State Leadership Conference

Executive Director of APA’s Practice Directorate Dr. Katherine C. NordalWhat impact will health-care reform have on practicing psychologists? "We are in for change probably like none we have ever seen before," according to Katherine C. Nordal, PhD, executive director for professional practice at APA and the APA Practice Organization (APAPO).

"We are in uncharted territory, with new models of care delivery, new financing mechanisms and more," Nordal told participants at the opening session of the 2012 State Leadership Conference. "Our theme this year is bringing psychologists to the table: state leadership in health-care reform."

Sponsored by APA's Practice Directorate and APAPO, the March 10-13 event in Washington, D.C., brought together nearly 500 representatives from state, provincial and territorial psychological associations, APA divisions, APA governance and the American Psychological Association of Graduate Students, as well as early career and diversity delegates. In addition to attending educational and networking sessions, participants also converged upon Capitol Hill to meet with members of Congress and their staffs.

There's still much uncertainty about how the Patient Protection and Affordable Care Act will play out, said Nordal, explaining that a Supreme Court decision on several aspects is expected in June. But whether psychologists are in practice, research or education and training, she said, they must help shape health-care reform. For practitioners, concerns include the law's emphasis on electronic health records, bundled payments and other new financial mechanisms and fears that states will pay for greater access to care by cutting providers' reimbursement.

Another reason psychologists need to participate is that states are in the lead when it comes to implementation. Health-care reform will result in millions more Americans enrolled in Medicaid and new state insurance exchanges, which will give individuals and small businesses in each state access to a range of affordable health insurance plans, for example. "Unfortunately for us, 16 states don't recognize psychologists as providers under any Medicaid services, and other states have variable coverage," said Nordal. Several state psychological associations are already fighting to ensure that psychologists can remove those and other barriers to their full participation.

Successful advocacy will depend on effective partnerships with groups representing other health-care professionals, Nordal added. APA has joined the Patient-Centered Primary Care Collaborative (PCPCC), a large and diverse coalition of health-care delivery stakeholders, including businesses, associations of health-care clinicians, insurers, consumers and others working to promote the patient-centered medical home model, for instance. "There has been much more attention to behavioral health issues at the PCPCC conference since APA came to their table," said Nordal. Urging psychologists to get involved in all aspects of reform, Nordal concluded, "The future of our profession depends on it, and so do the health and welfare of the patients we serve."

Alan Weil, executive director of the National Academy for State Health PolicyAlan Weil, JD, executive director of the National Academy for State Health Policy, offered a closer look at states' role in implementation.

Four areas are especially critical:

Designing state insurance exchanges. Half of newly insured Americans will obtain coverage through the exchanges, said Weil, so their design and implementation are critical.

Simplifying and integrating eligibility systems. Health-care reform will also bring a massive Medicaid expansion. Currently, said Weil, enrolling requires coming in between 10 a.m. and 3 p.m., taking a number, waiting, handing over sensitive details about your life and then waiting some more. "Then you get a letter you can't read that explains what you got wrong and tells you you have to come back," said Weil. "That has to change if the coverage promise of the state exchanges and Medicaid expansion is to be realized."

Promoting coordination of care. Inefficiencies contribute greatly to the financial pressures the health-care system faces—and these pressures will only increase as coverage expands. "No one wants reimbursement rates to be the vehicle for savings," said Weil. "Everyone wants to do it through efficiency."

Designing benefits packages. The law requires that insurance sold in the exchanges include a package of essential benefits in 10 categories, including mental health and substance disorder services. States have a lot of "wiggle room" within that broad mandate, said Weil, warning that psychologists should be concerned about states' final determinations.

When it comes to implementation, most states are focusing on areas with federal funding attached, such as setting up exchanges and improving eligibility systems. Psychologists, Weil said, should be involved not just in areas "where federal dollars are making things happen but where psychologists need to make things happen."

Psychologists shouldn't focus on their own reimbursement rates, however, Weil cautioned. "If we're trying to improve the health-care system and what you bring to every conversation is your list of grievances, that's not much of a path for progress," he said. Instead, he said, psychologists must focus on "building a better system."

—R.A. Clay