“All politics is local” goes the saying, but it’s just as true about health care—reform of the health care system and the movement toward integrated care are rolling out differently in California and North Carolina, in the Rocky Mountain states and the Midwest, in the Deep South and New England.
So APA wants to provide information and resources to district branch leaders who can return to their states and communities and use their new knowledge to help psychiatrists adapt to changes as they are happening “on the ground.”
Lori Raney, M.D., chair of the APA Task Force on Integrated Care, said integrated care is the new “gold standard” for care and requires a new skill set for psychiatrists related to population health and data-driven care.
That was the purpose of an APA-sponsored course titled “Health Reform—Policy and Practice Implications for Psychiatry” held June 21 in Chicago to “train the trainers.” The two-day course was presented by Irvin “Sam” Muszynski, J.D., director of APA’s Office of Healthcare Systems and Financing (OHSF); Karen Sanders, director of delivery-system initiatives and integrated care in OHSF; Colleen Coyle, J.D., APA general counsel; and Lori Raney, M.D., chair of the APA Task Force on Integrated Care.
The goal of the course, attended by 90 district branch leaders and psychiatrists from around the country, was to provide them with a broad overview—and some detailed analysis—of vast systemic changes that are unfolding differently in different parts of the country so that they can go back to their states and share with their colleagues information to help them understand and adapt to the changes.
In an overview on the first day, Muszynski referenced the 2013 report by the Board of Trustees Work Group on Healthcare Reform, which was led by current APA President Paul Summergrad, M.D., explaining that health care reform may not be for everyone (Psychiatric News, May 3, 2013). “The implications of health reform for psychiatric practice are quite broad, although they will differentially impact APA members depending on their primary practice settings and choices regarding participation in emerging models of care and payment,” he explained. “While the changes wrought by health reform are not fully predictable, they will, because of the underlying fiscal realities, be widespread and ongoing. It is likely that some aspects of psychiatric practice will remain relatively unchanged, even as reform initiatives change other aspects of practice significantly.”
Muszynski emphasized five points:
There is a paradigm shift in health care that predates the Affordable Care Act.
The steadily rising cost of health care is a driving factor.
The care system is broken, and current health care delivery and payment methods are inefficient.
Integrated models of care are imperative but they require a different payment model.
Psychiatry has a “value proposition” for health care reform, and APA has an opportunity to lead in the reform effort.
A key goal of the course was to encourage psychiatrists to seize the initiative. “Psychiatrists are in demand, and there are currently no rules,” Coyle said in a lecture on contracting. “Therefore, psychiatrists have a small window of opportunity to make the rules. . . . Contracts reflect the balance of power, and they should reflect the bargaining power or the perceived bargaining power of the physician.”
Raney stressed that integrated care is the new “gold standard” for medical care and will require a new skill set for psychiatrists related to population health and data-driven care. But she also reinforced the concept that psychiatrists—by virtue of their training in medicine in general and psychiatry in particular—are uniquely qualified to work in integrated care settings and be leaders in team-based care.
The course contained four modules—an overview of health care reform, delivery system initiatives and innovations, resource material on practice management and policy issues, and advocacy resource materials—and used a 115-plus page course book that will be available to APA members on the APA website. Muszynski said the practice management materials provide a range of resources for practitioners, regardless of whether they are actively involved with health care reform initiatives.
He added that feedback has been very favorable from participants, many of whom have indicated they are eager to receive more assistance from APA on these issues.
“North Carolina felt very fortunate to be allowed to bring a ‘learning collaborative’ of members who all have varying interest and experience in integrated care, accountable care, practice management, and medical leadership,” Robin Huffman, executive director of the North Carolina Psychiatric Association (NCPA), told Psychiatric News. “North Carolina and the NCPA have been engaged in integrated care efforts for many years, and our recent work involves us in a Towards Accountable Care Consortium with other medical societies in the state. North Carolina members were pleased that our accountable care ‘toolkit’ for psychiatrists was referenced several times by speakers and those in the audience. It made us feel like we are on track in identifying the needs of psychiatrists and trying to bring them needed information.
“Our team has already been meeting and discussing how to package the large amount of material APA shared,” she noted. “We intend to do a series of presentations, trainings, and resource meetings over the next couple of years to help our members learn about the evolving health care system and figure out where they fit in.”
She added, “Personally, as a DB exec, I am so excited about the efforts APA is making to take the lead and engage psychiatry in the health care delivery arena.” ■