I go to most of the millions of meetings I attend so that I can advocate on behalf of consumers or educate providers and systems on behalf of consumers. Sounds fun, but it takes a lot of ... well,
cojones ... to face down or gently persuade or whatever the situation calls for. And, of course, like anyone would, I get tired of it. So, meetings like that aren't often among my favorite things to do. I usually pay both a physical and an emotional price.
But every once in a while I get to go to a meeting that really does change my perceptions about our world. And recently, I got lucky—I was invited to participate in a very small, exclusive, high-powered "think tank" on the future of mental health care. I was surrounded by people from Harvard, Yale and Princeton. We had former state health directors, hospital system directors, insurance execs, pharma people, clinic directors, therapists ... and me. But hey ... at least there was a consumer there.
Before I go too much further, I do want to mention that you would be proud of how I represented consumer needs and interests in the meeting. At the end of the two days, many of these top-tier leaders said that the most important thing they gained there was an understanding, finally, of the disconnect between what consumers want/need and what the system is actually providing them. And I was able to "represent" that to them.
I wish I could share with you everything I learned, but I had to sign a confidentiality agreement. The information delivered and developed officially belongs to the consulting company that came in and the think tank's funder. What I can share with you, though, are some overriding themes for you to consider about the future of health care and what those might mean for mental health services. I doubt that you'll be surprised by any of these.
- Health care funding systems that are already-broken and not sustainable in the future: We face rising insurance costs—co-pays, deductibles, prescription prices—and increasing limits on what is covered. Could we be moving toward a system of catastrophic coverage only? By that, I mean we'd have insurance but it would only help us if something truly major happens to us. What does this mean for insurance parity? What does this mean for wellness programs or chronic care models?
- An increasing focus on evidence-based practices (EBP), treatment algorithms and data mining to identify what's working and which doctors have the best results at the lowest prices: As many before me have indicated, EBPs can be seen as simply a way to deny insurance coverage for anything not included in the "evidence." And that evidence is often, by its very nature, out of date and applicable only to systems and treatments that existed, say, 10 years ago. What does this mean for advancing research or having access to new treatments?
- An increasing impact on the provider workforce: If insurance gets more complicated, data collection more time-consuming and there are more pressures on doctors to fit treatments into artificial algorithms or EBPs, many doctors might opt out of insurance of any kind ... or of practicing at all. On the other hand, nurses might be used for 90% of our face-to-face time with the more expensive doctor being used just during the last 10% of our already-short visit. So, what does this say about the availability of psychiatrists?
