Psychotherapy Finances

Mental health professionals have dabbled in the business of providing services over the web with a visual connection via Skype. The idea hasn’t really caught on, partly because of licensing issues from state to state. Security and HIPAA are concerns.

Also, managed care generally doesn’t reimburse for such services.

But you have to wonder how long that will last. Last week, OptumHealth announced it was launching a program in Detroit called the “NowClinic,” an online service that hooks up Optum nurses and physicians via a visual connection with customers of Rite Aid pharmacies.

The program is described as a “private, face-to-face” consultation inside a room provided at Rite Aid stores. But outside of store hours, the connection can be achieved through www.myNowClinic.com/RiteAid. Medication may be prescribed.

A chat with an Optum nurse is free, but a virtual 10-minute visit with a physician will cost $45.

Optum is an arm of UnitedHealth Group, which also oversees United Behavioral Health, covering 43 million lives.

*

When it comes to social media, it seems everybody has to get into the act. Hospitals, government agencies and medical/ mental health practices have developed Facebook fan pages. Many individual practitioners are on Twitter.

ValueOptions — the third largest managed care company for mental health benefits — announced in September that the company has created a presence on Twitter, Facebook and LinkedIn. The pages are basically places to put company announcements, but one advantage for providers is that the pages afford comments as well.

The addresses are:

Facebook:
http://www.facebook.com/pages/ValueOptions-Inc/116504905055345?ref=sgm

Twitter:
http://twitter.com/valueoptions

LinkedIn:
http://www.linkedin.com/in/valueoptions

- John Nelander, Contributing Editor

Niche markets change with the times.

Consider this: In today’s topsy-turvy economic climate, investment advisers are dealing with clients who are often on edge and fearful of the future. Through the Internet, these clients have access to the same information on particular stocks that their investment adviser does.

So what does the adviser actually have to offer? The answer is management skills — not only of the portfolio, but of the person.

Turns out, this has opened up a new niche for private practice psychologists, according to the September issue of the APA’s Monitor on Psychology.

The magazine featured psychologist Frank Murtha, who launched a coaching company named MarketPsych. It caters to the Wall Street crowd with the slogan: “Where mind meets money.”

“Today’s professionals provide more personalized financial services in the form of financial counseling based on a deeper understanding of who their clients are and what they need,” Murtha notes on his website. “Successful financial advisors are spending less time managing their client’s money and more productive time managing clients themselves - their emotions, their expectations and the relationship.”

Murtha partnered with a Los Angeles psychiatrist who advises companies on how to boost client retention, and a San Francisco pro who “works with trading desks and active traders who want to improve their mental skills to make consistent profits.”

They offer coaching sessions by the hour or as a package. Murtha himself is based in New York.

“One of the things I tell advisers,” Murtha told the Monitor, “is that if you take a look at the percentage of your day that gets spent managing your clients’ money versus the percentage you spend managing your clients—their emotions, their expectations—then you may discover that you and I are in the same business. You’re not financial advisers, you’re financial counselors.”

- John Nelander, Contributing Editor

The poverty rate spiked to almost one in six Americans, the highest in two decades, according to a U.S. Census Bureau report released this week. Household income declined. The report released Tuesday compared 2009 to 2010.

Despite the continuing economic headwinds, the number of Americans without health insurance remained basically flat, edging up from 49 million in 2009 to 49.9 million in 2010. Due to population increases, that’s about 16.3% of the public.

Details were released in the report: Income, Poverty, and health Insurance Coverage in the United States: 2010.

There was a drop in the number of people covered by private plans and a small increase in the number covered by Medicaid and other government plans. The percentage of American workers who get their health insurance from their employers dropped from 56.1% to 55.3% from 2009-2010.

Those covered under government plans increased from 30.6% to 31%. About 15.4% of that is Medicaid coverage.

There were 7.3 million children under age 18 without insurance in 2010, about the same as the year before. But the uninsured rate for children in poverty was 15.4%, greater than the 9.8% rate for all children.

Among regions, the South had the highest percentage of people without health insurance, 19.2%. Next came the West at 17.7% followed by the Midwest with 12.7% and the Northeast at 11.8%. These percentages were mostly unchanged, or had changed only slightly, since 2009.

