by Judy E. Hall, PhD
One of the founding reasons for the National Register in 1974 was the prospect of national health insurance through a single payer plan. The education and training of licensed psychologists varied tremendously and was not necessarily related to healthcare provision. Hence the establishment of a credential to distinguish healthcare providers in psychology from other licensed psychologists. Fast forward to 2010 when Health Care Reform legislation is signed by the President on the heels of the law that established national parity for benefits coverage of mental health and substance use disorders (MH/SUD). Combining all those forces with an ambitious agenda oriented towards value in healthcare, we now face implementing that legislation over the coming years.
It is difficult to predict the impact on our profession except this time, psychology will need to collaborate with other healthcare professions - parity of a different kind. Our healthcare system needs more properly trained psychologists and other healthcare providers to serve the expanded demand for services by 95% of the population. Part of this will occur through the state option to expand Medicaid coverage beginning April 1, 2010 but required by 2014 so that individuals whose income is at or below 133% of the federal poverty line receive healthcare services. This is expected to affect 16 million additional enrollees. Other expansion efforts affect an additional 16 million through various insurance programs.
With regard to delivery system redesign, global capitation of an integrated health care system will become more prevalent. Other system models include hospitals and physician groups deciding to form accountable care organizations (ACO) in their community, which will result in a need for additional credentialed healthcare providers. Person-centered healthcare homes (medical homes) begin with fee for service model but that will shrink over time. Then, case rate or capitation with a pay for performance will be phased in. Savings resulting from reduced total healthcare expenditures (bending the cost curve) will provide bonuses for those involved. These healthcare homes, which will include psychologists, will need to include preventive and wellness services in order to reduce overall expenditures. Payments for inpatient care will bundle hospital and physician services, including those for costs in the 30 days post hospital stay.
One exciting aspect of insurance reform is the requirement that 85% of the premiums paid to insurance companies and Medicare are to be spent in actually providing services. Coupled with the bans on annual and lifetime limits and to pre-existing conditions exclusions, as well as ensuring guaranteed issue and renewal of coverage, reform also means that people will actually be provided an essential health benefits package: MH/SUD and medical/surgical care.
A national commission to review and project the workforce needs will be established by 9/30/2010; this will help align resources with national needs. A bonus is the $11B additional funding of the community health centers which, in addition to opening up new employment sites, will provide preventive and wellness services at their already existent 1200 health center organizations (8000 delivery sites). Psychologists trained in evidence-based services will be essential to the workforce. Those interested in working in underserved areas will benefit from waiver of tuition reimbursement through the National Health Service Corps. There are many opportunities for psychologists.
After the legislation was signed, I attended the ACMHA, the College for Behavioral Health Leadership, annual meeting (I have been a member for more than ten years). Go to www.acmha.org for analyses by consultants and noted public policy figures in the behavioral healthcare field.
I believe that the next several years present a great opportunity for credentialed health service providers in psychology. Learning how to function in a team with our healthcare partners is fundamental to that success. For the past several years we have profiled team approaches to healthcare in The Register Report and on our web site. If you know of others not profiled yet, please email me a brief description of the delivery system and the director’s name and contact information.
If you are involved with a hospital that plans to become an ACO, we would love to hear from you. NationalRegisterPro.org, our deemed source credentials web site, can be extremely useful in providing deemed source information on 11,000+ psychologists and helping the ACO to build a diverse and expanded network of credentialed providers. Also, if you are involved in planning at the state level for the expansion of Medicaid to serve the uninsured, for the same reasons, we would like to hear from you also. In both these instances, others can benefit from your experience.
These are exciting opportunities with challenging tasks ahead for healthcare professionals, state and federal governments (including Medicare and Medicaid), hospitals/healthcare organizations, community health centers, and others. Now that we have the legislation, we enter the regulatory phase. We will do our best to advocate for health service providers on the national stage. We want to hear about your involvement at the local level.
Judy E. Hall, Ph.D.