Psychotherapy Finances

The nation’s largest insurance companies appear to be jockeying for position as more provisions of the health care reform law begin to take effect. Dealing with uncertainty seems to be the main concern of top execs.

Profits overall look healthy but companies are shuffling the leadership deck in an effort to generate innovative ideas to keep revenues rolling in.

Two of the biggest insurers reported fourth quarter profits this week and came out on opposite ends of the spectrum. UnitedHealth Group, the biggest company by sales, saw fourth quarter net income jump 10% to $104 billion, beating analysts’ estimates.

Medicaid and Medicare enrollment both increased, and the early mandates of the new health reform law proved to be not as costly as UnitedHealth officials first thought, according to Bloomberg News. In addition, health care access has been down during the recession as people delay care even if they have coverage.

UnitedHealth, the parent company of Optum Behavioral Health Solutions, began the new year with a shakeup of its top executives.

At the other end of the scale, WellPoint, the biggest insurer by enrollment, saw its fourth quarter profit plunge 80% compared to the fourth quarter of 2009. The steep drop was attributed to the 2009 sale of a pharmaceutical benefits subsidiary, which boosted the bottom line a year earlier.

Still, even after adjusting for the sale, WellPoint’s net income in the fourth quarter was down 2.1%. The Hartford Courant reports that the company has logged a steady decline in enrollment, with 33.67 million covered lives on December 31, 2009; 33.47 million on September 30, 2010; and 33.32 million on December 31, 2010.

A story in Thursday’s Wall Street Journal reported that WellPoint will pursue diversification this year and will actively seek new acquisitions.

Wellness programs, which focus on the healthy, top the agenda. Chief financial officer Wayne DeVeydt told the Journal: “There is a lot of new space that is out there. We don’t see the health-insurance market going away … but at the same time here’s how we’re going to diversify out of our core, focus on the healthy, health [information technology] and a better consumer experience.”

Magellan Health Services, which will announce fourth quarter earnings on February 24, also brought in new leadership for its behavioral health business this week. Keith Dixon comes to Magellan from CIGNA Corporation, where he spent the bulk of his time as president of CIGNA Behavioral Health, from 1997 to 2006.

Prior to that, Dixon was president of United Behavioral Health, which is now Optum Behavioral Health Solutions.

College students have always been a rich source of potential clients. There are issues aplenty in the ranks of undergraduates, from adjustment problems to test anxiety. Here’s another issue that may be underserved – depression.

A new Northwestern University study reveals that one of four college students who visit a university health center for a cold or sore throat are actually struggling with depression, but the symptoms are usually missed.

Up to 3 percent of these depressed students have suicidal thoughts, according to the study.

Because they’re not identified, they drink too much or turn to drugs, researchers said.

“Depression screening is easy to do, we know it works, and it can save lives,” said Michael Fleming, professor of family and community medicine at Northwestern University Feinberg School of Medicine. “It should be done for every student who walks into a health center.”

The study was based on a survey of 1,622 college students at several campuses including the University of Wisconsin, the University of Washington and the University of British Columbia.

The Northwestern research echoes other studies that have been done over the past decade. The number of college students on psychiatric medications have increased 10 percentage points since 2000, according to a piece by National Public Radio that aired earlier this week.

Part of that is due to a larger number of students with disabilities moving into the university system, which may not have happened two decades ago.

Katherine Nordal, the American Psychological Association’s Director for Professional Practice, told NPR: “These are youngsters many of whom in the past wouldn’t have even finished high school. Special education services in high school mean that more students with emotional difficulties and special needs are going on to college.”

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Professional associations are getting their summer conventions organized, and first up is the American Psychiatric Association annual meeting May 14-18 in Honolulu, HI.

The APA created a special newsletter this year to update members on the event called Hukilau.

As the APA website explains: “Hukilau (pronounced hoo-key-lau): a way of fishing in which people pull together to cast the net or a festive beach gathering. The Hukilau will pull together all the information you need to attend the 2011 meeting, our festive gathering by the beach.”

