Perspective on Practice

By 2014, the Patient Protection and Affordable Care Act will bring health insurance to 32 million previously uninsured Americans by expanding Medicaid and establishing state-based health plan exchanges for the individual and small group markets. More than half of current Medicaid beneficiaries with disabilities have a mental illness, and when mental illness is experienced along with other common chronic physical disorders, health-care costs escalate by about 75 percent. The health-care services delivered to these individuals are fragmented and poorly coordinated across providers, which often results in higher costs and poorer care. So states are intensifying their efforts to develop more cost-effective managed and integrated-care models for high-need, high-cost Medicaid beneficiaries.

It is imperative that we continue to assert psychology’s position in this evolving health-care system since psychologists know a lot about how to best provide care to those with mental illness, substance use disorders and chronic physical conditions. For psychology’s voice to be heard, psychologists must receive appointments to and representation on the assorted task forces, advisory panels, coalitions and commissions being put together to determine how reform will be realized at the state level. Our involvement and input will influence the role of behavioral health and psychology’s position in the health-care delivery system.

Here are just a few examples of states leading the way:

  • Several members of the Arkansas Psychological Association represent psychology in the mental health work group developing mental health bundled payments for the state, including care delivery and provider reimbursement. Outcomes will be reported to the Centers for Medicare and Medicaid Services and to state insurance companies.

  • The Massachusetts Psychological Association is working with a coalition under a grant from the Children’s Health Insurance Program Reauthorization Act to integrate all children’s services with quality assessment measures, developing a position paper with the commissioner of mental health on the role of behavioral health providers in health-care reform and advocating to secure the role of private sector behavioral health providers in health-care reform.

  • The New York Psychological Association’s 2011 Integrated Behavioral Health Task Force has been meeting with Gov. Andrew Cuomo’s Medicaid Redesign Team to support integration of behavioral health services in patientcentered medical home and accountable care organization demonstration projects.

  • The North Carolina Psychological Association has a member on the state’s subcommittee charged with working on healthcare reform. The association is also active in legislative efforts that would protect patient information in the state’s proposed health information exchange, and it is working to ensure psychology’s participation in developing integrated care models.

  • Well-attended health-care summits in Maryland, Massachusetts and New York have brought together psychologists, health-care and economics experts, policymakers, representatives of other health-care professions and consumer groups to talk about how to ensure that behavioral health-care issues are included in their states’ health-care reform efforts.

The state associations will continue their work on March 10, when nearly 500 practice leaders will gather in Washington, D.C., for our 29th State Leadership Conference (SLC), themed “Bringing Psychology to the Table: State Leadership in Health Care Reform.” This year, with the work of health-care reform implementation before us, our programming is focused on strategies for educating our members about the issues, psychologists’ roles in the evolving health-care system and opportunities where state-level advocacy can make the most difference.

Our emphasis on collaboration, involvement in coalitions and building key relationships with regulators and decisionmakers is not new. We have been training psychology’s future leaders for this kind of advocacy for well over a quarter of a century. Our work together at this year’s SLC will set the stage for our joint advocacy efforts with our state associations for the next several years.

As always, I welcome your comments.