APA's Business Initiative Widens Access to Quality Care

Now in its sixth year, APA's Business Initiative interfaces with America's employers, who finance over half of the health care economy. Employers have welcomed the opportunity to work with APA as they realized the business advantages of seeking effective treatment of psychiatric disorders. They have identified depression, anxiety, and substance use disorders as major workplace problems.

APA has responded to their concerns through a rich array of activities. Initially the task was to find out what issues concerned employers through meetings with business leaders, industry medical directors, employee assistance and human resource executives, benefits managers, and benefits consultants.

A major invitational conference at the Carter Center in June 2001 helped to pull the effort together and resulted in a valuable publication of proceedings. More recently APA worked with the producers of world congresses on health care to mount a World Congress on Behavioral Health and Wellness, which was held last spring and slated again for this May (Psychiatric News, June 17, 2005).

After the terror attacks on 9/11, APA created the Partnership for Workplace Mental Health in collaboration with Fortune 500 companies, business and professional associations, mental health organizations, and federal government agencies. The partnership initially addressed the emotional consequences of disasters, through an invitational conference and a brochure to help people deal with disaster in the workplace. Over a million copies of the brochure were distributed by employers and government agencies, even the United Nations.

The partnership's agenda now encompasses the full spectrum of workplace mental health issues and is a major program of the American Psychiatric Foundation (APF).

Seed money from APF for informational activities has been augmented by grants from employers, the Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, pharmaceutical companies, and Cyberonics.

Mental HealthWorks, a quarterly newsletter going to more than 24,000 employers and psychiatrists, summarizes breaking news about employers' approaches to addressing mental disorders and provides links to other resources.

From the outset, APA has promoted the “business case for quality mental health care”—that is, speaking to employers in their own terms. To impact corporate health care purchasing decisions, we must demonstrate that investments in quality mental health care for employees produce measurable, positive results on the corporate bottom line.

APA commissioned a review of the literature on the benefits of offering access to quality mental health care that led to an article in the Journal of Occupational and Environmental Medicine in 2002. An updated review appears in the November 2005 issue of that journal, and a review on access to treatment for substance use disorders is coming soon.

What about the partnership's impact in the real-life arena of employee mental health care? The Mid-America Coalition on Health Care in Kansas City provided APA with an opportunity to participate in a communitywide campaign to bring about change (Psychiatric News, May 6, 2005). The coalition is an exceptional gathering of stakeholders in the health care system—major employers, providers, academics, government bodies, and insurers. For their focus the participants chose depression.

Employee surveys and careful preparation preceded action to increase awareness of and intervention for depression. But they also addressed the challenge of assuring that care would be available when employees sought it.

The Kansas City initiative confirmed for participants that many people with mental disorders go first to their primary care physicians (PCPs). Unfortunately, many slip through the safety net due to underdiagnosis and undertreatment by these PCPs. Working with insurers and the American Academy of Family Physicians, the Mid-America Coalition conducted an innovative study that undermined a mis-perception in PCP offices that PCPs would not be reimbursed if they coded for depression.

But what of the next step after an initital visit with a PCP, which should often be referral to a psychiatrist for expert medication management and psychotherapy?

Many employers complain that psychiatrists aren't available when needed for referrals. Most major employers place their health benefits under contract with managed care organizations (MCOs). Widespread disaffection with managed care has caused many psychiatrists to withdraw from MCOs. Furthermore, behavioral carveouts often interfere with relationships between PCPs and psychiatrists, because they aren't on compatible provider panels.

Employers have clout with managed care systems, more than could be achieved through any legislated mandate. The problem is not usually poor benefits on paper; it is the impediments to access posed by poor relations between MCOs and many psychiatrists.

The success of APA's Business Initiative so far has been the result of partnership—employers and psychiatrists working together to achieve a common goal: high-quality care for the employed people of America. It is urgent that we achieve the next step, namely, the establishment of local and national partnerships of employers, insurers, government, universities, primary care physicians, psychiatrists, and other professionals. APA's Business Initiative has laid the foundation to accomplish this.

More information about the initiative and Mental HealthWorks is available via e-mail to [email protected] or online at<http://workplacementalhealth.org/index.cfm>.▪