ALOHA - Division One column

“I’M LEAVIN’ ON A JET PLANE”

            I have been fortunate to serve for two terms on the Board on Children, Youth, and Families (BCYF) of the National Academies of Sciences, Engineering, and Medicine.  There is a strong mental health presence on the Board including psychologist Ann Masten.  Natacha Blain, who is the Director, is a former APA Congressional Science Fellow.  This spring we heard from a number of national education and health experts who addressed a wide range of critical issues affecting our nation’s children and their families.  One of the most exciting aspects of BCYF is its emphasis on bringing together professionals from a wide range of disciplines to explore issues of national concern from their unique vantage points.  In developing its reports, discussion papers, etc. BCYF often convenes open sessions in Washington, DC and across the nation to hear from those most directly involved.  The Institute of Medicine (IOM), which is in the process of undergoing internal reorganization and name/brand change, was established in 1970 by the National Academy of Sciences to “secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public.”  The National Academy of Sciences was granted a charter by the Congress in 1863 to advise the federal government on scientific and technical matters.

Scaling Up:  David Hawkins, Professor of Social Work at the University of Washington, briefed us on the compelling Discussion Paper he chaired Unleashing the Power of Prevention.  “Every day across America, behavioral health problems in childhood and adolescence, from anxiety to violence, take a heavy toll on millions of lives.  For decades the approach to these problems has been to treat them only after they’ve been identified – at a high and ongoing cost to young people, families, entire communities, and our nation.  Now we have a 30-year body of research and more than 50 programs showing that behavioral health problems can be prevented.  This critical mass of prevention science is converging with growing interest in prevention across health care, education, child psychiatry, child welfare, and juvenile justice.  Together, we stand at the threshold of a new age of prevention.  The challenge now is to mobilize across disciplines and communities to unleash the power of prevention on a nationwide scale….  Within a decade, we can reduce the incidence and prevalence of behavioral health problems in this population by 20 percent from current levels through widespread policies and programs that will serve millions and save billions.  Prevention is the best investment we can make, and the time to make it is now.”

David and his colleagues opined: * When it comes to giving young people a healthy start in life, our nation faces very different challenges than it did just 30 years ago.  And, * Behavioral health problems in childhood and adolescence take a heavy toll over a lifetime, with significant impacts on rates of economic independence, morbidity, and mortality.  Seventy-two percent of all deaths among adolescents are due to motor vehicle crashes, accidents, suicide, violence, and difficulties in pregnancy.  Daily, an average of 1,700 young people are treated in hospital emergency rooms for assault-related injuries.  Smoking, which begins in adolescence for 80 percent of adult smokers, increases the risk of morbidity and mortality through adulthood.  Underage drinking costs society $27 billion per year and delinquent behavior costs society $60 billion annually.  Behavioral health problems reflect and perpetuate social inequities.  Different social groups, characterized by gender, race, ethnicity, citizenship, sexual orientation, and class, experience dramatically different levels of behavioral health.  For example, almost 83 percent of the deaths of American Indians and Alaskan Natives are attributed to behavioral health problems.

A large body of scientific evidence over 30 years shows that behavioral health problems can be prevented.  Prior to 1980, few preventive interventions had been tested and virtually no effective preventive interventions had been identified.  Today, more than 50 programs have been found effective in controlled studies of interventions aimed at preventing behavioral health problems in children, adolescents, and young adults.  These can be categorized as: * Universal programs, which seek to reach all children and youth without regard to level of risk exposure.  * Selective programs, which focus on young people who have been exposed to elevated levels of risk, but who do not yet manifest behavioral health problems.  And, * Indicated programs, which focus on youth who evidence early symptoms of behavioral health problems.

The challenge is to “scale up,” expanding these effective programs in order to achieve population-wide reductions in behavioral health problems.  To accomplish this critical objective it will be necessary to establish interdisciplinary programs and training in evidence-based prevention that involve the full complement of practice settings and, encouraging cross-sector collaboration across today’s vertically organized (“siloed”) agencies.  These efforts will help advance the movement in health care towards integrated primary care, which is a growing public health concern.  We possess the requisite knowledge.  What is needed is the creation of a comprehensive services architecture that provides population-based universal care, including prevention.  Behavioral health problems now surpass communicable diseases as the country’s most pressing concerns for the well-being of our younger people.  Unleashing the power of prevention is a call to action that our nation can’t afford to miss.

The Social Determinants of Health:  Transformative change is evolving.  At the Uniformed Services University of the Health Sciences (USUH), we recently attended several presentations by senior health policy leaders within the Department of Defense (DoD) and the Centers for Medicare and Medicaid Services (CMS) describing how the increasing use of information technology was allowing for the development of quantitative metrics to determine whether, in fact, the clinical services being rendered were effective, on both an individual and population basis.  The former U.S. Army Surgeon General Patricia Horoho has consistently emphasized “the importance of transforming Army Medicine from a healthcare system to a System for Health.  The patient healthcare encounter is an average interaction of 20 minutes, approximately five times a year.  Therefore, the average amount of time spent with each patient is 100 minutes; this represents a very small fraction of one’s life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families and Retirees.”

