5/18/2013 • Mental health professionals love to process, but few of them love to “organize” INDEPENDENT PRACTICE American Mental Health Alliance • We have to talk about organization . INTEGRATED CARE (AMHA-USA) 1995 • Organization is essential for the AMHA-Oregon – Portland Metro Area – formed 1996 Creating a high performance independent challenges we mental health practice network capable of face! providing a practice-research level of care Central Oregon – AMHA-USA members forming COMPHA and quality Central Oregon Mental Health Professionals Alliance AMHA-USA Introductions • AMHA-USA is a national mutual-benefit corporation; • Michael Conner, Psy.D. INDEPENDENT PRACTICE designed as a structure for local multi-disciplinary groups • Michaele Dunlap, Psy.D. INTEGRATED CARE of mental health professionals. • David Johnson, LCSW • Martha Blake, , MBA, NCPsyA Creating a high performance independent • Initially the intent was to build chapters state by state, but • Christine Glenn, Ph.D. mental health practice network capable of our experience since 1995 has taught us that more providing a practice-research level of care localized groups can serve AMHA values more effectively. and quality 1
5/18/2013 We’re saving trees today Schedule • Glossary -- FYI You will leave here understanding more • Directory -- FYI about health care reform and its impact on Information and Background to 9:30 • Tablets – FYI mental health practice – now and in the near 9:30 – 10:45 Dave Johnson presents - health care reform • Powerpoint slides, numerous articles, Glossary with live overview future. links, the FAQ’s and Ostrich Questions will all be available 10:45 break after 5/31 on line at You will leave here understanding a model 11:00 -12:00 Mike Crew, JD discusses legal questions www.AMHA-OR.org concerning the structure of Independent for collaboration and integration of care that Click: Professional Training Practice Associations. meets and exceeds the intent of the 12:00 – 1:00 Lunch, downstairs in the Community room. Affordable Care Act. Schedule AMHA-USA AMHA-OR 1:00 – 3:00 Conner will present the Connecting Care/ IPIC • Has been an active and stable Chapter of USA since its model. Johnson and discussants will provide incorporation in 1996 – descriptions of its many activities AMHA’s mission is to develop local groups of mental health additional perspectives. and benefits can be found in the pages of a recent Therapists Directory (the 22 nd AMHA-OR has published) professionals that are mutually supportive, that share education and research activities and clinical consultation; • The Board of AMHA-OR voted in 2012 to support AMHA- 3:00-3:15 Break groups that facilitate appropriate clinical referrals, and that USA in its intent to create new chapters in Oregon to meet support the mental health of their communities with focus the challenges on healthcare reform. 3:15-4:30 Presentation Continues. on ethical concerns including client choice and privacy. • All AMHA-OR members are members of AMHA-USA Review of questions – opportunities. • AMHA-OR is moving toward revised by-laws which will allow accommodation to health care reform, IPA contracting. 2
5/18/2013 AMHA-USA AMHA-USA AMHA-USA currently supports development of a Central AMHA-USA currently supports development of a Central Oregon Independent Practitioners Alliance by: Oregon Independent Practitioners Alliance by: Is willing to support development of other Oregon • Allowing individual practitioners to join at a low initial • Providing initial funding for the creation of IPA Bylaws and Chapters … where ever there are groups of mental annual fee, in order to begin pilot projects that concomitant attorney consultation. health professionals who want to come together in demonstrate and refine Connecting Care protocols. • Providing an electronic structure which allows simple and support of one another and subscribe to the • Negotiating discounts for the EMR, (billing, measurement continuous credentialing of local group/chapter members. Principles of AMHA and clinical data management systems) the group will need to gain and serve accountable care contracts. BUT WAIT!! AMHA-USA Supports These Principles: • People have the right to choose their own therapists. We hope to help you adapt to • We’re getting ahead of the story! • Psychotherapy is a collaborative process between • Many mental health professionals do not want to deal with Healthcare reform therapist and client in service of the client. the looming changes in health care. • Therapists shall preserve client confidentiality. • Many mental health professionals barely recognize the challenges to their current expectations for being in • Mental health professionals shall create an It is not our objective to scare you practice. interdisciplinary community that promotes and supports competent and ethical practice. OR to tell you what you must do. 3
5/18/2013 The Affordable Care Act is a Federal law that demands significant changes in the delivery of health care services across the board. Up until now, “a usual and customary Beginning in 2013 the “fee for service” model has begun Beginning in 2013 the “fee for service” model has begun fee” was tied to a particular procedure. Qualified providers moving toward extinction. Oregon is the lead state for the moving toward extinction. Oregon is the lead state for the submitted claims for services rendered and payment was implementation of the Affordable Care Act. Governor implementation of the Affordable Care Act. Governor made according to a contracted payment schedule. Kitzhaber successfully petitioned the Federal government Kitzhaber successfully petitioned the Federal government that Oregon be a test case for initiating Accountable Care, that Oregon be a test case for initiating Accountable Care, in exchange for an infusion of money to cover the in exchange for an infusion of money to cover the shortages in the Oregon Health Plan and even more shortages in the Oregon Health Plan and even more money to be the beta test for accountable health care. money to be the beta test for accountable health care. Haven’t we been through this before with Are we Toast? Managed Care? The old way of insulated-isolated-private practice will be What can be done to help us stay in private practice extinct within the next few years as the Affordable Care Act Managed care was not based on Federal Law. Managed and continue to bill insurance companies for our expands from the Oregon Health Plan to Medicare and Care was instituted by insurance companies as an attempt services? then to private insurance. It is almost certain that to control costs within the fee for service model. Managed insurance companies will contract with groups of providers care went out of favor largely because it restricted care and rather than individuals. They will need to do this in order to did not produce the anticipated savings and resulted in ensure that they have a pool of qualified providers who can numerous, significant law suits. deliver quality/measurable services along with the necessary infrastructure to support accountable care. 4
5/18/2013 There are alternatives There are alternatives IPAs, Independent Mental Health Practitioner Associations are an excellent course of action because they can give us the ability to negotiate contracts and fee structures. Since an individual practitioner cannot do this, a group, organized to meet the Your practice can be all private pay professional and legal requirements, is AMHA membership necessary to fulfill this function. can help you with that too. What I will talk about Individual (solo) practice Structural and Functional • The resistance and personal challenges when adapting to • Payers want to contract with groups Model for Healthcare healthcare reform • Groups will be paid more • Individual vs Group vs Organizational issues Reform • Out of network will still be required to use technology • What is Healthcare Reform to us • Functional group or organizational model Mike Conner • The technology requirements 5
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