1. Health Care Reform 2014: Implications for Professional Practice
Dan Abrahamson, PhD
Assistant Executive Director
Kansas Psychological Association
April 5, 2014
Wichita, KS
Slide 1—Title Slide
WITH THE SUPREME COURT DECISION IN THE SUMMER OF 2012 AND THE RE-ELECTION OF PRESIDENT OBAMA, THE ACA HAS SURVIVED AND IMPLEMENTATION OF THE LARGEST EXPANSION OF THE HEALTHCARE SAFETY NET IS PROCEEDING. STATES WHICH HELD OFF DECISIONS ARE NOW MOVING FORWARD (OR NOT) WITH MEDICAID EXPANSION, PARTICIPATION IN CMMI DEMONSTRATION PROJECTS, AND DEVELOPMENT OF HEALTH INSURANCE EXCHANGES WITH DEFINED BENCHMARK PLANS. CONGRESS MUST ALSO ADDRESS THE SGR PROBLEM AND A SIZEABLE PACKAGE OF MEDICARE EXTENDERS.
THERE WILL BE WINNERS AND LOSERS, SO TO SPEAK, AS HEALTHCARE REFORM PLAY OUT. RIGHT NOW IT APPEARS SOME OF THE “WINNERS” ARE SOCIAL SECURITY, MEDICAID, SCHIP, AND MEDICARE BENEFITS. “LOSERS” INCLUDE MEDICARE PAYMENTS TO PROVIDERS AND HOSPITAL OP PROGRAMS, GME, PREVENTION FUNDS, NIH, AND FDA. WE ARE GOING TO ADDRESS THE IMPLICATIONS OF HCR FOR PRACTICING NEUROPSYCHOLOGISTS AND HOPE THAT SOME OF WHAT WE PROVIDE THIS MORNING WILL HELP YOU TO HAVE STRONG AND THRIVING PRACTICES.

2. Compelling Need for U.S. Health Care Reform
About 50 million uninsured Americans
Annual health expenditures of over $2.7 T
Health costs comprise about 17% of GNP
Fragmented system with variable quality
Increased life expectancy but often with
chronic illnesses

3. The Economic Context for Reform
2010 Healthcare expenditure = $2.7T
Healthcare is single largest contributor to national debt: Medicare = 15%; Medicaid = 8%; Social Security = 20%; Defense = 20%
All Health Expenditures, 2009:
51% (34% Ins. & 13% out of pocket)
49% 37%, 22%, 16%)
By 2020, Fed. Govt. will pay 49% of all health
State budgets in worst shape since WWII

4. Economic Context: Mental Health
Largest purchaser of MH/SUD services is the government!
Mental Health Spending, 2009:
Private insurance, 26%; Out-of-pocket, 11%; Charity, 3%
Public funding, 60%
Medicare, 13%
Medicaid, 27%
Other federal, 5%
Other state/local, 15%

5. Economic Context : Mental Health
Mental Health Spending Trends
1986 = 7.3% of all health spending
2003 = 6% of all health spending
2009 = 6.3% of all health spending
2014 = 5.9% of all health spending
Spending by provider class:
Psychiatrists = 6% of all mental health $$
Non-psychiatric physicians = 5%
Psychologists/SW/Cs = 5% or 0.315% of total mental health $$; psychologists only 16% of this provider group
Hospitals = 26%
Specialty MH/SUD = 30%
Insurance Administration = 7%

6. Mental Health: Shifts in Spending
Distribution of Mental Health Expenditures by Type of Service, 1986 and 2005
$32 Billion
$113 Billion 7%
Prescription Drugs
33%
Outpatient
19%
Inpatient
Source: Substance Abuse and Mental Health Services Administration. (2011). National Expenditures for Mental Health Services & Substance Abuse Treatment Washington, DC. As cited in Kaiser Commission on Medicaid and the Uninsured. (April 2011). Mental Health Financing in the United States: A Primer. Washington, DC.