“Dr. Janet Heinrich, Senior Advisor at CMS’s Center for Medicaid and Medicare Innovation (CMMI), described the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons which was not only insightful, but confirming.  She discussed the various grants and programs that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers.  CMMI is pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology” (Omni Cassidy, USUHS).

CMMI was established by President Obama’ Patient Protection and Affordable Care Act (ACA).  Its underlying objective is to test innovative models to * reduce expenditures, while * preserving or enhancing the quality of care (i.e., the Triple Aim concept of former CMS Administrator Don Berwick -- Better care for individuals, Better care for populations, and Reduced costs).  Historically, our fee-for-service system has been provider-centered, provides incentives for volume, is unsustainable, and results in fragmented care.  The Administration’s vision is patient-centered, providing incentives for outcomes, sustainable, and emphasizing coordinated, team based care.

As of January, 2015 HHS announced its goals for value-based payments within Medicare fee-for-service as having payments tied to quality or value through alternative payment models at 30 percent by the end of 2016 and 50 percent by the end of 2018.  And, fee-for-service payments tied to quality or value at 85 percent by the end of 2016 and 90 percent by the end of 2018.  Medicare growth has fallen below GDP (Gross Domestic Product) growth and national health expenditures since 2010, due, in part, to these efforts.  Currently 477 Accountable Care Organizations (ACOs) – another initiative established under the ACA to foster systems of organized care – have been established across the nation, with 121 new ACOs in 2016, which cover 8.9 million assigned beneficiaries.  Pioneer ACOs were designated for organizations with experience in coordinated care and ACO-like contracts.  These models demonstrated savings for three years in a row of $92, $96, and $120 million.  One concrete example, the Independence at Home demonstration project saved more than $3,000 per beneficiary, with the year one results producing more than $25 million in savings.  Currently there are 14 total practices, including one consortium, participating in this model, with approximately 8,400 patients enrolled in the first year.  All health care is local and CMMI has been working closely with the private insurance sector to transform our nation’s health care system.  The underlying goal -- Better care, Smarter spending, and Healthier people, as measured by objective health metrics.  “I don’t know when I’ll be back again.”

Pat DeLeon, former APA President – Division One – March, 2016

 

 

“I’M LEAVIN’ ON A JET PLANE”

I have been fortunate to serve for two terms on the Board on Children, Youth, and Families (BCYF) of the National Academies of Sciences, Engineering, and Medicine.  There is a strong mental health presence on the Board including psychologist Ann Masten.  Natacha Blain, who is the Director, is a former APA Congressional Science Fellow.  This spring we heard from a number of national education and health experts who addressed a wide range of critical issues affecting our nation's children and their families.  One of the most exciting aspects of BCYF is its emphasis on bringing together professionals from a wide range of disciplines to explore issues of national concern from their unique vantage points.  In developing its reports, discussion papers, etc. BCYF often convenes open sessions in Washington, DC and across the nation to hear from those most directly involved.  The Institute of Medicine (IOM), which is in the process of undergoing internal reorganization and name/brand change, was established in 1970 by the National Academy of Sciences to "secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public."  The National Academy of Sciences was granted a charter by the Congress in 1863 to advise the federal government on scientific and technical matters.

Scaling Up:  David Hawkins, Professor of Social Work at the University of Washington, briefed us on the compelling Discussion Paper he chaired Unleashing the Power of Prevention.  "Every day across America, behavioral health problems in childhood and adolescence, from anxiety to violence, take a heavy toll on millions of lives.  For decades the approach to these problems has been to treat them only after they've been identified – at a high and ongoing cost to young people, families, entire communities, and our nation.  Now we have a 30-year body of research and more than 50 programs showing that behavioral health problems can be prevented.  This critical mass of prevention science is converging with growing interest in prevention across health care, education, child psychiatry, child welfare, and juvenile justice.  Together, we stand at the threshold of a new age of prevention.  The challenge now is to mobilize across disciplines and communities to unleash the power of prevention on a nationwide scale….  Within a decade, we can reduce the incidence and prevalence of behavioral health problems in this population by 20 percent from current levels through widespread policies and programs that will serve millions and save billions.  Prevention is the best investment we can make, and the time to make it is now."

David and his colleagues opined: * When it comes to giving young people a healthy start in life, our nation faces very different challenges than it did just 30 years ago.  And, * Behavioral health problems in childhood and adolescence take a heavy toll over a lifetime, with significant impacts on rates of economic independence, morbidity, and mortality.  Seventy-two percent of all deaths among adolescents are due to motor vehicle crashes, accidents, suicide, violence, and difficulties in pregnancy.  Daily, an average of 1,700 young people are treated in hospital emergency rooms for assault-related injuries.  Smoking, which begins in adolescence for 80 percent of adult smokers, increases the risk of morbidity and mortality through adulthood.  Underage drinking costs society $27 billion per year and delinquent behavior costs society $60 billion annually.  Behavioral health problems reflect and perpetuate social inequities.  Different social groups, characterized by gender, race, ethnicity, citizenship, sexual orientation, and class, experience dramatically different levels of behavioral health.  For example, almost 83 percent of the deaths of American Indians and Alaskan Natives are attributed to behavioral health problems.

