Health care is changing today. Right now in my small state of Massachusetts new models are being developed and experimented with. Everyone is talking about the sacrifices we’ll all need to make to bring the cost of health care down to manageable levels.
The direction this is all moving in is team-based “medical homes” where people get all of their care within one group. This group will get paid a flat fee per patient by insurance companies and the business must figure out how to make ends meet.
In theory this is a good model, but there will be bumps as it develops. One such missing link is, “Where does mental health care fit in?”
Those who make these decisions know they need to find a place for mental health and I”m sure they will,but this means that you need to be prepared to work within a large medical care group, collaborating with a large number of other health care providers. You’ll make a salary, while someone else deals with the reimbursement issues. Outcomes will be measured because funds will be tight and if you’re not showing that your work has any benefit, why should any one pay you?
This first model of our future work space is appealing in many ways. Your clients will get coordinated care, communication among providers (who will be all linked in to one electronic medical record system) will be smoother than it is now, and you won’t need to worry about referrals or getting paid. You’ll have plenty of clients!
This model will also only give access to insurance reimbursed mental health care for medically necessary conditions. This means your client base may be at differing levels of accute need. Most will probably be approved for services to get them to a point of average functioning (getting to work/school, maintaining some social relationships) but won’t get services to optimize their lives. Long term therapy will be out of the question.
Personally, I see merit in this model (we’ll call it Model 1). It will get mental health care to many people who currently can’t access or afford the care they need. Over time it WILL decrease costs and the patient will be better served by a group of people who are all accountable to each other to provide cost effective care.
But what will happen to the majority of clients we see in our practices now?
Most of the people you see now for issues of social, marital/relationship, career, or academic distress will not qualify for insurance covered mental health care. Their conditions are not medically necessary. Yes, we know a child who has a hard time making friends can become depressed, but until they are depressed, their care isn’t medically necessary. Does that make sense?
Now I know that many of you are bristling at this idea that the type of care you are offering now won’t be medically necessary in the future. But remember, costs MUST COME DOWN. There will be limits to what will be covered, for mental health and all other health conditions.
So I’d like to introduce mental health care reform Model 2.
This model will exist outside of the insurance-based health care system, but will be just as needed and in demand. The public will quickly get the message that unless they are in really bad shape emotionally, they won’t be able to get therapy covered by their insurance. Most people won’t want to wait until they or their family members are basket cases before getting help, so they will search for alternatives.
There is a billion dollar industry out there right now that supports my theory of Model 2 – alternative or holistic health care. Every year people spend money out of their own pockets for supplements, acupuncture, massage, and Eastern medical interventions that have never been covered by insurance. They pay because they feel these approaches are better for them than traditional, insurance reimbursed medicine.
Private Practice of the (Near) Future
If you want to have an independent private practice in the future, you will need to find ways to tap into people’s needs so that they choose to go outside of their medical home to work with you. This isn’t as hard as it sounds (remember, billions of dollars are already being spent for services outside of managed care).
Of course, you’ll need to specialize and become the “go to” person in your community for a specific presenting concern.
And you’ll need to market yourself and your services.
You’ll need to give people a compelling reason to come work with you before their problems become acute.
And you’ll do well by collaborating with the medical groups who may send you referrals when they know their patients need help, but their insurance won’t cover it yet.
I’m no psychic, but the writing is on the wall over here in Massachusetts. Fee for service is going away fast. You’ll need to decide where you want to work in the near future. Both Model 1 and Model 2 have their merits and will appeal to different people.
If you want to see clients all day long and not worry about the business end of things, chose Model 1. You’ll have less autonomy, but more direct client contact.
If you enjoy being your own boss, multi-taking and building a work space that is your own, Model 2 is the way to go.
Here, at the Biz Savvy Therapist, you know we’ll be talking about Model 2. There are so many opportunities to create a helping business that is innovative and thriving!
Change is coming. You can’t stop that. Take time to consider how you want to engage with the change because you have options. But don’t just let change happen to you…that’s frustrating and leads to feeling helpless.
So how about you? What does the future of your practice look like?
