State Leadership Conference

When spreading the word about how psychology can help overweight and overstressed Americans, psychologists need to be like Paul Revere-someone known, trusted and capable of delivering a message people will act on. That's how Russ Newman, PhD, JD, APA's executive director for professional practice, described the challenges and opportunities facing psychologists at the APA Practice Organization's 2006 State Leadership Conference.

Held March 4-7 in Washington, D.C., more than 600 participants from 60 states, provinces and territories gathered to discuss the theme "Psychology and Communities: Advancing Health, Building Resilience and Changing Behavior."

Describing this year's theme as a continuation of last year's focus on the connection between health and behavior, Newman said the psychological community now faces the task of continuing to get that message across to the public, influencing policy-makers and helping people change their behavior to lead healthier lives.

However, improving the health of Americans will not be easy, he said. Just under two-thirds of the population is either obese or overweight; high levels of stress exacerbate the situation, sometimes leading people to smoke, eat unhealthy foods and avoid exercise. As a result, unhealthy behavior plays a role in all six leading causes of death in the United States: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide.

Psychologists have a unique role to play in addressing those health problems, Newman said, because what they know about changing behavior can help people lead healthier lives. Furthermore, psychologists' expertise can help society as a whole drive down health-care costs.

"To state the obvious, good health is all about behavior-everyday behaviors that can be learned," said Newman. "If improving health has the potential to solve many of the problems in our current health-care system...it is not such a stretch to say that health-care reform, then, is really all about behavior reform."

Ways psychology can help

To use psychology's insights to change people's behavior, Newman says psychologists working through their organizations should:

  • Educate the public. Efforts such as APA's Mind-Body Health campaign have raised awareness about the health effects of stress through such initiatives as a recent survey conducted in partnership with the National Women's Health Resource Center and iVillage.com. The survey's results received widespread coverage via radio, television, newspapers and magazines (see the April Monitor).

  • Promote psychologically healthy workplaces. For example, the Psychologically Healthy Workplace Awards programs run by state associations and APA's Business of Practice Network help businesses understand the link between employee well-being and organizational performance (see page 40).

  • Increase community participation. Psychologists can work through state psychological associations to form a "community networking initiative." Such coalitions find ways for psychologists to participate in civic groups, cultural groups, service organizations and local politics, with the goal of spreading the word of how psychology can contribute to solving local problems. Examples include the "Heads Up Kentucky!" effort by the Kentucky Psychological Association (see "Connecting psychology and community"), and efforts to integrate mental health care into primary care at the Geisinger Medical Center in Danville, Pa.

"Others besides us need to know that we have solutions to some of our country's most significant problems," said Newman. "And, we must do more to collaborate with others-other professions and other communities-if we hope to put those solutions to good use."

National efforts

After Newman discussed psychology's role in the health-care debate, he briefed conference participants on ongoing legislative efforts, including:

  • Medicare and Medicaid. APA's Practice Organization successfully reversed a 4.4 percent decrease in Medicare reimbursement rates for 2006 and prevented the weakening or elimination of Medicaid's Early and Periodic Screening and Diagnostic Treatment Services program for children.

Following a persistent, multiyear effort by the Practice Organization, Medicare now recognizes psy chological and neurological testing and assessment as having a "professional work value" when reimbursements are calculated. As a result of having this work value included, reimbursements for the revised psychological and neuropsychological testing codes that took effect Jan. 1 have increased as much as 122 percent for some services in some geographic areas, Newman said. The Practice Organization is working with the Centers for Medicare and Medicaid Services for the issuance of clear instructions to insurance carriers to accept the revised codes.

Mental health court. An initiative SLC attendees lobbied for during Capitol Hill legislative visits in 2005-securing funding for the Mentally Ill Offender Treatment and Crime Reduction Act-resulted in $5 million in funding this fiscal year, thanks to help from Sen. Mike DeWine (R-Ohio) and Rep. Ted Strickland (D-Ohio). The funding marks the first appropriation for this new law, which builds on funding for its predecessor, the mental health courts program.

  • Mental health parity. Efforts to achieve mental health parity at the national level stalled last year, but a bill expected in the Senate may outlaw discrimination against people in need of mental health services. Four more states enacted mental health parity laws last year, bringing the number of states with some form of a parity law to 41.

  • Small business health plan/association health plan (AHP) legislation. Organized psychology worked in 2005 to prevent Congress from enacting legislation exempting AHPs, also known as small business health plans, from state-level health consumer protection laws, such as mental health insurance parity and psychology "freedom of choice" laws. Unfortunately, Newman reported, the legislation is back in 2006 "in a more muscular form" called the Health Insurance Marketplace Modernization and Affordability Act (HIMMA), which applies to all state-regulated health plans. HIMMA could affect 68 million Americans in group health plans and millions more with individual health insurance coverage. During Capitol Hill visits, conference participants urged elected officials to oppose this legislation.

  • CIGNA lawsuit. A lawsuit alleging that some of the nation's largest managed-care companies conspired to reduce and delay payments to nonphysician health-care providers, including psychologists, resulted in an $11.5 million settlement with CIGNA. In August, more than 4,000 psychologists received almost $2.2 million. Settlement talks continue with other defendants in the suit.

  • Hospital privileges. In California, the struggle continues over implementing a 1990 state Supreme Court decision allowing psychologists to lead team treatments and admit, diagnose and discharge patients, all without the oversight of a psychiatrist. After the state Department of Health Services issued regulations implementing the law in state hospitals, psychiatrists sued, and the court ordered the department to reissue the regulations under a different procedure. For more, see "Psychologists' hospital privileges benefit patients".

  • Prescription privileges. New Mexico now has three prescribing psychologists, and Louisiana has 30, who have written more than 10,000 prescriptions. In 2005, nine states introduced legislation seeking to give prescription-writing authority to trained psychologists. Three states have filed bills this year, and two more are expected to introduce legislation soon.