The APA’s convocation speaker will be Archbishop Desmond Tutu, who helped guide South Africa’s transition from apartheid to democracy.

Internet groups serving the mental health profession were buzzing this week about what went wrong in Tucson, when alleged gunman Jared Lee Loughner killed six people and seriously wounded a congresswoman.

While the mainstream media were preoccupied with discussions of whether the country’s bitter political partisanship played a role in the attacks, professionals have been speculating about the nature of Loughner’s mental health issues.

Clinicians can’t diagnose an individual via news reports, but even a lay person could see from reading his messages on YouTube that something was amiss.

Calming the roiled political waters is an admirable goal. But the Loughner issue may have been put into better perspective this week in a Wall Street Journal column by E. Fuller Torrey, founder of the Treatment Advocacy Center and author of The Insanity Defense: How America’s Failure to Treat the seriously Mentally Ill Endangers Its Citizens.

As Torrey points out, the U.S. began to empty state mental hospitals in the 1960s due to civil rights concerns. But the new policy was enacted without a backup plan for the former patients. They were left to drift through society, homeless and untreated.

Two attacks related to Congress occurred in the 1980s. Dennis Sweeney, a man with untreated schizophrenia, short former congressman Allard Lowenstein in 1980. Another attack by an untreated schizophrenic occurred in 1998 when two police officers were killed as the man was trying to shoot his way into the Capitol Building.

Torrey neglected to mention the most infamous example of all – the bizarre behavior of John Hinckley Jr. who, in 1981, shot and seriously wounded President Reagan in an attempt to impress actress Jodie Foster. He was found not guilty by reason of insanity and has been in institutional psychiatric care ever since.

Torrey writes: “Over the past three decades, things have only gotten worse. A 2007 study by the U.S. Justice Department found that 56% of state prisoners, 45% of federal prisoners, and 64% of local jail inmates suffer from mental illness.”

Obviously, this is an issue that has never been fully addressed. The Tucson shooting may be a wake-up call on how we as a nation discuss political reform. But it’s also a reminder that the country has failed to tackle a serious social problem.

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Magellan Health Services jumped on the Tucson shootings this week by teaming up with the Arizona Department of Health Services to offer a free 24-hour counseling hotline for state residents “process feelings of grief, sorrow and depression.”

A gold star for the company’s public relations effort and who knows – it might well have provided some needed help.

An organization of psychologists in private practice launched a campaign today to encourage physicians to refer patients with mental health issues to a psychologist before prescribing medication for the problem.

The National Alliance of Professional Psychology Providers (NAPPP) has purchased space to run ads supporting the campaign in the New York Times, Wall Street Journal and The Washington Post. And spots will be aired on national cable TV channels starting as early as next week.

The print ad features a photograph of a man in a white lab coat handing out a blank prescription. Under it, a box in the style of cigarette warning label reads: “WARNING: Having your family physician treat depression can be harmful to your health.”

It goes on to say: “There is a health care crisis no one is talking about: physicians treating patients complaining of behavioral disorders with medications the doctors know, or should know, are no more effective than sugar pills.”

NAPPP was formed in 2006 by a group of psychologists who were dissatisfied with what the American Psychological Association provided to psychologists in private practice. The organization has had some big ideas along the way, including establishing a provider network of psychologists that would compete with managed care.

NAPPP has said little about this network concept in the years since that announcement. But this prescription drug campaign is the most public project ever undertaken by the organization and should at least increase its visibility if the campaign comes off as planned.

John Caccavale, NAPPP executive director, explained the campaign this way in a news release Friday: “Every day, physicians, who are untrained and lack the expertise to diagnose possible mental health problems, are prescribing drugs, which do not work, for conditions patients may not even have. We are failing patients in need of quality mental health services.”

He also says: “Psychotropic medications should only be considered after a patient has been fully evaluated and diagnosed by a doctoral level specialist in behavioral health and has failed to significantly improve from non medication intervention.”

NAPPP plans to use YouTube, Facebook, Twitter and Linkedin to build networks that will help get their point across. The organization has also established a separate Website at http://www.truthindrugs.com.