Psychiatr News January 6, 2006
Volume 41, Number 1, page 20
© 2006 American Psychiatric Association
APA's Business Initiative Widens Access to Quality Care
Norman Clemens, M.D.
Norman Clemens, M.D., is chair of the Committee on APA/Business
Relations.
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
cmiller{at}psych.org
or online at
<http://workplacementalhealth.org/index.cfm>.
Related Articles:
-
Economic Incentives Increase Access to Depression Care
- Steven Sharfstein
Psychiatr News 2006 41: 3.
[Full Text]
-
Limiting Treatment Access Ultimately Costs Employers
- Aaron Levin
Psychiatr News 2006 41: 6.
[Full Text]
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