Rates among ethnic groups: White: 15.3%; White, not Hispanic: 11.5%; Black, 20.3%; Asian, 16.5%; and Hispanic origin, 31.6%. Rates dropped among Black, Asian and White, not Hispanic and White groups. They edged up among Hispanics.

Foreign-born non-citizens had an uninsured rate of 45.1% in 2010, about the same as the year before.

- John Nelander, Contributing Editor

Magellan Health Services has been tapped to administer a new Medicaid program for behavioral health services in Louisiana. The two-year contract begins March 1 of next year and run through February 28, 2014 with a one-year optional extension through February 28, 2015.

The contract was awarded by the state’s Department of Health and Hospitals. It’s expected to generate annual revenues of $150 million for Magellan. About 150,000 are expected to access behavioral services including 50,000 children, according to the New Orleans Times-Picacyune.

There are two caveats to the Magellan announcement. First, the contract must be approved by the Louisiana Department of Administration. Second, the successful bid could be challenged by another bidder. This is what happened to the state’s Medicaid contract for medical services — it was awarded to Louisiana Health care Connections, Amerihealth Mercy of Louisiana, and AmeriGROUP Louisiana. But Aetna Better Health, Aetna’s Medicaid arm, filed a formal protest in August.

A second protest was filed by Coventry health Care of Louisiana.

The Medicaid contract in Louisiana covers about 875,000 lives and is worth, overall, about $2.2 billion.

In addition to Magellan, ValueOptions, Cenpatico of Louisiana, Perform Care Behavioral health Solutions, and AmeriHealth Company submitted bids for the state’s behavioral health Medicaid business.

The contract awards are part of a plan to build a new, more integrated care system in the state, according to the Times-Picayune. State officials are trying to move from a fee-for-service model to coordinated care networks.

Louisiana will begin negotiating a per-patient fee to Magellan, which will be responsible for building a statewide network of therapists to treat the Medicaid population, the paper said.

In our April issue, we wrote about the problem of clients logging on to consumer rating websites with posts critical of their therapy experience. It’s difficult or impossible for the clinician to respond due to privacy laws and other concerns.

Some physicians are asking new patients to sign a statement agreeing not to post reviews about their experience. But David Ballard, assistant executive director for marketing and business development at the American Psychological Association doesn’t advise practitioners to take that route.

“It’s not enforceable,” he says.

The whole issue of social media and how it relates to medical practice has become complex. So, the Mayo Clinic has come out with a series of videos on how health care providers should use social media and the web in general.

One very quirky animated video is called: “The new doctor-patient social media contract” and it addresses the topic of web-based critique sites. You can watch this video directly on YouTube by clicking here.

Two guys are having coffee at a Starbucks. One says to the other: “I went to the doctor today and the nurse gave me a form to sign. She told me the doctor would not see me unless I signed the form.”

His friend says that’s no big deal, it’s just about HIPAA and privacy issues. “That’s the problem,” his friend says. “It’s not about HIPAA. It said I cannot go to a website and rate the doctor or comment on my experience. I thought I had freedom of speech. Is this legal?”

“Oh my God,” his friend says. “That is sneaky. Whatever will they think of next? I know places that actually have Facebook sites and encourage patients to write about their experience.”

“So what should I do?”

The friend says: “How about you give the doctor a form to sign too. If she signs your form, you’ll sign her form. She has to sign a form saying she will not blog or tweet about you without your consent. Even if she does not use your name or her name on the post.”

“Wow. Gotcha. You are a genius.”

In other words, expect patient resistance if you try to prevent someone from rating your practice online. But there are other ways to address this problem, which are outlined in the Psyfin story.

Other Mayo Clinic videos make the point that whatever a clinician posts online stays there and may be subject to retrieval at any time. Conduct yourself accordingly on Facebook, Twitter and other sites.

“Anything online should be considered public, whether it’s a tweet, a blog, a comment,” one expert advises in the video. “Anything you post, think about it before you hit return.”

- John Nelander, Contributing Editor