Psychotherapy Finances

It’s not exactly news that Americans are taking more antidepressants and anti-anxiety drugs, often via prescriptions from their primary care physician.

But a new study released last week puts some surprising numbers to the trend and offers some insight into the whys and wheres. The report from Medco Health Solutions, a pharmacy benefits management company, is called America’s State of Mind.

Between 2001 and 2010, analysts say, the use of mental health-related medications among the insured population jumped 22%. One in five adult Americans took a drug in 2010 to treat depression, anxiety or ADHD, the report says.

That breaks down to 15% of men and 25% of women. Women ages 45 and up showed the greatest increase in use over the decade — up 43%.

More adult women use mental health-related pharmaceuticals than men. But in children and adolescents it’s just the opposite. Boys are using them at a higher rate although the use among girls is increasing at a faster rate.

Researchers also broke down the useage by state and region. By far the region with the highest useage of antidepressants and other mental health medication was the Central-South (Kentucky, Tennessee, Mississipp and Alabama). The researchers speculated that higher rates of diabetes in this area contributes to the prescription drug use.

The area in which mental health drug useage is lowest is the Great Lakes region of Wisconsin, Illinois, Indiana, Ohio and Michigan.

Antidepressants are the most commonly used mental health medication and women have the highest rates of useage, the study shows. But use among men is rising fast — 28% from 2001 to 2010.

An additional note: As we’ve reported over the past several years in Psychotherapy Finances, Attention Deficit Hyperactivity Disorder is no longer just a children’s disease. The diagnosis is now widepsread among adults, and women in particular.

Women ages 20-44 show the highest useage rate (2%), but that’s up 264% since 2001.

The complete report can be downloaded from the Medco website.

Practitioners we talk with have been noting that clients are starting therapy with higher deductibles to fill — even with traditional health insurance plans. Here’s a new report that puts some numbers on the problem.

Consumers who access medical care, or mental health services, are facing much higher deductibles, and the problem is expected to snowball over the next decade. In 2003, 52% of the insured had deductibles to fill before coverage kicked in; that jumped to 74% in 2010, according to the study conducted by the nonprofit foundation, The Commonwealth Fund.

Premium costs to workers for employered-sponsored policies during that time increased by 63% in an era of declining or stagnant incomes. At the same time, the cost to employers soared 98%.

Overall, employer-sponsored health insurance premiums have shot up 50% since 2003, the foundation’s new 50-state analysis shows, and by 2020 a family premium would be $24,000 if that rate of increase continues.

The website contains an interactive map where you can click to see specific information on your state.

“Whether you live in California, Montana, or West Virginia, health insurance is expensive. Out-of-pocket costs for premiums and care are consuming a larger share of people’s incomes at a time when incomes are down in a majority of states,” Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the report said in a news release.

“Workers are paying more for less financial protection. The steady rise in costs from 2003 through 2010, before enactment of the Affordable Care Act, points to the urgent need for health insurance market and health care system reforms.”

Average deductibles were highest in Wyoming at $1,479 and lowest in Hawaii at $519.

- John Nelander, