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WYPR News explores the future of mental healthcare and The Affordable Care Act.

The Magic Pill, Part 5: Having Insurance May Not Be Enough To Meet Your Mental Health Care Needs

Mary Rose Madden

This story is the fifth installment in a five-part series on mental health care. Click here for the entire series.

While the White House struggles with the Affordable Care Act’s Healthcare Exchange web site, many with psychiatric problems say the shortage of mental health professionals is their primary concern. 

When she was 22, Katia Crosby was diagnosed with bipolar disorder. She saw psychiatrists, therapists, and tried to manage her illness. Yet, she had a manic episode when she was 35.  The first thing she was asked was,  “Are you taking your meds?”  Yes she was, she says, but she knew they wouldn’t save her.   In fact, at times, she suffered because of them,  "I lost memory, I could not read a children’s book.  I could not draw a clock."  Crosby says she was crippled and paralyzed by the illness.   "The matrix of things that can go wrong, do go wrong every day".  Crosby was caught in the matrix of finding treatment and medication, paying for it - and often fighting for it.

Steven Sharfstein – president and CEO of Sheppard Pratt in Towson, says an overall shortage of psychiatrists, combined with a shortage of those who take insurance, creates a public health problem.  “There are a lot of people who suffer in our society who don’t get care. It’s a tragedy that the country’s three largest psychiatric institutions are Rikers Island, the Cook County Jail and the Los Angeles County Jail."  Sharfstein says someone needs to “bring the stick” to solve the shortage problem.

Sharfstein’s son, Joshua Sharfstein, state secretary of  Health and Mental Hygiene, is trying to do just that by addressing the “adequacy” of insurance networks; that is, are there enough providers to meet mental health needs,  "if a patient can't find a doctor, that's an adequacy issue.   And we’re going to do more than ever to fix it".   Sharfstein also chairs the board of the Maryland Health Exchange and it’s in that role that he’ll try to get a handle on the problem by determining how many providers are in the exchange and how many the insurance networks need.  He says it's still a little unknown how they'll measure "network adeqaucy" to see if the exchange's networks meet the board's standards, but they'll be seeking consumers' complaints and conducting surveys through various organizations to understand the situation. 

After that, he says, "the exchange could require corrective action or tell them they can’t be on the exchange anymore".  He says that could benefit all Marylanders.  "On the private sector, they don’t do a lot – and I think they’re going to have to do more".  In the public sector in Maryland, Sharfstein’s department raised Medicaid reimbursement rates for psychiatrists by 20 percent last July.

That raise is good news for Jesse Fask, a clinical social worker who works primarily with children whose families are on Medicaid.  He says it's very hard to find child psychiatrists who will take Medicaid, but he tries to work with their primary care physicians.  He runs into problems, though, adding "if they need something more complicated, it’s very hard.  A lot of these kids need psychiatric medication and it’s hard to find".  Fask says sometimes, he calls the hospitals and they will do it.  

Raising reimbursement rates may help attract more psychiatrists.  It’s a step in the right direction, says Steven Sharfstein.  But the overall cost for the private insurance system to adequately care for the all the people on its network is going to be very high, he says.  "We need to be focused on making this work right now.  The step after this – make sure what we do works - that we are able to show value-based treatment.  I believe the fee for service system is going to change.  It’s too costly.  There will be more bundling of payments".  

That’s exactly what Peter Beilenson, the president and CEO of Evergreen Healthcare Cooperative, is trying to do.     In one of their two different healthcare plans offered on the exchange, they do not use the fee for service model.  That means rather than worry about reimbursements, they offer their behavioral health professionals flat salaries.   It’s a more "innovative approach," the co-op says.   And they’ve not had a problem attracting the providers.  That’s not necessarily the magic pill, but, he adds, but it’s a start