health care reform and psychology katherine c. nordal, phd
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Health Care Reform and Psychology Katherine C. Nordal, PhD Executive Director for Professional Practice American Academy of Clinical Neuropsychology June 22, 2012. Compelling Need for Health Care Reform. One of the only developed countries without universal health coverage - PowerPoint PPT PresentationTRANSCRIPT
Health Care Reform and Psychology
Katherine C. Nordal, PhDExecutive Director for Professional Practice
American Academy of Clinical NeuropsychologyJune 22, 2012
Compelling Need for Health Care Reform
One of the only developed countries without universal health coverage
About 45 million Americans uninsured
Fragmented system with variable quality
Increased life expectancy but often with chronic illness
The Economic Context for Reform
2010 Healthcare expenditure = $2.7THealthcare is single largest contributor to national debtFederal expenditures 2010: Medicare = 15%; Medicaid = 8%; Social Security = 20%; Defense = 20%
By 2020, Fed. Govt. will pay 49% of all health
State budgets in worst shape since WWII
The Economic Context for Reform
Healthcare costs in 2009:• 1% population = 21.8% of costs• 10% population = 63.6% of costs• 50% of population = only 2.9% of costsMedicare spending:• 5% beneficiaries = 43% costs• 25% beneficiaries = 85% costs• 50% beneficiaries have >5 chronic
illnessesMedicaid spending:• 15% are disabled and = 43% of costs• 10% are elderly and = 23% of costs• Summary: 25% of population = 66% of
costs
The Economic Context for Behavioral Health Care
Mental Health Spending• 1986 = 7.5% of all health spending• 2003 = 6% of all health spending• 2014 = 5.9% of all health spendingPsychologists/LCSW/LPCs = only 8% of mental health pending, or 0.047% of mental health $$Medications will be 30% of mental health spending by 2014Psychologists are approximately 16% of the behavioral healthcare workforce58% mental health spending is in public sector
Enactment of Health Care Reform
After 1½ years of tumult and negotiation, President Obama signed into law both
the:
Patient Protection and Affordable Care Act (P.L. 111-148) on March 23, 2010
Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) on March 30, which includes a package of amendments
Key Challenges Facing Health Care Reform
Overall Goals of Health Care Reform
To preserve employer-based health insurance
To expand coverage to 32 million more Americans (Medicaid, Insurance Exchanges)
To transform the health care system to address the needs of the whole patient through:• Preventive Services• Primary and Integrated Care• “Triple Aim”: better care
experience; better health outcomes; lower cost
Insurance Market Reforms in Affordable Care Act
No lifetime or annual dollar limitsNo rescissions of coverage except for
fraudCoverage of pre-existing conditionsGuaranteed coverage acceptance and
renewalRequirement of effective appeals
processEstablishment of premium rating
requirementsProhibition of participant and provider
discriminationState consumer assistance offices
Health Care Reform: Remains a Work in Progress
Many of the law’s key provisions – such as those that establish the state health insurance exchanges – will not go into effect until January 1, 2014
New law is facing serious challenges by House Republicans in Congress and by governors and state attorneys general through the federal courts
Ongoing Congressional Attacks on Health Care Reform
House voted in January 2011 to repeal the health care law, whereas the Senate voted in February against repeal
House voted in April to cut off funding for health care reform for Fiscal Year 2011, which the Senate did not support
State Legal Actions Pending Against Health Care Law
To date, 30 states have challenged the constitutionality of the ACA:Two federal judges upheld
the law
One judge invalidated the individual mandate provision
One judge struck down the entire law
Supreme Court Decision 6/2012
APA Health Care Reform Priorities
Integrated Health CareMental and Behavioral Health
CarePrevention and WellnessPsychology Workforce
DevelopmentElimination of Health
DisparitiesSupport for Psychological
Research
Why Focus on Integrated Care?
Aspects of overall health are missed by sole focus on physical or mental health
Behavioral factors are leading causes of chronic illness and mortality
Chronic illness accounts for 75% of nation’s health spending
Why Focus on Integrated Care?
