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Tele-Mental-Health: a glimpse of the affordable care act




This weeks blog is a summary of a what the health markets will look like in the next few years to come.  The information presented here is a snippet of the massive amounts of “BIG” data that was reflected upon at the workshops and in the convention hall.

I was a bit of a fish out of water.  The participants were generally executives of multi-million dollar super agencies that spent as much administrative time on acquisition and merger as they did on the health and mental health of their customers, clients and patients.

Having said that, my belief in the macro/micro theories led me to deciphering the noise from the meaningful data.  I came away from the conference having had a great time with an old friend attending from the west coast and carving out some innovative ideas that will help me to pull my psychoanalytic practice at the forefront of the 21st century thinking and technology.

This conference summary is about the big picture.  I will write a follow up article on how Mindfulness in Psychoanalysis will make changes in service delivery.  But for today below is a glimpse of the world after Obama-Care is implemented.

With the arrival of the Affordable Care Act (obama-care) we are entering a new era for medicine and public health in America.  It is an era powered, driven and managed by “BIG” data, meaning that technology, the internet, iPads and smartphones will be as integrated into medical practice as is the blood-pressure cuff and the thermometer.  And all of this new technology will not only impact how and when we see our physicians, but in what will be expected from the consumer in the providing of health and mental health services.  With the changes that we will see in medicine and in insurance coverage it is yet another brave new world that we are entering.  Both the doctors and the consumers will be new at this game-plan.  It will be wise to begin to prepare ourselves for a new form of service delivery where we are not only the consumer, but a partner in health care coverage.

Medical Homes

The best way to describe a medical home is to think about it as a cyber place rather than a brick and mortar place, although, there will be many physical locations that will be used as the hub for medical homes, the practice of interactive health care will begin with a primary care worker.  From this central point of entry into the new medical world, we can expect to see partnerships with the YMCA to be as focal as partnership with specialist.  The specialist will be for the high end user.  The healthier we are the more we will be encouraged to follow public health policies–no smoking, take meds on time, do a blood pressure reading twice a day, avoid sugar, avoid too many starches, eat greens, avoid caffeine, brush, rinse, floss…………

The Big Data that has been collected on Americans point to particular guide posts that appear to be generic or central to most healthy humans…lack of adherence to the know quality of health factors will be treated (as they should) not as forms of acute illness, but rather as a form of chronic illness.  In the old medical model a distinction was NOT made between a chronic condition and an acute condition.  Patients walked into their doctors offices expecting to be taken care of.  The new paradigm is walking into a coordinated medical home where all of your data exist, and we the consumers, along with the physician strolling through our options.  We become partners in health.  This is not yet a reality, but it is rapidly coming down the pike.

Coordinated Care

This coordinated care is expected to be a gateway to quality of health, but we have all seen what happened when managed care was suppose to do that in the 1980’s.  Everyone fell through some crack or some loop-hold and managed care became the biggest obstacle to receiving care.  The old managed care model placed private practice fees as the basis of delivery of care. Essentially some of the biggest providers either did it right and declared bankruptcy, or did it wrong and survived by saving the insurance companies lots of money.  Managed care became GATE-KEEPERS, rather than Gate-ways to health care.

It seems to me that the largest component of the affordable care act will take place behind the curtain of OZ.  The federal government has stepped in and made one huge sweeping motion that will change the game entirely.  Insurance companies, under the new act to take effect in 2014 are mandated to spend a formula driven amount on money on the provision of services.  It will no longer be un-regulated.  An insurance company will have to spend X % of its subscription fees on paying providers.  This is a huge change from the companies choosing to keep as large a percent of profit for shareholders as they deem fit.

Also in this changing retail market there is one more provision that will change the face of health and public health.  Insurance companies are moving from a fee for service model to a cost-effectiveness or value based model.  Medical practices will not be paid for a broken bone, but will be paid for a “repaired” broken bone.  It does not sound like such a big change, but moving from fee for service to a goal driven out come model may change everything.

What we saw happen in Mental Health in the 1970 and the 1980’s was a shift from the analytic model of therapy being provided, to a behavioral mental health model where only cognitive behavioral therapy was considered reimbursable, based on goals achieved.  I do not think that the mental health care act passed 50 years ago was effective in recognizing the best care, they became experts in a new language.  Out-come oriented psychotherapy and short term counseling replace sound theory about the relationship building that was necessary to facilitate major changes in depressive and anxiety driven conditions, which by the way we now know for sure accompany every chronic illness.

Fifty years later we are moving our physician based health care system to a public health, population driven paradigm that will require proven out-comes before the insurance companies pay for the service.   The reducing of cost for our health care is the driving force in the new medical homes model of care.  I am convinced that we will not spend less on health care, but a new distribution of assets will arrive with the new care act.  It is yet to be seen, but considering the strength of the insurance lobbies, I doubt that they will make less money.  There is a good chance that the losers in this new market driven, big data driven world will be both the providers and the consumers.  What bankers are to our economy, insurance companies are to the health and public health of Americans.

The markets are driven by profit margins not quality service provision or even consumer (patient) outcomes.  It is yet to be seen, but there are indictors that the healthier you are, the more favorable will be the new health systems for you.  The place where we will continue to be stuck is the work needed to be done for the most recalcitrant aspects of society–the unmotivated, depressed patient who can not become compliant because of subjective, unexplainable conditions that have yet to identify the genetic source for the condition.

There is a glimmer of hope based on the acknowledgment that all chronic disease are also psychosomatic conditions.  This is where mental health is going to have a newer and perhaps more forceful voice in holistic patient care….

Thank You for Reading,


Dr. A.L. Dussault





Author: aldussault

I am an artist, photographer, watercolorist, and primarily a modern psychoanalyst. I blog about politics and consciousness as well as create digital fine art photos of my pen & inks and my water colorings. My hobby is studying piano.

2 thoughts on “Tele-Mental-Health: a glimpse of the affordable care act

  1. Thanks for all the info. The regulation of the health insurance industry is long overdo. I wasn’t aware of that aspect of “Obamacare”
    Vermont just announced they are going with the single payer model. Obama had to compromise on that to get the ACA through. If they are successful, it could change things nationaly. One would hope anyway.

  2. I think that is very good news

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