A large body of scientific evidence over 30 years shows that behavioral health problems can be prevented.  Prior to 1980, few preventive interventions had been tested and virtually no effective preventive interventions had been identified.  Today, more than 50 programs have been found effective in controlled studies of interventions aimed at preventing behavioral health problems in children, adolescents, and young adults.  These can be categorized as: * Universal programs, which seek to reach all children and youth without regard to level of risk exposure.  * Selective programs, which focus on young people who have been exposed to elevated levels of risk, but who do not yet manifest behavioral health problems.  And, * Indicated programs, which focus on youth who evidence early symptoms of behavioral health problems.

The challenge is to "scale up," expanding these effective programs in order to achieve population-wide reductions in behavioral health problems.  To accomplish this critical objective it will be necessary to establish interdisciplinaryprograms and training in evidence-based prevention that involve the full complement of practice settings and, encouraging cross-sector collaboration across today's vertically organized ("siloed") agencies.  These efforts will help advance the movement in health care towards integrated primary care, which is a growing public health concern.  We possess the requisite knowledge.  What is needed is the creation of a comprehensive services architecture that provides population-based universal care, including prevention.  Behavioral health problems now surpass communicable diseases as the country's most pressing concerns for the well-being of our younger people.  Unleashing the power of prevention is a call to action that our nation can't afford to miss.

The Social Determinants of Health:  Transformative change is evolving.  At the Uniformed Services University of the Health Sciences (USUH), we recently attended several presentations by senior health policy leaders within the Department of Defense (DoD) and the Centers for Medicare and Medicaid Services (CMS) describing how the increasing use of information technology was allowing for the development of quantitative metrics to determine whether, in fact, the clinical services being rendered were effective, on both an individual and population basis.  The former U.S. Army Surgeon General Patricia Horoho has consistently emphasized "the importance of transforming Army Medicine from a healthcare system to a System for Health.  The patient healthcare encounter is an average interaction of 20 minutes, approximately five times a year.  Therefore, the average amount of time spent with each patient is 100 minutes; this represents a very small fraction of one's life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families and Retirees."

"Dr. Janet Heinrich, Senior Advisor at CMS's Center for Medicaid and Medicare Innovation (CMMI), described the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons which was not only insightful, but confirming.  She discussed the various grants and programs that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers.  CMMI is pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the 'social determinants of health' that place individuals at risk for specific diseases and serve to maintain symptomology" (Omni Cassidy, USUHS).

CMMI was established by President Obama' Patient Protection and Affordable Care Act (ACA).  Its underlying objective is to test innovative models to * reduce expenditures, while * preserving or enhancing the quality of care (i.e., the Triple Aim concept of former CMS Administrator Don Berwick -- Better care for individuals, Better care for populations, and Reduced costs).  Historically, our fee-for-service system has been provider-centered, provides incentives for volume, is unsustainable, and results in fragmented care.  The Administration's vision is patient-centered, providing incentives for outcomes, sustainable, and emphasizing coordinated, team based care.

As of January, 2015 HHS announced its goals for value-based payments within Medicare fee-for-service as having payments tied to quality or value through alternative payment models at 30 percent by the end of 2016 and 50 percent by the end of 2018.  And, fee-for-service payments tied to quality or value at 85 percent by the end of 2016 and 90 percent by the end of 2018.  Medicare growth has fallen below GDP (Gross Domestic Product) growth and national health expenditures since 2010, due, in part, to these efforts.  Currently 477 Accountable Care Organizations (ACOs) – another initiative established under the ACA to foster systems of organized care – have been established across the nation, with 121 new ACOs in 2016, which cover 8.9 million assigned beneficiaries.  Pioneer ACOs were designated for organizations with experience in coordinated care and ACO-like contracts.  These models demonstrated savings for three years in a row of $92, $96, and $120 million.  One concrete example, the Independence at Home demonstration project saved more than $3,000 per beneficiary, with the year one results producing more than $25 million in savings.  Currently there are 14 total practices, including one consortium, participating in this model, with approximately 8,400 patients enrolled in the first year.  All health care is local and CMMI has been working closely with the private insurance sector to transform our nation's health care system.  The underlying goal -- Better care, Smarter spending, and Healthier people, as measured by objective health metrics.  "I don't know when I'll be back again."

Pat DeLeon, former APA President – Division One – March, 2016

 

Sent from my iPhone

ALOHA - D55 column

THIS LAND IS YOUR LAND, THIS LAND IS MY LAND

            As the Administration and the private sector steadily implement provisions of President Obama’s Patient Protection and Affordable Care Act (ACA), its population-oriented public health perspective will, over time, significantly impact our nation’s health care practitioners of all disciplines.  At our Uniformed Services University of the Health Sciences (USUHS) health policy class, we strive to expose graduate students in psychology and nursing to the experiences of those who are actually shaping policy and their life-long journeys.  Not surprisingly, a number of common themes keep reoccurring, one of which is the importance of having a long-term vision, while being responsive to unanticipated challenges and opportunities.  Another is the extent to which health care “belongs to” no one discipline; instead, it is influenced by many complex factors, with the patient, not the provider, ultimately making any critical decisions.