At least half of mental health treatment is provided in primary care
High co-existence of physical disorders and behavioral health problems
Adults with SMI in public sector die younger ( by 25 years)due to untreated physical health problems
Psychology’s Strengths in Integrated Care
Psychological and neuropsychological assessment
Applying behavioral principles to modify health-risk factors
Promoting patient responsibility and resilience
Attending to interpersonal barriers to behavior change
Understanding environmental determinants of behavior
Designing, monitoring, and evaluating interventions
APA and Integrated Health Care
APA Implementation Efforts: Promoted the inclusion of psychology in the
new integrated health care initiatives
Arranged meetings to enhance partnerships with primary care organizations representing nurses, physicians, and medical students
Joined the Executive Committee of the Patient-Centered Primary Care Collaborative, a coalition dedicated to promoting the “patient-centered medical home”
ACA Impacts Behavioral Health
Eligibility and Service Delivery
• Covers persons up to 133% of FLP by 2014 (adds 16-22M folks)
• Essential Health Benefits with parity for Medicare Advantage, Medicaid Managed Care, CHIP, and Benchmark Plans
• Preventive Care and Wellness• Health Home options for SMI and those
with 2 or more chronic illnesses (with significant federal $$ to Mcaid for first 2 years)
ACA Impacts Behavioral Health
Eligibility and service delivery:
• Accountable Care Organizations (ACOs): composed of integrated provider networks with shared electronic records, practice protocols, performance incentives
• Patient-Centered Medical Homes (PCMH)• Home and Community Based Services
Options• Co-location grants for behavioral health
and primary care—training grants for co-located care
• Dual Eligible Care Management
ACA Impacts Behavioral Health
Payment and Performance:
• Global, bundled, episode payments• Pay for Performance• Higher rates for PCPs• Medicare Shared Savings• Integrated care grants and training
grants (like GPE)• FQHC investment of $11B• Quality Measures (11 of 51 are behavioral
health)• Clinical Effectiveness Research
Implications of Health Care Reform for Psychology
Psychology’s expanded role: primary care, integrated delivery systems, assessment and care planning, behavior change for wellness and treatment of chronic disease, prescribing and medication management
Increasing demand for the use of EBPs and clinical outcome measures
Implementing advances in telehealth, HIT, and electronic health records
Addressing health disparities and increased emphasis on cultural competencies
Implications of Health Care Reform for Psychology
Need to adapt to new models and systems of health care delivery
New skills and training models needed for integrated, interdisciplinary and team-based care
Payment reforms: bundled payments, shared-savings models, ACOs, etc. How will psychologists in both public and private sector be paid?
Opportunities for Psychologists
Prevention and Health Promotion: Elimination of cost sharing for eligible preventive
servicesDepression screening for adolescents and adultsScreening and counseling for child and adult obesityCounseling for alcohol misuse and tobacco use for
adults New initiatives funded under the Prevention and Public
Health Fund New incentives for corporations to promote employee
health and reduce workplace stress
Opportunities for Psychologists
Client Populations and Clinical Settings:
Increased client access due to insurance reforms and new state health exchanges at parity
New grant program to establish community-based, interdisciplinary health teams to support primary care
New Medicaid state option for health teams and health homes to treat persons with at least two chronic conditions (including serious mental disorders)
Challenges to Psychology Practice
Difficult economic times
Stigma surrounding seeking mental health care
Pressures from public and private payers to reduce costs
Psychologists are a small part of the pool of mental health providers and psychotherapy has become a commodity to be purchased at the lowest possible cost
Accessing capital to meet health information technology demands
Adjustment from FFS to other payment mechanisms that may be required for participation in ACOs
Provider reimbursement if global rates are not risk adjusted and performance payments do not take into account disparities in outcomes for individuals with SMI and substance use disorders
Challenges to Psychology Practice
APA Practice Organization at Work
Coordinated over 300 Capitol Hill visits for the 2012 State Leadership Conference:• SGR• Medicare Physician Definition (HR.831,
S.483)• BHIT (5.539)
Advocated successfully for law enacted
in December that halted the threatened 25% cut in the Medicare Sustainable Growth Rate (SGR) through 2012
APA Practice Organization at Work
Medical Economic Index (MEI): Objected to revisions that would negatively impact psychologists due to their low practice expense. 22 MOCs wrote to CMS on our behalf.
Advocacy for additional protection of psychological test data under HITECH
Letter to Secretary Sibelius to urge inclusion of psychologists as participants in ACOs, thereby ensuring better access of Medicare beneficiaries to mental health, substance abuse, and behavioral health services
APA Practice Organization at Work
Supported repeal of Medicare Independent Payment Advisory Board whose cost-cutting measures prior to 2020 would impact only health professionals and drug manufacturers
Continuously monitor proposed Medicare reimbursement policies as they might impact psychological practice.
Urged CMS to include psychologists as providers of behavioral services for obesity. Unsuccessful to date.
APA Practice Organization at Work
Supporting S. 539, The Behavioral Health Information Technology Act of 2011 which would allow mental health facilities and practitioners to receive reimbursement for purchasing electronic health record keeping systems
Closely monitoring parity implementation at the state level and successful in working with SPTAs to addressing violations
State Implementation of Health Care Reform Initiative involving staff and governance: 2012 State Leadership Conference programming focused on this initiative
APA Practice Organization at Work
Medicare Physician Definition Bills:H.R. 831 (Rep. Jan Schakowsky + 34)S. 483 (Sen. Olympia Snowe + 7)
Also Supported by:National Council for Community Behavioral
Healthcare Association for Ambulatory Behavioral
Healthcare Bazelon Center for Mental Health Law
APA’s Health Care Reform Team
Staff Working Group:CEO, Deputy CEO, and Senior Policy
AdvisorGovernment Relations Offices: Practice,
Public Interest, Education, and SciencePublic & Member Communications Office
Involvement of APA Leadership and Members, as well as other organizations
Collaboration with the APA Practice Organization (APAPO) – APA’s affiliated 501(c)(6) entity that works to advance the professional and business interests of practitioners
For Updates on APA Health Care Reform Initiatives
http://www.apa.org/health-reform/
Contact Information
Email: [email protected]: 1-800-374-2723Web: www.apa.orgwww.apapracticecentral.org