Most of the practicing psychologists who are APA members see themselves as clinical psychologists or mental health professionals, W. Douglas Tynan, PhD, told participants at the State Leadership Conference in March. But given the way the health-care system is evolving, that definition is too limited, said Tynan, APA's director of integrated health care.
"I'm going to suggest that you're all health psychologists," said Tynan. "Much of what you do impacts the health of your patients."
Trends in the rapidly evolving health-care system support that new self-definition, said Tynan. Under the Affordable Care Act, for example, the fee-for-service model is giving way to a growing emphasis on payment for the quality and outcome of services provided. There's a movement toward patient-centered medical homes, in which care is coordinated and integrated according to a whole-person orientation. Other trends include an increased emphasis on health-care teams and increased funding for primary care.
Even psychologists in solo or small private practices should consider how they can integrate their work with that of physicians and others focused on physical health, said Tynan.
What are the "on-ramps" to integrated care? First, said Tynan, start using — and advocating for — health and behavior codes, which allow psychologists to bill for the behavioral services they provide to patients with medical conditions. Although there can be challenges with using the codes, said Tynan, using them demonstrates that psychologists do things directly related to health.
Psychologists can also explore opportunities with physician groups. Because the Affordable Care Act requires insurers to cover screening and counseling for depression, alcohol misuse, obesity, intimate partner violence and several other problems, psychologists can approach physician groups and offer their expertise. "A lot of practices don't want to screen for depression, for example, because they don't know where to send people," Tynan pointed out.
In addition to helping with screening, psychologists can also offer to work with a medical practice's patients, emphasizing the ways psychological services can improve outcomes for patients with diabetes, heart disease or other physical problems. When approaching a potential partner, psychologists might identify the practice's needs by asking about the top three reasons that patients come in and what visits are the hardest to manage. Focus first on the most difficult, highest-cost patients, typically those with chronic health problems and concurrent mental health diagnoses, Tynan suggested.
It's important to track revenue and costs as a way of demonstrating psychology's value, added Tynan. While upfront costs may increase, he said, integrating psychological and medical care reduces costs in the long term by reducing emergency and inpatient expenses.
"There's no one-size-fits-all to integrated care," said Tynan. "But my point today is that you have skills and expertise that are highly valued in the health-care system right now."
Rebecca A. Clay is a journalist in Washington, D.C.