APA Continues Charting Course on Health Care Reform

It’s unquestionable that health care in our country is continuing to undergo dramatic transformation. In a world in which some changes are within our control, but many others are beyond, it is incumbent that APA is a strong, well-informed, and engaged advocate for patients and families and for psychiatry. It is essential that we lead in this area, as you and our Board have for several years identified health care reform as one of our highest priorities.

In that spirit, APA is engaged in multiple health care reform initiatives. Last year, the Board of Trustees Ad Hoc Work Group on APA Health Care Reform was appointed to review APA’s activities in this area and to make recommendations for the ongoing prioritization and direction of APA. The goal of the work group, which continued the efforts of two prior Board work groups, is to situate APA and American psychiatry so that we are better able to strategically influence U.S. health care reforms and fully integrate these efforts into our organizational structure. At the March Board meeting, the work group, chaired by one of the authors of this column, Trustee-at-Large Anita Everett, M.D., came forward with a thoughtful and encompassing report, which was unanimously approved by the Board.

Organized into six priority areas, the report presents a strategic recommendation for each area and includes three to five tactical recommendations that are actionable by APA over the next several years. Here is a brief summary of the half-dozen priority areas and strategic recommendations:

• Quality. Prioritize psychiatric leadership in defining the quality measurement of psychiatric services in U.S. health care.

• Financing: Establish a sustainable advocacy and communications strategy to demonstrate the value of psychiatry to key audiences: legislators and regulators, employers as purchasers, health plans, and the general public.

• Integrated care: Design a plan of action to define and advocate for payment models for integrated care that will support sustainability. Work with the U.S. Centers for Medicare and Medicaid Services around newly announced plans to offer bundled payments and other payment reforms based on quality.

• Research: Effectively influence the national research agenda on health care services including models of integrated care and co-morbid psychiatric and general medical disorders.

• Health information technology: Leverage our position as clinical leaders to stimulate advances in technology so that electronic medical record (EMR) and app developers work with APA to create EMRs and apps that more efficiently and effectively support the unique clinical needs of psychiatric physicians.

• Workforce and education: Develop a national strategy that defines and highlights the relative role and value of psychiatrists in organized systems of care that include other physicians and behavioral health and allied professionals.

The full report can be accessed here. Its recommendations align closely with the recent Board-approved strategic plan for APA, which is posted at http://psychiatry.org/strategicplan. Both plans require our ongoing and close cooperation with other medical groups.

Many distinguished and talented individuals served on this work group. Our thanks go to Lori Raney, M.D. (vice chair), Harsh Trivedi, M.D., Barry Perlman, M.D., David Gitlin, M.D., Glenn Martin, M.D., Howard Goldman, M.D., Jay Shore, M.D., M.P.H., Herbert Pardes, M.D., Jürgen Unützer, M.D., M.P.H., Barry Sarvet, M.D., Rhonda RobinsonBeale, M.D., Roger Kathol, M.D., and John Wernert, M.D. The APA administration was also a key part of this work.

As has been already noted, this work group is the third in a series of critical work groups that have examined issues and opportunities for psychiatry since the passage of the Affordable Care Act (ACA) in March 2010. For reference, the first of these work groups convened in 2011; its work culminated in an extensive report that recognized numerous opportunities, many of which, such as the Milliman report detailing the increased medical costs of patients with psychiatric illness, APA used to increase the knowledge of APA members as well as effectively target APA policy, education, and advocacy activities. The report is available here.

The second work group was oriented toward product development, and its work culminated in the production of resources in three areas: (1) advocacy documents for the new Medicaid opportunities under the ACA, (2) a white paper on the need for psychiatric quality and outcomes measures, and (3) training and education materials for psychiatrists on integrated care.

The third work group, as detailed here, reviewed an inventory of APA’s extensive activities on health care reform and considered how best to build on these activities. Rather than create new councils or committees, the work group recommends working within APA’s existing structure (that is, APA’s administration, councils, and the Assembly) to execute its plan. By resolution of the Board of Trustees, a status report on each of the recommendations will be given by CEO and Medical Director Saul Levin, M.D., M.P.A., to the Board at its October meeting.

We would like to note that the work group dedicated its report to the memory of Wayne Katon, M.D., who was both a friend and a colleague (read a remembrance from this issue here). He devoted a substantial part of his extraordinary career to developing the evidence base to support the effectiveness and efficacy of integrated and collaborative care. We are greatly indebted to his work, which will inform the advancement of our profession for many years to come. ■