With the re-election of President Barack Obama and a U.S. Supreme Court decision upholding the Affordable Care Act (ACA), the groundwork has been set for the biggest changes in how health care is provided since the establishment of Medicare, delegates to this year’s State Leadership Conference (SLC) were told.
Time is running short before the Jan. 1, 2014, startup of ACA, warned Katherine C. Nordal, Ph.D., executive director of the APA Practice Directorate and Practice Organization, sponsor of the SLC, which drew about 500 delegates in mid-March.
However, unlike the 25 years it took for psychologists to be included in Medicare, psychology will be at the starting line when the ACA takes effect in about eight months. “We have to be ready,” Nordal said. “We don’t have 25 years to wait.”
Nordal and Mark B. McClellan, M.D., who presented the keynote addresses at the conference, agreed that the race to take full advantage of the practice opportunities when an estimated 30 million Americans will be added to the rolls of insured Americans during the next few years is necessary if psychology is to remain relevant and important.
Both, however, said not to expect any immediate or big changes in how psychological services are provided.
“We need to think and act incrementally,” said McClellan, director of the Engleberg Center for Health Care Reform and former director of Health and Human Services in the administration of George W. Bush.
Nordal agreed. “This race is not a sprint. It will be more like a marathon. We have to be in the race for the long haul.”
McClellan also emphasized that part of the rationale for ACA was to put the brakes on the amount of money the United States spends on health care, and to get a handle on those costs will require a new way of looking at how psychology and other health care providers deliver and bill for their services. He hinted that the day when psychologists and others are no longer reimbursed on a fee-for-service basis is not too far into the future, although exact new reimbursement schemes have yet to be decided.
“How do we improve the quality of this nation’s health care without spending more money will be the focus as we move into a new way of providing care,” McClellan said.
Better coordination of care, screening and referral will be important elements of any successful practice, as well as providing emergency care beyond telling someone to call 911, he said. More mental health services need to be aligned with physical health to help insure better outcomes. Patient-reported outcomes and better outcome measurements will be part of the new large health care picture, he added.
He was later asked how to measure outcomes for those with serious mental health problems. “We may not know for 10 years if someone has improved,” the questioner told McClellan. “We have clients that will never improve.”
As the new law takes effect and the government decides on how to deal with such thorny issues, markers will be developed to measure improvements, McClellan said.
There are many models of how mental health care can be implemented in primary care and other settings and it is in psychologists’ interest to see how their skills best fit into the various models. Psychologists whose skill sets do not fit comfortably into new strange settings may have to develop new skills, Nordal said.