“Dr. Janet Heinrich, Senior Advisor at the Center for Medicaid and Medicare Innovation (CMMI) of the Centers for Medicaid and Medicare Services (CMS), visited our policy course at USUHS.  The insights she provided about the mission of her organization to promote healthcare that is better and smarter, as well as healthcare that ultimately leads to healthier persons was not only insightful, but confirming.  At USUHS, the mission of our graduate, nursing, and medical programs is to improve the health of the nation.  In doing so, we are committed to developing healthcare systems and implementing practices that recognize and treat the person as a whole.  Our former U.S. Army Surgeon General Patricia Horoho emphasized ‘the importance of transforming Army Medicine from a healthcare system to a System for Health.  The patient healthcare encounter is an average interaction of 20 minutes, approximately five times a year.  Therefore, the average amount of time spent with each patient is 100 minutes; this represents a very small fraction of one’s life.  It is in between the appointments – in the Lifespace – where health really happens and where we desire a different relationship with Soldiers, Families and Retirees.’

            “Dr. Heinrich discussed the various grants and programs funded by her organization that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers.  One of the ways CMS is pursuing this goal (initiated by the ACA) is by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology.  Social determinants of health have been highlighted as key factors in recognizing and treating diseases that lead to the most deaths in our nation, such as cardiovascular disease, stroke, and diabetes.  In considering these, one is forced to recognize the person as a whole being – not one who sits in a vacuum, but as one who is affected by myriad socio-ecological factors, including race/ethnicity, socioeconomic status, and education.  Leading public health organizations, like the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), have recognized that treating the whole person means viewing said person as a product of where they ‘live, learn, work, and play’ and acknowledging such social factors as key influences of their health, and thus, their treatment.  CMS’s commitment to facilitating healthcare’s transition from being provider-centered to person-centered (i.e., recognizing social determinants of health) is exploring systematic means of treating the whole person – efforts that are crucial to our healthcare system becoming better, smarter, and leading to healthier lives.  Our speaker also made it clear that all healthcare is local.  CMMI’s collaborative efforts with private insurance payers foreshadows the magnitude of change providers will be experiencing, especially as the advances in information technology continue to shape healthcare delivery and provide objective measures of healthcare outcomes” (Omni Cassidy, USUHS).

            One of the most impressive examples of psychologists “making a real difference” in the lives of our nation’s active duty military personnel, their families, and our Veterans, has been the continual efforts of Barbara Van Dahlen, Founder and President of Give an Hour.  Indeed it was because of the work of Give an Hour – providing over 185,000 hours of free care to our military and Veteran communities – that Barbara was inspired to tackle the primary barrier to the delivery of mental health care in our nation, our culture.  With a small group of trusted colleagues, she developed and launched a collective impact effort aimed at changing the culture of mental health in America.  “Mental health concerns affect one in five Americans.  And yet, we continue to struggle with how to think about, talk about, and address the emotional well-being of our citizens.  Culture change happens more rapidly when high-profile champions and celebrities get involved in the conversation.  The Campaign to Change Direction has been fortunate to have several impressive champions adding their voices to this critical effort.  First Lady Michelle Obama was the first to take up this cause.  She spoke at the launch of the Campaign in March of 2015 and has frequently used her powerful voice to amplify the effort.

“Brian and Melinda Wilson – along with the director, writer, and actors from the film Love & Mercy about Brian’s life – joined the campaign last fall and have done much to help drop the movement into the cultural stream.  And Richard Gere recently agreed to share his perspective, and his image, for a PSA promoting the importance of recognizing the Five Signs of emotional suffering – the hallmark of the campaign – as a critical step in preventing homelessness.  We are honored by the support of all these champions.  Their time and their brands are in great demand, and they have chosen to lend both to help us change the culture of mental health.  They recognize the need for change, and they are willing to do their part to make it happen.  The most recent artist to add his voice to this effort is country music star and Grammy Award winner, Chris Stapleton, who just released a powerful music video, ‘Fire Away.’  His video will allow us to reach and engage a huge number of people – some we might not have been able to reach otherwise.  The video is artistically beautiful and emotionally painful.  Some who see ‘Fire Away’ will be reminded of their own struggles; some will most certainly be reminded of loved ones lost to suicide.  All will be touched [www.changedirection.org].”

            Those who are passionate about RxP should embrace the vision of Elaine Foster, one of the first USAF prescribing psychologists.  “After graduating from the DoD Psychopharmacology Demonstration Project (PDP) I served as a prescribing psychologist in the Air Force for over 20 years.  I continued to serve our active duty military after retiring, again as a prescribing psychologist under contract with the Air Force.  During that time, I prescribed for our veterans when we had space available at our military clinic….  If I walked across the hospital parking lot to our annexed VA clinic, I could no longer prescribe to that same patient I’d been prescribing to while he or she was active duty.  The current VA restrictions are illogical….  Because New Mexico recognizes prescribing psychologists, I can now prescribe to our veterans, but only in New Mexico and only through a third party contractor….  This just does not make sense.”