7. Economic Context: RxP and Mental Health
RxP: 50% of increased MH spending
RxP: 3X growth rate as other services
RxP: 28% of all MH spending in 2009
New drugs/new generics/patents expiring
Fewer side effects
More PCPs comfortable with prescribing
66% spent on antidepressants and antipsychotics
14% spent on ADHD medications

8. Treatment Settings for Behavioral Health Care
Types of Mental Health Services Used in Past Year, Among Adults Receiving Treatment, 2009
Source: Kaiser Commission on Medicaid and the Uninsured. (April 2011). Mental Health Financing in the United States: A Primer. Washington, DC.

9. Economic Context for Reform: Chronic Illness
Healthcare costs in 2009:
1% population = 21.8% of costs
10% population = 63.6% of costs
50% of population = only 2.9% of costs
Medicare spending:
5% beneficiaries = 43% costs
25% beneficiaries = 85% costs
50% beneficiaries have >5 chronic illnesses
Medicaid spending:
15% are disabled and = 43% of costs
10% are elderly and = 23% of costs
Summary: 25% of population = 66% of costs

10. Patient Protection and Affordable Care Act of 2010
Culmination of a 100-year effort that challenged five former presidents
Comparable with passage of the Social Security Act in 1935 and Medicare in 1965
Almost on par with Civil Rights legislation in the 1950s and 1960s

11. Controversial Aspects of Health Care Reform
Cost estimate of $180 billion over 10 years (Congressional Budget Office, 2012, prior to Supreme Court ruling)
Individual mandate to purchase health insurance or pay a penalty upheld by Supreme Court ruling, June 2012
Medicaid expansion by states funded mostly by federal government with threatened loss of current funding for noncompliance. Loss of current funding not upheld by Supreme Court

12. Key Challenges Facing Health Care Reform

13. Overall Goals of Health Care Reform
To preserve employer-based health insurance
To expand coverage to 32 million more Americans (Medicaid, Insurance Exchanges)
To improve quality of care by addressing the needs of the whole patient through:
Preventive Services
Primary and Integrated Care
Reduce growth rate of healthcare costs
TRIPLE AIM: 1. ENHANCED PATIENT EXPERIENCE; 2. IMPROVED OUTCOMES; 3. BEND THE COST CURVE

14. ACA Expands Eligibility & Coverage
Medicaid expansion covers persons up to 133% of FPL by 2014 (adds 16-22M)
Health Insurance Exchanges (up to 400% of FPL)
Essential Health Benefits with parity for Medicare Advantage, Medicaid Managed Care, CHIP, and Benchmark Plans
Preventive Care and Wellness
THERE IS MUCH WORK TO DO AT THE STATE LEVEL. THE MEDICAID EXPANSION IS OPTIONAL AND VIEWED BY MANY GOVERNORS AS A HUGE FISCAL CHALLENGE DESPITE 100% FEDERAL FINANCING OF THE EXPANSION IN THE FIRST COUPLE OF YEARS.
HEALTH INSURANCE EXCHANGES: ONLY 17 STATES AND DC HAVE PLANS; 6 STATES ARE PLANNING AND MAY COLLABORATE WITH THE FEDS WITH THEIR BLUEPRINTS DUE NOVEMBER 16, 2013 OR THE FEDS WILL CREATE, ADMINISTER, AND REGULATE.

15. Insurance Market Reforms in Affordable Care Act
No lifetime or annual dollar limits
No rescissions of coverage except for fraud
Coverage of pre-existing conditions
Guaranteed coverage acceptance and renewal
Requirement of effective appeals process
Establishment of premium rating requirements
Prohibition of participant and provider discrimination
State consumer assistance offices
GREAT NEWS FOR CONSUMERS

16. ACA Impacts Care Delivery
Accountable Care Organizations (ACOs)composed of integrated provider networks with:
shared electronic records
evidence-based practice protocols
outcomes measurement
performance incentives
Patient-Centered Medical Homes (PCMH) will have features similar to ACOs
Home and Community Based Services Options

17. Why Focus on Integrated Care?
Aspects of overall health are missed by sole focus on physical or mental health
Behavioral factors are leading causes of chronic illness and mortality
Chronic illness accounts for 75% of nation’s health spending

18. Why Focus on Integrated Care?
Percentage of Adults with Mental Health Conditions and/or Medical Conditions,
Adults with Mental
Health Conditions
29% of Adults with Medical Conditions Also Have Mental Health Conditions
68% of Adults with Mental Health Conditions Also Have Medical Conditions
Adults with Medical Conditions
Source: Druss, B.G., and Walker, E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: The Robert Wood Johnson Foundation.

