively impact health care, states are in the driver’s seat. States directly regulate the practice of health-care professions and the health-care work force. State-level policies and practices will determine whether health-care reform results in increased access and more affordable care.

Under the Affordable Care Act, states have particularly important roles regarding Medicaid expansion, the creation of health insurance exchanges, or HIEs, and regulations governing insurance companies that offer products through those exchanges. Medicaid programs and HIEs provide the means for expanding coverage to the uninsured, a principal objective of the federal health-care reform law. Policies related to these mechanisms will be created at the state level.

The evolving health-care system demands new models for delivering services in a more agile, responsive and effective way. The Affordable Care Act puts the onus on states to be innovators in creating models through medical home grants and other integrated-care initiatives. We don’t know yet what these programs will look like.

The success of health-care reform will depend upon collaboration among regulators, insurers and providers. Success hinges on the ability of these groups to cooperate in pursuing the goal of providing access to high-quality health care at a cost the public can accept.

It is critical for psychology to be at the table where policies are formed, and the network of state psychological associations provides the vehicle for our engagement. Several state psychology leaders already are guiding the way, including:

  • Maine Psychological Association members Diana Prescott, PhD, and Gordon Kulberg, PhD, who serve on the board of the Maine Primary Care Association (MePCA). Dr. Prescott, along with the state association’s President-elect Jeff Matranga, PhD, and members Rob Ferguson, PhD, and Sandy Coleman, PhD, presented to the MePCA board on integrating psychology into primary care. The two groups have also worked together on employing early career psychologists.
  • Sally Cameron, executive director of the North Carolina Psychological Association, who was part of a state team that participated in the National Governors Association meeting in April. The teams tackled the complex issue of how to integrate behavioral health care into HIEs, identify barriers and develop solutions. Implementing HIEs will involve negotiating privacy concerns related to electronic health record-keeping. The presence of mental health groups is critical to such discussions.
  • Elena Eisman, EdD, a member of APA’s Board of Directors, has joined two groups by invitation of the Massachusetts commissioner of mental health. In the first, she’s part of a 50-member coalition financed by the Massachusetts Children’s Health Insurance Program Reauthorization Act Quality Demonstration Grant to develop and maintain an integrated approach to measuring and improving outcomes across all settings of child health-care delivery. The second, smaller group will look at designing models that will include behavioral health in patient-centered medical homes in the state.
  • Michael Goldberg, PhD, also of Massachusetts, who has been named an “expert adviser” for a work group of primary-care and behavioral health clinicians, state agency representatives and health plans involved with the Massachusetts Patient-Centered Medical Home Initiative. He is advising the work group about integrating behavioral health services into primary-care settings.

The states are not just participating in health-care reform: They are leading it. States will influence the future of our discipline in this evolving health-care system. Our state associations are the natural conveners for psychology at the state level.

As we engage in these policy discussions, it is important to remember that we have strength in numbers. Psychology’s voice has never been so important, and your state psychological association is counting on your support.

We need to ensure that emerging state-level models of care include behavioral health and psychological services. If we’re not at the table, it’s because we’re on the menu.

As always, I welcome your comments by email.