From a health policy perspective, our nation is undergoing a radical transformation from what might once have been considered, not that long ago, a "momma-pop" individual-oriented health care delivery model to becoming a systematically data-driven and provider accountable health caresystem that will ultimately be client-centered with an emphasis upon prevention, wellness, and holistic care. This fundamental change reflects the essence of President Obama's Patient Protection and Affordable Care Act (ACA). There are several driving factors which made the enactment of his far reaching legislation timely and politically feasible. Health care costs have continued to rise at an unacceptable rate. Today health care in the United States is more expensive than in any other developed nation costing $2.7 trillion in 2011, or 17.9% of the national gross domestic product. Numerous studies have confirmed that there is much variation in health care spending, use, and quality within geographical areas; and further, that according to the Institute of Medicine (IOM) regions that deliver more services do not appear to achieve better health outcomes than those that deliver less. In fact, underuse, misuse, and overuse of various services often put patients in danger.
Equally important has been the unprecedented advances occurring within the communications and computer technology fields. Not that long ago, on April 27, 2004, then-President George W. Bush noted: "The way I like to kind of try to describe health care is, on the research side, we're the best…. (W)hen you think about the provider's side, we're kind of still in the buggy era…. It's like IT, information technology, hasn't shown up in health care yet…. If properly used, it is an industry-changer for the good. It enables there to be a better cost structure and better quality care delivered, in this case in the health field. And, yet the health care industry hasn't touched it, except for certain areas …. By introducing information technology, health care will be better, the cost will go down, the quality will go up." Today, it is becoming increasingly possible to systematically compare provider outcomes across diagnoses, patient populations, systems of care, and the longevity of patient lives. Those seeking to provide and pay for Quality Care are actively exploring the critical psychosocial-economic-cultural gradient of care which APA CEO Norman Anderson has been proposing for over a decade.
Within the political/health policy context, as former Mississippi resident (and now Practice Directorate Executive Director) Katherine Nordal has emphasized at State Leadership Conferences (SLC), change is here. "The clock is ticking towards full implementation of the law [ACA] and January 1, 2014 is coming quickly. But January 1st is really just a mile marker in this marathon we call health care reform. Many of our practitioners increasingly will need to promote the value and quality they can contribute to emerging models of care. Health care reform is a marathon – we're in it for the long haul. New models of care and changes in health care financing won't take shape overnight. For two years in a row at SLC our theme has been health care reform, and we've focused on the critical need for psychology to get engaged. We can't hope to finish the marathon called health care reform if we're not at the starting line. Fortunately, many psychology leaders have embraced our call to action."
Those of our colleagues who have gravitated to specialized fields such as forensic practice, organizational coaching, and providing integrated health services will do very well over the next decade. As former APA President Ron Fox has emphasized to the psychology-nursing Health Policy class I teach at the Uniformed Services University of the Health Sciences, although we may think that what we have learned during our extensive training is self-evident – it is not, and he assures the graduate students that they will be well respected as they advance in their chosen careers. Katherine also emphasizes that the individual States are now in the driver's seat under the ACA and that local political/policy involvement is absolutely critical for the profession. The underlying statute and implementing regulations for two of the major ACA provisions, the Patient-Centered Medical Home and the Accountable Care Organization, do not expressly mention "psychology." At last spring's SLC Katherine highlighted your association's impressive efforts to demonstrate psychology's "value-add" under Medicaid and within interdisciplinary primary care settings, both of which are central to the ACA. Reflecting upon organized psychology's highly emotional objections to President Clinton's Managed Care initiatives, Blowin' in The Wind readily comes to mind. "How many times must a man look up before he can see the sky?" We would suggest that "The answer my friend is…." -- Within the 2010 IOM report "On the Future of Nursing: Leading Change, Advancing Health." Aloha,
Pat DeLeon, former APA President – Mississippi Psychological Association – January, 2014