19. Prevalence of Behavioral Health Conditions in US
Percent of US Adults Meeting Diagnostic Behavioral Health Criteria, 2007
Source: Kaiser Commission on Medicaid and the Uninsured. (April 2011). Mental Health Financing in the United States: A Primer. Washington, DC.

20. Comorbidities Compound Costs
Monthly Health Care Expenditures per Person for Chronic Conditions, with and without Comorbid Depression, 2005
Source: Melek, S., and Norris, D. (2008). Chronic Conditions and Comorbid Psychological Disorders. Cited in: Druss, B. G., and Walker., E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: The Robert Wood Johnson Foundation.

21. Interaction Between Medical Disorders and Mental Illness
Model of the Interaction Between Medical Disorders and Mental Illness
Chronic Medical Disorders
RISK FACTORS
Childhood Adversity
Loss
Abuse and Neglect
Household Dysfunction
Adverse Health Behaviors and Outcomes
Obesity
Sedentary Lifestyle
Smoking
Self care
Symptom Burden
Disability
Quality of Life
Stress
Adverse life events
Chronic stressors
SES
Poverty
Neighborhood
Social Support
Isolation
Mental Disorders
Source: Druss, B. G., and Walker., E.R. (February 2011). Mental Disorders and Medical Comorbidity. Research Synthesis Report No. 21. Princeton, NJ: The Robert Wood Johnson Foundation.

22. Why Focus on Integrated Care?
At least half of mental health treatment is provided in primary care
High co-existence of physical disorders and behavioral health problems
Adults with SMI in public sector die younger ( by 25 years)due to untreated physical health problems

23. Psychology’s Contributions to Integrated Care
Conducting thorough psychological assessments
Treating more complex, complicated patients
Applying behavioral principles to modify health-risk factors
Promoting patient responsibility and resilience
Attending to interpersonal barriers to behavior change
Understanding environmental determinants of behavior, including impact of families and systems

24. Psychology’s Contributions to Integrated Care
Supervision of M.A. level therapists, case managers
Development of programs designed to provide population-based care
Designing, monitoring, and evaluating interventions
Program administration
Enhancing health team and organizational development

25. ACA Impacts Payment and Performance
Move will be away from Fee-for-Service
Global, bundled, episode payments
Pay for Performance
Higher rates for PCPs
Medicare Shared Savings & other model
FQHC investment of $11B
Quality Measures (11 of 51 are behavioral health)

26. The Healthcare Environment
Declining reimbursements
Increased/incessant demands for cost containment
Increased cost of doing business (rent, labor, equipment, insurance, etc.)
Increasing “competition” in psychotherapy marketplace
Growing regulatory demands (billing, privacy, confidentiality, patient consent, F-W-A, EHR, retirement planning, occupational safety, etc.)
Lack of negotiation leverage
And ever escalating healthcare costs!
AND ALL OF THIS “REFORM” ACTIVITY IS SUPERIMPOSED ON A HEALTHCARE ENVIRONMENTT WHICH HAS ALSO CHANGED DRAMATICALLY SINCE THE 1980’S!

27. Evolving Healthcare Landscape
Increased regulation of price and volume of psychological services by public/private payers
Rapid and large-scale consolidation of health insurance market leading to more payer power: providers have lower reimbursement and less autonomy and consumers have higher premiums
Professional, market, and regulatory developments encouraging more collaborative care practices
Emergence of new reimbursement mechanisms to replace FFS: P4P, Global payments, Episode of care payments, Shared Savings

28. Evolving Healthcare Landscape
Federal/State policies pushing integration:
Quality payment programs with incentives to meet certain quality standards
Health Information Technology (HIT): cost and ability to meet “meaningful use” criteria to be eligible for incentives
Anti-trust Enforcement Policy: allows integrated provider organizations to negotiate with plans re: payment rates but groups without integration (financial and clinical) are prohibited from such negotiation

29. Reasons to Integrate
Aggregate capital to finance, develop, implement and maintain infrastructure (HIT & data reporting systems) necessary to collect, track, and report quality information required for performance-based reimbursement mechanisms
Develop collaborative care systems necessary to achieve real quality improvement in patient care
Insurers, employers, consumers demanding data on provider performance: adherence to quality outcome and process measurement, patient satisfaction, cost of care

