Turbulence Ahead in the Behavioral Health Marketplace

I recently found myself thinking . . . again . . . about changes in the behavioral healthcare marketplace and wondering how our customers are doing. A couple of weeks ago, Monica Oss of Open Minds wrote about dramatic changes in reimbursement methods in the public behavioral health sector in New Jersey and how organizations there are adapting and positioning themselves. We have been watching our larger customers go through multiple changes in how they are structured and how they serve clients over the past five or more years; simultaneously, most of our smaller, private practitioners seem to have made few changes in how they provide services.

Ms. Oss lays out some of the payment issues very clearly:

The reasons for the shift away from fee-for-service (FFS) reimbursement are many and the emerging value-based payment and pay-for-performance (P4P) payment models are many and complex. But the challenges for executive teams, regardless of the emerging payment model in their market, fall in two categories — market positioning for future sustainability and competitive organizational performance.

At the front end, a focus on markets and business approaches to practice turns many small providers off. They do not want to recognize or address the fact that they are running a business and that doing so takes thought and consideration about their market and about how they measure up compared to others who provide the same services. They see themselves as helpers, not as business persons. On the other hand, failure to be informed about transformations that are rapidly occurring and where they will fit into the altered professional environment, will likely leave them stranded in a practice that is slowly dying.

One of the most profound of the emerging changes is the integration of behavioral health and physical health services into one setting.

Since my own training is as a psychologist, I decided to take a quick look at what American Psychological Association (APA) is promoting to its members to help them prepare for and address the dramatic modifications that are likely coming in mental health service delivery. At first glance, I was pleased to see that the organization has developed a Center for Psychology and Health. I do recall that this was a major push of my friend and colleague Suzanne B. Johnson, Ph.D. when she was APA President. But it took some patience and searching to find any meaningful information.

I visited the APA website, but had to read the small print three-quarters of the way down the page to get to the first mention of the Center for Psychology and Health. Once I navigated to that page, the first thing I saw there was ‘Health Psychology CE Programs.’ I had to push past my hesitation (because I am not a ‘health psychologist’); I read around the rest of the page and found a few things that looked hopeful, but only found those under the headers ‘For Students and Educators’ and ‘For the Public.’ An article entitled Moving into Primary Care was hidden behind a link named ‘Five ways to collaborate with physicians’ in the ‘For the Psychologist’ section. On the other hand, an article named ‘What is Integrated Care?’ was listed under ‘For the Public.’ The information would be quite appropriate for professionals who are wanting to have an understanding of just what this integration of mental health care and general health care is really all about.

When I went to the website of the APA Practice Organization, I was more disappointed. I found no headers about integrated care or pay for performance. When I used the search box for those terms, I did find some articles. Unfortunately, only one was recent (2013). The next most recent article was written in 2009.

The website of the National Council, on the other hand, has easily-found, current information about their Center for Integrated Health Solutions, a joint project with SAMHSA. Clearly, the public behavioral health community is rapidly moving in this direction.

I am afraid that psychologists and other private practice mental health professionals might be having a difficult time figuring our where they might fit into a different kind of marketplace, or even that a different kind of marketplace is on its way, because their professional associations are doing a terrible job of helping them conceptualize and create the alternative practice structures that will be needed to survive in this turbulent arena.

What is your organization doing to redefine, re-position and reinvent your practice to assure that you will thrive well into the future? Please share your comments below.