“We can’t afford to be left out of health care again and then
have to spend decades playing catch-up,” said Executive
Director of APA’s Practice Directorate Dr. Katherine C. Nordal.
Psychologists should take the lead in reforming health care,
said Dr. Mark B. McClellan, of the Engelberg Center for Health
Care Reform at the Brookings Institution. “The public doesn’t
trust government or insurers. The people they trust are you:
psychologists, physicians, nurses and others involved in care.”
traditional response to runaway health-care costs has been
to squeeze provider reimbursement. But that approach is
unsustainable, McClellan said, because professionals are already
getting paid less or not at all for the services that make the most
difference to patients and because professional services account
for only a small percentage of costs. Instead, psychologists
should offer a vision of what a truly reformed health-care
system could look like.
The good news is that health-care reform offers an
alternative to saving money by paying providers less, McClellan
said. “We’re moving away from paying providers based on
volume and intensity and instead paying providers based on
what we really want: better results with lower costs.”
But getting there will require a new emphasis on
measurement. The new health-care system will demand
evidence that patients benefited from services — a marker
more difficult to quantify than number of office visits or
tests performed, McClellan said. To address the difficulty of
proving long-term improvements to mental health, he called
for an incremental approach, with interim indicators such as
percentage of clients screened for depression.
With better measurement, McClellan said, new
reimbursement systems become possible. In accountable care
organizations, for example, clinicians who can demonstrate
better quality and lower costs can share in the savings.
“The goal is not about short-term savings,” said McClellan.
“It’s about value — how to improve health without spending
more money overall.” n