30. Reasons to Integrate
Allows ability to collect your own monitoring and evaluation data that may be needed to correct inaccuracies in tiering or designations imposed on your practice by payers
Share risk as needed in capitated contracts where there will be high-cost patients
Negotiating efficiencies with TPAs by sharing a manager who can analyze and negotiate contracts
Larger integrated groups may be favored by payers due to geographic coverage, mix of services, etc.
#1 reason: Market a valuable/competitive product that you cannot produce acting independently

31. Implications for Professional Practice
New care delivery models/systems: PCMHs, ACOs
New skills and training models for integrated, inter- professional team-based care
Implementing advances in telehealth, HIT, and electronic health records
Increasing demand for the use of EBPs (Evidence-based practices) and quality measures
Payment reforms: P4P, Global payments, Bundled payments, Shared-savings models
WITH HEADLINES ABOUT INTEGRATION, HOSPITAL EMPLOYMENT, ACOs. ETC., PSYCHOLOGISTS WHOSE PRACTICE STRUCTURE IS AN “N” OF 1 OR VERY SMALL GROUP ARE UNDERSTANDABLY ANXIOUS ABOUT HOW THEY MIGHT NOT ONLY SURVIVE, BUT SUCCEED GIVEN THE CHANGES THAT LIE AHEAD.
TO BE SURE, HEALTHCARE ECONOMICS GENERALLY AND THE IMPLEMENTATION OF SOME PROVISIONS OF THE ACA HAVE FUELED EFFORTS TO CREATE LARGER HEALTHCARE SYSTEMS WHOSE MISSION IS TO DELIVER QUALITY CARE AT AN AFFORDABLE COST. AND THESE EFFORTS WILL CONTINUE.
WHILE THESE SYSTEMS ARE NOT THE ANSWER FOR EVERY PSYCHOLOGIST OR EVERY PATIENT, THAT DOES NOT MEAN THAT YOU MAY NOT NEED TO CHANGE THE WAY YOU ORGANIZE YOUR PRACTICE.

32. Primary Work Setting of APA Practicing Psychologists
Slide 8 – Survey Highlights: Primary Work Setting
Independent solo
practice
Institution-based
Practice
Independent
Group practice
Academic: teaching and/or research
Other
THESE DATA COME FROM A 2011 SURVEY OF PRACTICE ASSESSMENT PAYERS AND ARE FAIRLY SIMILAR TO WHAT WE KNOW ABOUT MEDICAL PRACTICES. FROM , 41% OF MEDICAL PRACTICES HAD 2 OR LESS PHYSICIANS AND 62% OF MDs OWNED AN INTEREST IN THEIR PRACTICES. BY 2008, HOWEVER, % OF THOSE SMALL PRACTICES DROPPED TO 32% AND 60,000 MDs WERE EMPLOYED BY HOSPITALS (2X THE NUMBER IN 2001) AND 22% OF MEDICAL RESIDENTS SAID THEY EXPECTED TO BE EMPLOYED BY HOSPITALS.

33. APA’s Health Care Reform Team
Staff Working Group:
CEO, Deputy CEO, and Senior Policy Advisor
Government Relations Offices: Practice, Public Interest, Education, and Science
Public & Member Communications Office
Involvement of APA Leadership and Members, as well as other organizations
Collaboration with the APA Practice Organization (APAPO) – APA’s affiliated 501(c)(6) entity that works to advance the interests of practitioners

34. The APA Center for
Psychology and Health

35. APA Center for Psychology and Health Organizational Chart
Ellen Garrison, PhD
Coordinator
APA Practice Health Care Team
State Implementation Advisory Group
Collaborating Units*
Health Leadership Team
Working Group
of APA Member Primary Care Experts
(TBD)
Director of
Integrated Health Care (TBD)
Assistant Coordinator
Health Team
Norman Anderson, PhD
Director
Randy Phelps, PhD
Office of Health Care Financing
*The APA Practice Health Care Team and the State Implementation Advisory Group are combined
APA Practice Directorate (c3) and APA Practice Organization (c6) activities.
*The APA Practice Health Care Team and the State Implementation Advisory Group are combined
APA Practice Directorate (c3) and APA Practice Organization (c6) activities.

