Psychologists must find ways to expand their participation in Medicaid and get consumers the help they need, said speakers at
the State Leadership Conference. From left to right: Dr. Stephen R. Gillaspy, of the University of Oklahoma Health Sciences Center,
Shirley Higuchi, of APA’s Practice Directorate, Dr. Arthur C. Evans Jr., of Philadelphia’s Department of Behavioral Health and
Intellectual disAbility Services, and Dr. Robin Henderson, of the Central Oregon Health Council.
that their counterparts in another state cannot. And payment
structures and rates vary tremendously.
Part of the problem is how policymakers view psychologists,
said Evans. “In the policy world, psychologists are often viewed
as therapists who cost a lot of money or doctors who can’t
prescribe,” he said.
Medicaid’s coming expansion gives psychologists a chance
to change those perceptions, especially if they go beyond
psychotherapy, said Evans. For example, psychologists can help
in the push for greater accountability and the trend toward
pay-for-performance by offering their measurement and data
analysis skills. “It’s a very powerful way to shape provider
behavior,” said Evans, explaining that health systems need a lot
of help with this kind of work.
Psychologists are already helping to improve care and lower
Medicaid costs in central Oregon. In 2009, Henderson and
others began experimenting with ways to achieve better health,
better care and lower cost. They first placed psychologists in
primary-care clinics, then lobbied to get legislation passed in
2011 to create the Central Oregon Health Council. The council
oversees the region’s coordinated care organization, an umbrella
group of hospitals and providers all working together to
improve residents’ health.
“Coordinated care organizations are based on principles
psychologists know and love, such as the idea that mind and
body are connected,” said Henderson, who also serves as the
council’s executive director. In contrast, many Medicaid plans
have behavioral health carve-outs that break that connection.
Today, Henderson and her colleagues are working on more than
40 transformation initiatives, including 17 pay-for-performance
measures. Goals include integrating behavioral health into
primary care and advancing patient-centered primary-care
homes. “Primary care is the mental health home of the future,”
said Henderson. “Primary care is where we need to be.”
In other states, psychologists are finding different ways to
improve Medicaid beneficiaries’ access to care. In Oklahoma, for
instance, Stephen R. Gillaspy, PhD, and others have successfully
fought to obtain Medicaid reimbursement for health and behavior
assessment and intervention billing codes, which cover behavioral
services provided to patients with physical health problems.
While Medicare and most private insurance companies
now accept health and behavior codes, “the last big challenge
is Medicaid,” said Gillaspy, an associate professor of pediatrics
at the University of Oklahoma Health Sciences Center. It took
five years for Gillaspy and others to convince the state Medicaid
agency to begin reimbursing for the codes in 2010. Patients’
access to needed services was the key selling point, said Gillaspy.
Another achievement was persuading the Medicaid agency
to allow psychology interns and fellows to get Medicaid
reimbursement for services provided under supervision, just
like medical residents and fellows and master’s-level trainees.
“There’s a lack of providers out there,” said Gillaspy.
“If [health-care authorities are] interested in having more
psychologists treat patients, this is one way to do that.” n