            Beth Rom-Rymer’s Illinois RxP trainees understand the importance of personal involvement.  “I was born in Chicago and I am a first generation American.  My parents immigrated from the former Soviet Union as teenagers.  My grandfather practiced biological psychiatry while my father, an American trained psychiatrist, embraced psychotherapy, in addition to treating patients with medication.  I became interested in psychology after taking a psychology-literature class in high school.  I would like to be able to offer my future patients a more comprehensive treatment by being able to prescribe medication, when necessary, and to offer psychotherapy.”

            It Seems Like Only Yesterday:  2016 marks the 25^th anniversary of The National Psychologist (TNP) newspaper which has become a staple for practitioners.  TNP was founded in 1991 by a wonderful person and former reporter, Henry Saeman, former Executive Director of the Ohio Psychological Association.  In its very first issue Henry wrote: “The National Psychologist will grant the opportunity for conflicting views, and will avoid serving as a mouthpiece for any individual or cause, realizing there are two or more sides to most stories, relying on experience and good sense to decide what constitutes news and information.  We will seek to flush out important issues affecting practitioners, and if articles contradict their convictions, readers will find a publication which is receptive, subject to space limitations, to present opposing, legitimate viewpoints with civility.”  In 1996, TNP was a first-place winner in a national editorial competition of the American Society of Business Press Editors.  This award was presented to Henry for the article he wrote, “Behavioral Health and the Managed Care Dilemma.”  Upon his death in 2003, his son, Marty, has been at the helm.  The circulation remains between 28-30,000 practicing psychologists nationwide.  Do subscribe to be current on the ever-evolving health care environment [www.nationalpsychologist.com].

            At this year’s impressive State Leadership Conference (SLC) Expanding the Practice Spectrum, Katherine Nordal urged those present to forge their own destiny.  “SLC is a major training ground for leadership and advocacy for students, Early Career Psychologists, and our diversity delegates.  You are our future leaders!”  “This land was made for you and me.”  Aloha,

Pat DeLeon, former APA President – Division 55 – March, 2016

 

IT IS NOT THE CRITIC WHO COUNTS

   This Spring's APAPO State Leadership Conference (SLC) –Expanding the Practice Spectrum -- was extraordinarily exciting, with Katherine Nordal urging those present to be actively engaged in shaping their own professional destiny.  Our nation's health care environment is undergoing unprecedented change, with increasing numbers of non-physician providers expanding their scopes of practice, reimbursement systems focusing upon outcomes rather than volume of services (i.e., "pay for performance"), and a growing societal appreciation of the social determinants of quality health care.  Patient-centered care, provided by interprofessional teams of providers, is the future.  The effective integration of behavioral health within primary care is rapidly becoming a major focus.  Right after SLC, APA President Susan McDaniel spoke with a group of 12 Senate Democrats including leadership on Mental Health Reform.  At the same meeting, political scientist/columnist and long-time Capitol Hill observer, Norm Ornstein spoke of the tragic death of his son with schizophrenia, along with other patient/family rights spokespersons.  Susan was the only mental health leader who addressed the importance of integrated primary care.

            Katherine: "Welcome to our 33^rd annual state leadership conference.  Over the years, SLC has become a wonderful melting pot of psychologists representing several generations, various work settings and cultural and ethnic backgrounds.  This year 30% of SLC attendees are Early Career Psychologists [ECP].  SLC is a major training ground for leadership and advocacy for students, ECPs, and our diversity delegates.  A number of folks in this room got their start at SLC as a diversity delegate, like June Ching, the current vice-chair of CAPP, was a diversity delegate and has since been a state association President, Division 42 President and an APA Council representative.  YOU are our future leaders!  And we trust that you will lend a hand to those coming behind you to help groom another cohort of psychology's leaders."

            "Just this Thursday, our physician definition bill was introduced in the U.S. Senate by Susan Collins from Maine and Sherrod Brown from Ohio.  This legislation will add psychologists to the Medicare definition of 'physician,' thereby allowing us to practice to the full extent of our licensure.  Psychologists are the only doctoral trained health care professionals not included in the physician definition, which does include chiropractors, podiatrists, optometrists, and dentists.  Increasingly, CMS is developing new mental health measures which can only be reported through a registry.  This year, there's another election that we really need to pay attention to.  One of our very own, Ted Strickland, is running for the United States Senate!  We have brilliant psychologists doing brilliant things, thinking outside of the box, and trying new and innovative ways to practice.  We are building a positive future for professional psychology."