36. APAPO is dedicated to serving the
APAPO Mission
The mission of the APAPO is to advance, protect and defend the professional practice of psychology.
APAPO is dedicated to serving the
interests and needs of its members: APA members who pay the annual Practice Assessment to APAPO.
Consistent with our bylaws, the mission of the APAPO is to advance, protect and defend the professional practice of psychology. APA members who pay the annual Practice Assessment to APAPO are members of the APA Practice Organization. We are dedicated to serving the professional interests and needs of members in all practice settings and at all stages of their career.
The APA Practice Organization Committee for the Advancement of Professional Practice is currently involved with updating the mission statement for the c(6) Organization.

37. 501(c)(6) Business/Trade Association
As a 501(c)(6) organization, APAPO can:
Focus on advancing a particular trade – professional psychology
Engage in unrestricted lobbying
Work with a political action committee to facilitate political giving
The next few slides about the purpose, governance and organization of the APAPO may be especially informative for those of you who are new to Council this year.
APA is considered a 501(c)(3) organization under Internal Revenue Service rules, while APAPO is a 501(c)(6) organization.
A 501(c)(6) organization focuses on advancing a particular trade such as professional psychology, while a 501(c) (3) organization serves the public benefit.
There are other basic differences. For example, compared to a 501(c)(3), a 501(c)(6) organization like the APA Practice Organization can engage in unrestricted lobbying and may work with political action committees to facilitate political giving.

38. Legislative Advocacy Top Priorities for 2014
Medicare and Medicaid reimbursement
“Physician” definition in Medicare
HITECH incentive payments for electronic health records
One of the APA Practice Organization’s major functions is legislative advocacy. Many of our legislative goals in the APA Practice Organization relate to opening up access to psychologists’ services and breaking down barriers to necessary care.
This year’s top legislative priorities will be reflected in the messages that our State Leadership Conference participants take to meetings with their members of Congress and staff on Capitol Hill:
Medicare reimbursement. The APA Practice Organization and many other health care organizations advocated aggressively to prevent the drastic 26.5 percent Medicare “Sustainable Growth Rate” cut from taking effect on Jan. 1 of this year. Even so, all Medicare providers continue to face tremendous downward pressure on reimbursement as Congress considers huge cuts in program expenditures. Psychology advocates are calling on Congress to address plummeting Medicare payment for psychological services by addressing the underlying payment formula as well as payment reductions resulting from sequestration and other factors.
Inclusion of psychologists in the “physician” definition under Medicare. Unnecessary physician supervision requirements in Medicare are hampering psychologists from providing to Medicare patients their full range of services within state licensure. So, as we have done in recent years, we are again urging Congress in 2013 to pass bills that include psychologists in the Medicare “physician” definition – thereby ending inappropriate physician supervision without increasing Medicare costs.  
Psychologists’ eligibility for federal incentive payments to adopt electronic health record keeping. We are continuing to call on Congress to pass legislation that would make licensed psychologists eligible for incentive payments available to providers who integrate electronic health records into their practice. Pending legislation, which we expect to be reintroduced soon in the new Congress, would amend the Health Information Technology for Economic and Clinical Health, or HITECH, Act of 2009 in order to extend these incentive payments to psychologists.

39. Medicaid: H&B Codes

40. Serving SPTAs: 2013 CAPP Grant Examples
Minnesota
Pursuing funding for the development of electronic health records; ensuring psychologists role in behavioral health homes.
Vermont
Supporting the inclusion of psychologists in legislative process during Vermont’s restructure to a Single Payer Plan.
Kentucky
Ensuring parity in private insurance and Medicaid; addressing workforce capacity challenges with Medicaid expansion.
Georgia
Pursuing efforts to defend scope of practice regarding psychological assessments.
As this slide helps to depict, CAPP legislative grants for 2012 supported a variety of professional initiatives, including the following examples:
Pursuing the removal of legal barriers to practice incorporation by psychologists in New York with health care professionals in other disciplines
Seeking eligibility for psychologists in Missouri to use the Health and Behavior codes in Medicaid, and
Confronting the encroachment of Licensed Professional Counselors in Louisiana, and
Pursuing prescriptive authority legislation in Illinois

