is the future
A medical resident training at LifePoint Hospitals in Las Cruces, N.M., was going through a list of diagnostic riteria with a patient with depression. The resident
noted the patient’s poor appetite and was ready to move on to
the next item, when the psychology student training alongside
him probed a little more. The result? A diagnosis of a serious
“That would have been missed,” John Andazola, MD,
Psychologists must make the
program director of LifePoint Hospitals, told participants at the
State Leadership Conference in March. “We have to look at the
That’s just the kind of story that APA President Suzanne
Bennett Johnson, PhD, had in mind when she chaired the
session on integrated care. “Our current health-care system is
a failed system,” she said. “Integrated care is the exact opposite
of our current system: It is patient-centered care, and it rejects
Integration of behavioral health and primary care plays a
huge role in the Patient Protection and Affordable Care Act,
said Robert McGrath, PhD, director of Fairleigh Dickinson
University’s certificate program in integrated primary care.
Offering what he called “health-care reform 101,” he explained
several key terms, including patient-centered medical homes.
Called patient-aligned care teams in the Veterans Affairs system
— “because when you tell old soldiers about medical homes,
they think it’s a place to put you in your dotage,” McGrath said
— patient-centered medical homes mean providers working in
conjunction with primary-care providers.
case for working side by side
The health-care reform law also calls for the creation of
accountable care organizations, which will be responsible for
the complete care of Medicaid recipients. Unlike traditional
managed care, in accountable care organizations “it’s supposed
to be providers driving the ship,” McGrath said.
“Ideally, there will be less intrusion of third parties into
decision-making, since providers will do the decision-making,”
he said. “If accountable care organizations succeed, they’ll be
seen as a model for revamping the entire health-care system.”
State health exchanges are another key term to understand.
In 2014, McGrath said, employers with at least 50 employees
can pay a fine and shift employees from work-based insurance
to the state exchanges. According to McGrath, fiscal analyses
show that’s a winning strategy for most large companies.
Psychologists must participate in shaping such changes,
McGrath emphasized. They need to eliminate such barriers
to integration as reimbursement obstacles and statutes that
make it illegal in some states for psychologists to partner
with physicians. They also need to share data showing that
integrating psychological services into overall health care can
With 25 to 30 years’ worth of research showing that
integrated care is a good idea, why hasn’t it happened yet? There