One of the truly exciting challenges addressed at SLC is the advent of telehealth/ telepsychology.  Visionary Steve DeMers, ASPPB CEO, was successful in urging the APA Council of Representatives endorse, in principle, the Psychology Interjurisdictional Compact (PSYPACT) "to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries."  Clinical pharmacy has been in the forefront of this movement.  The School of Pharmacy at North Dakota State University:  "With more than 80 telepharmacy sites in the state, it is one of the largest (if not the largest) telepharmacy networks in the U.S., if not the world.  Thirty-six of North Dakota's 53 counties are designated by Health and Human Services as 'frontier counties' which is defined as less than six people per square mile.  So we are very rural and have a very large geographic area that is considered 'medically underserved' with many people having problems accessing even basic health care.  Telepharmacy has worked very well for us.  It has established or restored access to pharmacists and pharmacy services in areas of the state that had no services or had lost their services.  The North Dakota Board of Pharmacy established rules for telepharmacy practice which are now the standard of practice in delivering pharmacy services to remote rural communities.  Our research has demonstrated that the quality of services being delivered through telepharmacy vs traditional pharmacy services is the same including medication error rates.  All telepharmacy sites are receiving standard reimbursement for pharmacy services from third party payers and federal programs and all sites are still up and operational, not one has been lost, so our model has demonstrated that it is economically viable and sustainable.  Telepharmacy has increased the profit margins of pharmacists practicing in rural locations thus keeping our rural pharmacy businesses strong.  We have developed our telepharmacy services in both community and hospital settings.  We have developed a mobile wireless telepharmacy unit (R2D2 robot) for critical access hospitals that can provide 24 hour access to a pharmacist to any location in the hospital (emergency room, nursing station, patient bedside, pharmacy)" (Dean Charles Peterson, November, 2015).

Beth Rom-Rymer and Deborah Baker engaged 25-30 colleagues in a spirited discussion of the maturing RxP legislative agenda.  All eyes are currently on Hawaii and the inspirational process in Guam – thanks to the persistence of Judi Steinman and Lyndsey Miller.  In her travels, Beth continues to be inspired by her Illinois colleagues who are choosing to pursue prescriptive authority.  "I completed a two year fellowship in clinical health psychology in primary care, serving a Federally Qualified Health Center with mostly Hispanic migrant workers and their families.  I also served a growing Haitian community in this rural underserved city.  Throughout my rotations, I learned that there is a substantial need for psychiatric services and behavioral health services around the country.  As consultants, psychologists in primary care have a very important role.  With prescriptive authority, psychologists have tremendous potential to improve the quality and reach of behavioral health care services."  During SLC, David Ballard hosted the 11^th Annual Psychologically Healthy Workplace Awards ceremony.  This particular initiative, showcasing psychology and the business community, is very important; too many of our colleagues remain isolated within their own professional silos.

"Right after SLC, Dr. Janet Heinrich, Senior Advisor at CMS's Center for Medicaid and Medicare Innovation (CMMI), visited our health policy course at USUHS.  The insights she provided about the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons was not only insightful, but confirming.  She discussed the various grants and programs that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers.  They are pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the 'social determinants of health' that place individuals at risk for specific diseases and serve to maintain symptomology.  CMMI has been working in close collaboration with a number of the major private health insurers.  She emphasized that, without question, all health care is local" (Omni Cassidy, USUHS).

At SLC, HPA's new Executive Director, Ray Folen, quickly learned that finding the best table location is critical to success.  "Who spends himself in a worthy cause; … and who, at the worst, if he fails, at least fails while daring greatly" [Theodore Roosevelt; Spring, 1910].  Aloha,

 

Pat DeLeon, former APA President – HPA -- March, 2016

 

Sent from my iPhone

ALOHA - HPA

“IT IS NOT THE CRITIC WHO COUNTS”

            This Spring’s APAPO State Leadership Conference (SLC) –Expanding the Practice Spectrum -- was extraordinarily exciting, with Katherine Nordal urging those present to be actively engaged in shaping their own professional destiny.  Our nation’s health care environment is undergoing unprecedented change, with increasing numbers of non-physician providers expanding their scopes of practice, reimbursement systems focusing upon outcomes rather than volume of services (i.e., “pay for performance”), and a growing societal appreciation of the social determinants of quality health care.  Patient-centered care, provided by interprofessional teams of providers, is the future.  The effective integration of behavioral health within primary care is rapidly becoming a major focus.  Right after SLC, APA President Susan McDaniel spoke with a group of 12 Senate Democrats including leadership on Mental Health Reform.  At the same meeting, political scientist/columnist and long-time Capitol Hill observer, Norm Ornstein spoke of the tragic death of his son with schizophrenia, along with other patient/family rights spokespersons.  Susan was the only mental health leader who addressed the importance of integrated primary care.

            Katherine: “Welcome to our 33^rd annual state leadership conference.  Over the years, SLC has become a wonderful melting pot of psychologists representing several generations, various work settings and cultural and ethnic backgrounds.  This year 30% of SLC attendees are Early Career Psychologists [ECP].  SLC is a major training ground for leadership and advocacy for students, ECPs, and our diversity delegates.  A number of folks in this room got their start at SLC as a diversity delegate, like June Ching, the current vice-chair of CAPP, was a diversity delegate and has since been a state association President, Division 42 President and an APA Council representative.  YOU are our future leaders!  And we trust that you will lend a hand to those coming behind you to help groom another cohort of psychology’s leaders.”

            “Just this Thursday, our physician definition bill was introduced in the U.S. Senate by Susan Collins from Maine and Sherrod Brown from Ohio.  This legislation will add psychologists to the Medicare definition of ‘physician,’ thereby allowing us to practice to the full extent of our licensure.  Psychologists are the only doctoral trained health care professionals not included in the physician definition, which does include chiropractors, podiatrists, optometrists, and dentists.  Increasingly, CMS is developing new mental health measures which can only be reported through a registry.  This year, there’s another election that we really need to pay attention to.  One of our very own, Ted Strickland, is running for the United States Senate!  We have brilliant psychologists doing brilliant things, thinking outside of the box, and trying new and innovative ways to practice.  We are building a positive future for professional psychology.”