41. HEALTHCARE REFORM AT THE STATE LEVEL
Established in fall 2011 in response to the passage of the Affordable Care Act
Composed of the Practice Health Care Team and the State Implementation Advisory Group
Facilitated administratively through the State Advocacy Office
State Implementation Updates
Katherine/Brenda – You may want to insert a short sentence here that shifts the audience from the slide/topic before this... to these slides on State Implementation of HCR.
::CLICK 1:: In response to the 2010 passage of the Patient Protection and Affordable Care Act, APA Practice established an initiative in fall 2011 that combines the health care reform efforts of state leaders and the offices in APA Practice. Key Practice staff compose an internal Practice Health Care Team that meets every first Wednesday of the month to discuss issues facing our state leaders regarding health care reform. The APA initiative also has formed a State Implementation Advisory Group that is composed of representatives from various state constituencies. The Advisory Group does not formally meet but is called upon for consultation in an ad-hoc or as-need basis.
Also, the State Implementation of Health Care Reform initiative is facilitated administratively through the State Advocacy Office – under the guidance of the Practice Health Care Team and the State Implementation Advisory Group.
::CLICK 2:: ::THIS WILL START A QUICK SLIDE SHOW OF FRONT & BACK SIDES OF HCR ONE-PAGERS::
::DO NOT CLICK AGAIN – the slide show will play through by itself::
A one-page Update of the current work of this APA Practice Initiative is published quarterly and is made available to all state leaders. Here you our Updates from this year. The most recent update was released in August during APA Annual Convention and announces a new online tool for state leaders developed by this Practice Initiative.

42. State Implementation Initiative & APA Communities
Launched by the association in April 2012.
Designed as a professional network that enables users to connect and work collaboratively online, in real time.
Securely accessed via MyAPA ID.
The APA Practice Initiative: State Implementation of Health Care Reform is now using APA Communities to link leaders to resources and state efforts on health care reform.
::CLICK 1:: This past April, APA launched a new technology called APA Communities. This technology replaces APA’s former collaboration software called Teamsites. This new technology is a significant upgrade and is very user friendly.
::CLICK 2:: APA Communities is designed as a professional online network that enables users to connect and work collaboratively in real time. APA Communities is an online portal that securely accessed through a log-in name and password via MyAPA ID. Every APA member has a MyAPA ID associated with their membership number. Non-APA members can also register for a MyAPA ID on APA’s website. Non-APA members can only gain access to APA Communities through approval from APA Central Office staff.
::CLICK 3:: As the APA Practice Initiative on State Implementation of Health Care Reform began to take shape, it was clear that state leaders needed to be connected to resources on psychology’s role in health care reform. Because APA Communities is available to all members, the Practice Initiative is now using APA Communities to assist leaders on the state level.

43. State Health Care Reform Group on APA Communities
Tools for State Leaders
A Discussion Forum
A Document Library
Categorization of Resources:
Mental Health Priority Areas in ACA
Accountable Care Organizations
Health Care Financing
Health Care Medical Homes
Health IT
Insurance Exchanges
Integrated Care
Medicaid Redesign
Primary Care
Additional Categories:
SPTA Health Care Summits
Updates: APA State Implementation of Health Care Reform
Here we have a screen shot of the State Health Care Reform Group on APA Communities. This Group was created in response to the need for state leaders to have access to a central hub of information containing resources geared towards psychology in health care reform. Let me explain how the State Health Care Reform Group is organized.
::CLICK 1:: First, the State Health Care Reform Group is a discussion forum for state leaders. Members of the Group can post and reply to discussions with other Group members. As members actively participate, notifications are sent to the entire Group membership alerting them to new discussions or discussion responses in real time.
::CLICK 2:: Secondly, the State Health Care Reform Group is a document library. Group members can preview, download, and share a variety of publications, reports, white papers, or policy analyses that focus on mental and behavioral health issues within health care reform. This allows state leaders to quickly disseminate important information to their state constituencies. Similarly, notifications are sent to Group members instantaneously when a new resource has been added to the document library.
::CLICK 3:: Furthermore, all discussions and documents within the State Health Care Reform Group are assigned under categories named by the Practice Health Care Team to be psychology’s signature priority areas in ACA. The eight priority areas are:
- Accountable Care Organizations
- Health Care Financing
- Health Care Medical Homes
- Health IT
- Insurance Exchanges
- Integrated Care
- Medicaid Redesign
- Primary Care
Two additional categories capture resources that SPTAs have used to educate their membership on health care reform in their state and also updates from the APA State Implementation initiative, published quarterly and as you previewed on a previous slide.
Resources are further catalogued through a series of tags or “key terms” that represent specific topics within a given category. For example, a report found in the document library of this Group could be categorized under MEDICAID REDESIGN and then also carry the tags of ‘ESSENTIAL HEALTH BENFITS’ and ‘COST SAVINGS,’ if these topics were mentioned in the report text.
Additionally, each state has it’s own individual tag within this system, and so, this allows state leaders to locate resources or group discussions to aid them in comparing progress or best practices when navigating health care reform on the state level.
The State Health Care Reform Group on APA Communities is now live and accepting new members. For more information on this resource and how to join, please reference the State Implementation Update, one-pager you were provided today in order to find how to contact the State Advocacy Office staff.

