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Psychotherapy Will Need Advocates as Healthcare Consolidation Clouds Its Future
Demand has been growing, but psychotherapy is as misunderstood as ever. Many consumers dismiss it as lacking value since it is “just talking.” Some physicians view it as supportive and substitute non-licensed “behavioral counselors” in medical settings. Some behavioral experts mistakenly believe techniques are the essence of therapy, contrary to research.
This may be a clinical debate for now, but it will transition into a business matter as health systems gradually take over the funding and oversight for therapy. We are nearing that point. Business consolidation in healthcare is coalescing all segments of care delivery. Although they may not like it, clinicians should prepare to pass the baton for messaging on this issue to behavioral executives.
Attitudes about therapy vary. Consumers turn to it out of need, not belief in the process. Therapy is a relatively opaque clinical procedure. Medically trained staff within health systems seem to prefer certain types of therapy—they are accustomed to well-defined, stepwise clinical procedures. Policymakers are focused on reducing costs and finding scalable solutions to address the access crisis in behavioral health.
Our field will increasingly have its services managed by integrated health systems. Health plans, employers, and governments will continue as major payers, with health plans providing administrative functions for all. Health plans will delegate significant decision-making to health systems and maintain shared accountability. It is time for behavioral healthcare to boost its clout with all these entities.
A Strong Voice Inside Health Systems
Two realities must be appreciated to understand how health systems will likely manage our services in the near future. Their staff and leaders are medically trained and may be biased toward guideline-driven therapies with clear-cut procedures. Secondly, health systems are preparing to accept financial risk from health plans through value-based care (VBC) arrangements.
VBC can be structured in many ways, but at a high level, it is a model for providing comprehensive, integrated care within a tight budget. Health systems will fund behavioral care along with other specialties. Because the goal is to provide high-quality, comprehensive care while constraining costs, this may sometimes require limiting services. Therapy could be vulnerable to such cuts.
Behavioral executives may be the best non-technical, non-pedantic advocates for therapy. Psychologists are needed to explain that research validates therapy as highly effective, with results varying more by therapist than technical approach. Yet no one should assume research data are more persuasive than a lifetime of experience. Healthcare executives, like doctors and nurses, were trained in medical settings.
Behavioral executives might be our most persuasive representatives because they see therapy’s peculiarities and power. This entire discussion may seem odd when so many today are frustrated they cannot find a therapist to help them, but trends come and go. There is no reason to believe today’s circumstances will last. Funding models are changing, and leadership for behavioral services is changing.
As a group, therapists are famously poor businesspeople who assume their credentials alone should propel them to fine careers. Yet health systems are filled with professionals expecting fine careers. Each group will be competing for resources under VBC. Executives are the best voice for our field in those contentious discussions.
A Strong Voice Inside Health Plans
The management of behavioral services quietly passed a turning point in the past decade. Independent organizations managed behavioral healthcare starting in the 1990s, but health plans have now acquired them. The remaining behavioral executives, once senior leaders in these independent companies, have moved down in the org chart. How strong is our field’s voice among payers now?
Health plans control the management of services and can change behavioral healthcare in many ways, even if parity laws are enforced to the letter. When health plans give integrated provider systems financial risk, including control over service utilization, it is hard to predict how medications, therapy, or other services will be used. What guidelines will behavioral leaders suggest?
Psychiatrists largely provide biomedical rather than psychosocial interventions, even though they still rely on therapeutic alliance and empathy. Among behavioral clinicians, more psychiatrists hold leadership roles within health systems and health plans. What will they advocate should cost-cutting become a priority? Some may support the full range of psychotherapies, others not.
The background of our leaders is not the issue—it is far less critical than priorities and negotiating skills. We need our leaders to pursue executive roles in companies that will control our work. Other clinical practices may be at risk as well. Time will tell but it is running short. As healthcare consolidates, many things will change, and we need greater influence in the rooms where critical decisions are made.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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