One of the truly exciting challenges addressed at SLC is the advent of telehealth/ telepsychology.  Visionary Steve DeMers, ASPPB CEO, was successful in urging the APA Council of Representatives endorse, in principle, the Psychology Interjurisdictional Compact (PSYPACT) “to facilitate telehealth and temporary face-to-face practice of psychology across jurisdictional boundaries.”  Clinical pharmacy has been in the forefront of this movement.  The School of Pharmacy at North Dakota State University:  “With more than 80 telepharmacy sites in the state, it is one of the largest (if not the largest) telepharmacy networks in the U.S., if not the world.  Thirty-six of North Dakota’s 53 counties are designated by Health and Human Services as ‘frontier counties’ which is defined as less than six people per square mile.  So we are very rural and have a very large geographic area that is considered ‘medically underserved’ with many people having problems accessing even basic health care.  Telepharmacy has worked very well for us.  It has established or restored access to pharmacists and pharmacy services in areas of the state that had no services or had lost their services.  The North Dakota Board of Pharmacy established rules for telepharmacy practice which are now the standard of practice in delivering pharmacy services to remote rural communities.  Our research has demonstrated that the quality of services being delivered through telepharmacy vs traditional pharmacy services is the same including medication error rates.  All telepharmacy sites are receiving standard reimbursement for pharmacy services from third party payers and federal programs and all sites are still up and operational, not one has been lost, so our model has demonstrated that it is economically viable and sustainable.  Telepharmacy has increased the profit margins of pharmacists practicing in rural locations thus keeping our rural pharmacy businesses strong.  We have developed our telepharmacy services in both community and hospital settings.  We have developed a mobile wireless telepharmacy unit (R2D2 robot) for critical access hospitals that can provide 24 hour access to a pharmacist to any location in the hospital (emergency room, nursing station, patient bedside, pharmacy)” (Dean Charles Peterson, November, 2015).

Beth Rom-Rymer and Deborah Baker engaged 25-30 colleagues in a spirited discussion of the maturing RxP legislative agenda.  All eyes are currently on Hawaii and the inspirational process in Guam – thanks to the persistence of Judi Steinman and Lyndsey Miller.  In her travels, Beth continues to be inspired by her Illinois colleagues who are choosing to pursue prescriptive authority.  “I completed a two year fellowship in clinical health psychology in primary care, serving a Federally Qualified Health Center with mostly Hispanic migrant workers and their families.  I also served a growing Haitian community in this rural underserved city.  Throughout my rotations, I learned that there is a substantial need for psychiatric services and behavioral health services around the country.  As consultants, psychologists in primary care have a very important role.  With prescriptive authority, psychologists have tremendous potential to improve the quality and reach of behavioral health care services.”  During SLC, David Ballard hosted the 11^th Annual Psychologically Healthy Workplace Awards ceremony.  This particular initiative, showcasing psychology and the business community, is very important; too many of our colleagues remain isolated within their own professional silos.

“Right after SLC, Dr. Janet Heinrich, Senior Advisor at CMS’s Center for Medicaid and Medicare Innovation (CMMI), visited our health policy course at USUHS.  The insights she provided about the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons was not only insightful, but confirming.  She discussed the various grants and programs that enable clinics across the country to implement infrastructures and technologies that are person-centered, sustainable, incentivize quality of care over quantity of services, and are coordinated across multiple disciplines and providers.  They are pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology.  CMMI has been working in close collaboration with a number of the major private health insurers.  She emphasized that, without question, all health care is local” (Omni Cassidy, USUHS).

At SLC, HPA’s new Executive Director, Ray Folen, quickly learned that finding the best table location is critical to success.  “Who spends himself in a worthy cause; … and who, at the worst, if he fails, at least fails while daring greatly” [Theodore Roosevelt; Spring, 1910].  Aloha,

 

Pat DeLeon, former APA President – HPA -- March, 2016

 

If one needed an incentive to become involved in one's State Psychological Association, the opportunity to attend the annual APAPO State Leadership Conference (SLC) would be paramount.  SLC has consistently been the highlight of the APA year and this Spring 400-500 dedicated colleagues heard inspirational messages from Executive Director Katherine Nordal and psychologists Congressman Tim Murphy and former Ohio Governor Ted Strickland.  Ted was the first psychologist elected to the U.S. House of Representatives and is currently running for the U.S. Senate.  Early Career Psychologists (ECP), first time attendees, and graduate students were visibly evident.  The "changing of the guard" is upon us.  A former Chair of APAGS announced his candidacy for the APA Presidency and the Division's Le Ondra Clark Harvey received an APA Presidential Citation from Susan McDaniel, highlighting her passionate commitment to mentoring ECPs engaging in important social justice agendas.  David Ballard hosted the 11^th Annual Psychologically Healthy Workplace Awards ceremony.  Special congratulations to our Ohio colleagues for their numerous accomplishments.