44. SPTAs and Health Care Reform Education
2011
New York State Psychological Association
Massachusetts Psychological Association
Maryland Psychological Association
2012
North Carolina Psychological Association
Idaho Psychological Association
Maine Psychological Association
California Psychological Association
Indiana Psychological Association
Oregon Psychological Association
Washington State Psychological Association
2013
Connecticut Psychological Association
Wisconsin Psychological Association
Nevada Psychological Association
Minnesota Psychological Association
South Carolina Psychological Association
Rhode Island Psychological Association
Ohio Psychological Association
Oklahoma Psychological Association
Vermont Psychological Association
Sharing resources and educating our psychologists is a priority for both SPTAs and the State Implementation of Health Care Reform initiative. ::CLICK 1:: ((This will start a timed cascade of the bulleted list. Only one click is necessary.)) Since the passage of the Affordable Care Act, several states have taken action in developing programs, workshops, or summits that educate their SPTA members on what health care reform will look like in their state. This is a list of states that have held this type of programming since last summer.
These SPTA programs take many shapes. For instance, New York State Psychological Association convened a small think-tank format that focused on assessing the current climate and reform strategy discussions. Maryland Psychological Association offered an all day event that featured panels of speakers including health care economists and other experts. Additionally, some SPTAs have offered their health care programming as continuing education credits to their members.
At the conclusion of these programs, some SPTAs have created a summary report of their workshops or strategic discussions. For example, New York State Psychological Association published a brief Tool Kit on Health Reform that assists NYSPA members with how to best prepare for changes in health delivery in six critical areas delineated during the June 2011 health care reform think-tank. This document is a useful resource for not only members in New York, but can also serve as a model to other SPTAs looking to establish similar programming within their states. The NYSPA Tool Kit on Health Reform can be found on their website and has also been added to the document library of the State Health Care Reform Group on APA Communities.

45. Serving SPTAs: CAPP Grants
Funding level maintained for 2014
Organizational development, legislative, emergency and Canadian
$250,000 awarded in organizational development grants to 25 states and DC in 2014
$185,000 awarded in legislative grants to 13 states in 2013 (for 2014)
As I’ve already mentioned several times, our advocacy activities often involve partnering with state, provincial and territorial psychological associations, or SPTAs. Many of the laws and regulations that affect the day-to-day practice of psychology are enacted and implemented at the state level.
The APA Practice Organization Committee for the Advancement of Professional Practice, or CAPP, provides hundreds of thousands of grant dollars annually to SPTAs for organizational infrastructure support and advocacy initiatives. CAPP grants also are awarded for emergency requests as well as to the Council of Professional Associations of Psychologists in Canada.
I’m happy to report that, although we’ve had to trim APAPO expenses in other areas, the CAPP grant funding level for 2012 was maintained at the same level as in Each year, many SPTAs benefit from the funds provided by CAPP grants. For example, 19 states and DC received organizational development grants last year, while 18 states were provided with legislative grants.

46. Contact Information
Slide 26 – Contact APAPO 
Phone:
Web: