See the article below from The National Psychologist, May/June 2012,
Pages 1 & 3.
BCBS of Florida takes dangerous 'New Directions'
"Double, double toil and trouble; Fire burn, and caldron bubble."
– Macbeth by William Shakespeare
By Stephen A. Ragusea, Psy.D, ABPP
In the latter half of 2011, psychologists in Florida detected the
scent of an unholy witches' brew wafting out of Jacksonville. The
malodorous signs were obvious. First there were rumors of a carve-out
for mental health services. Then the letters started.
First, each participating mental health provider for Blue Cross
Blue Shield of Florida (BCBSF) received an odd letter in the mail,
announcing that all providers were to have their contracts terminated
in 90 days because "BCBSF has partnered with New Directions for the
management of all aspects of behavioral health services including
provider network contracting…. You will receive an application from
New Directions for network participation."
Oddly enough, BCBSF put the burden of patient notification on the
doctors. "Please notify your patients…that you will not be a
participating provider as of Jan. 1, 2012."
Of course, we all immediately went on the web to investigate this
New Directions outfit and discovered that it was a small managed care
company in Kansas run by a psychologist I'd met briefly some years
earlier. I vividly remembered him talking about how a community with
68 active psychologists only really needed 12 and he coolly described
to me how he would go into such a community, take over mental health
services and then slash the panel to reduce utilization and increase
profits.
It was a chilling conversation that I often recounted to others
over the years as an example of the underlying profit motive behind
the managed care industry. Little did I know this guy would ultimately
be implementing his strategy in my own state.
Soon, providers received another letter from New Directions laden
with distasteful and mysterious ingredients. The letter and
accompanying complex contract was approximately 20 pages long and
requested a response "within 15 days" although the letter itself was
undated. Included was a new reimbursement rate schedule that reduced
existing BCBSF rates, already discounted by 30 percent to 50 percent
below Medicare's reimbursement levels.
There were also a variety of surprising elements that seemed to be
illegal, unethical and/or inappropriate. The Florida Psychological
Association (FPA) formally sought the assistance of the Florida Office
of Insurance Regulation. They intervened and, soon thereafter, New
Direction revised the contracts and made a new mailing to pro-viders,
but there were still many problems.
We learned that BCBSF had actually become a co-owner of New
Directions and, therefore, this carve-out was more like a modified
carve-in. We also learned that BCBSF was beginning to partner with
other states to spread this new version of the gospel of mental health
cost containment.
Individual psychologists began reporting inconsistent information
received from New Directions and BCBSF. Confusing and disturbing
misinformation was also apparently being given to patients increasing
stress and interfering with good treatment. The FPA and the APAPO
contacted a variety of regulatory agencies and elected officials;
expressing great concern about the new direction mental health
coverage had taken in Florida.
On Aug. 25, 2011, the Parity Implemen-tation Coalition
(http://parityispersonal.org/) wrote a letter to three federal
departments: Health and Human Services, Labor and the Treasury.
Why was the Parity Implementation Coalition involved? Why would an
organization "formed to help ensure that the Mental Health Parity and
Addiction Equality Act of 2008…is properly enforced" be interested in
Florida's little problem? I don't know for sure, but I'm guessing that
they think the same way I do about this mess.
I think that this move by BCBSF is really the initiation of a
national movement to circumvent the Mental Health Parity legislation
we all worked decades to pass. I think that by reducing reimbursement
rates to levels lower than the hourly rate plumbers, auto body shops
workers and electricians charge, BCBSF hopes to drive doctors out of
its panel, making it much more difficult or impossible for patients to
find doctors willing to accept BCBSF health insurance.
Obviously, that process cuts utilization, drives costs down and
pushes profits up. That undermines the intent of the 2008 parity
legislation, making it more difficult for patients to get expert
treatment.
Although Florida happens to be the state where the model is being
given a trial run, it appears that this unholy witches' brew is
destined to be served nationally. That makes this assault on mental
health care terribly important and that's why so many organizations
are working hard to challenge this initiative.
The APAPO, the American Psychiatric Association, the National
Alliance for the Mentally Ill, and the FPA have all been working
cooperatively to bring the facts to the attention of regulatory
agencies who should take action. They should block this destructive
maneuver destined to set back the treatment of mental health problems
in America by decades. What can you do to help?
First, be aware of what's going on and tell others. Second, join
your state's psychological association and pay the APAPO assessment so
that we can add more power to our own brew to break the spell cast by
managed care. Third, contact your legislators and let them know about
this plot to subvert legislative intent and to assault the rights of
patients and the professionals who work so hard to serve them.
Throw these good ingredients into the pot and help neutralize the
witches' corrupt cauldron concoction. The fire is burning and the mix
is bubbling.
Your support is badly needed. Our professional futures and the
futures of our patients may depend on it.
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Stephen A. Ragusea, Psy.D., ABPP, is in private practice in Key West, Fla.