            It was particularly moving to see Interim CEO Cynthia Belar.  Cynthia is one of the profession's gifted visionaries who has long fostered the interaction of science and practice for the public interest, which is critical for psychology's future.  This year the Interprofessional Education Collaborative (IPEC) accepted nine new members, thereby expanding its representation of associations of schools of the health professions to 15 professions.  Established in 2009 by six organizations, IPEC is committed to advancing interprofessional learning experiences and promoting team-based care (a fundamental element of President Obama's Patient Protection and Affordable Care Act (ACA)).  The founding members include the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and the Association of Schools and Programs of Public Health.  The newest members are the APA and the training leadership of Podiatric Medicine, Physical Therapy, Occupational Therapy, Veterinary Medicine, Optometry, Allied Health, Social Work, and Physician Assistants.  IPEC's mission is to ensure that our nation's health care professionals become proficient in the competencies essential for patient-centered, community and population oriented, interprofessional, collaborative practice.  For psychology, this represents "integrated care."

            The SLC training sessions for the subsequent Hill visits stressed the critical nature of constituent presence.  Currently, 54 Senators and 36% of the House of Representatives have law degrees, with business backgrounds being very popular in the House.  We would suggest that each state association should seriously explore developing collaborative activities with their local Bar Associations, perhaps with their Family Law sections.  Katherine: "This year 30% of SLC attendees are Early Career Psychologists.  SLC is a major training ground for leadership and advocacy for students, ECP, and our diversity delegates.  YOU are our future leaders and we trust that you will lend a hand to those coming behind you to help groom another cohort of psychology's leaders.  We have brilliant psychologists doing brilliant things, thinking outside of the box, and trying new and innovative ways to practice.  We are building a positive future for professional psychology."  In keeping with this exciting evolution, Neal Morris, President of Division 55, noted that his convention program co-chairs, Joanna Sells and Omni Cassidy, are graduate students at USUHS.  Mahalo to Dan Abrahamson and Susan Lazaroff for their truly inspiring SLC.  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2016

 

Sent from my iPhone

ALOHA - Division 31 column

SUBSTANTIVE CHANGE IS IN THE AIR

            If one needed an incentive to become involved in one’s State Psychological Association, the opportunity to attend the annual APAPO State Leadership Conference (SLC) would be paramount.  SLC has consistently been the highlight of the APA year and this Spring 400-500 dedicated colleagues heard inspirational messages from Executive Director Katherine Nordal and psychologists Congressman Tim Murphy and former Ohio Governor Ted Strickland.  Ted was the first psychologist elected to the U.S. House of Representatives and is currently running for the U.S. Senate.  Early Career Psychologists (ECP), first time attendees, and graduate students were visibly evident.  The “changing of the guard” is upon us.  A former Chair of APAGS announced his candidacy for the APA Presidency and the Division’s Le Ondra Clark Harvey received an APA Presidential Citation from Susan McDaniel, highlighting her passionate commitment to mentoring ECPs engaging in important social justice agendas.  David Ballard hosted the 11^th Annual Psychologically Healthy Workplace Awards ceremony.  Special congratulations to our Ohio colleagues for their numerous accomplishments.

            It was particularly moving to see Interim CEO Cynthia Belar.  Cynthia is one of the profession’s gifted visionaries who has long fostered the interaction of science and practice for the public interest, which is critical for psychology’s future.  This year the Interprofessional Education Collaborative (IPEC) accepted nine new members, thereby expanding its representation of associations of schools of the health professions to 15 professions.  Established in 2009 by six organizations, IPEC is committed to advancing interprofessional learning experiences and promoting team-based care (a fundamental element of President Obama’s Patient Protection and Affordable Care Act (ACA)).  The founding members include the American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and the Association of Schools and Programs of Public Health.  The newest members are the APA and the training leadership of Podiatric Medicine, Physical Therapy, Occupational Therapy, Veterinary Medicine, Optometry, Allied Health, Social Work, and Physician Assistants.  IPEC’s mission is to ensure that our nation’s health care professionals become proficient in the competencies essential for patient-centered, community and population oriented, interprofessional, collaborative practice.  For psychology, this represents “integrated care.”

            The SLC training sessions for the subsequent Hill visits stressed the critical nature of constituent presence.  Currently, 54 Senators and 36% of the House of Representatives have law degrees, with business backgrounds being very popular in the House.  We would suggest that each state association should seriously explore developing collaborative activities with their local Bar Associations, perhaps with their Family Law sections.  Katherine: “This year 30% of SLC attendees are Early Career Psychologists.  SLC is a major training ground for leadership and advocacy for students, ECP, and our diversity delegates.  YOU are our future leaders and we trust that you will lend a hand to those coming behind you to help groom another cohort of psychology’s leaders.  We have brilliant psychologists doing brilliant things, thinking outside of the box, and trying new and innovative ways to practice.  We are building a positive future for professional psychology.”  In keeping with this exciting evolution, Neal Morris, President of Division 55, noted that his convention program co-chairs, Joanna Sells and Omni Cassidy, are graduate students at USUHS.  Mahalo to Dan Abrahamson and Susan Lazaroff for their truly inspiring SLC.  Aloha,

Pat DeLeon, former APA President – Division 31 – March, 2016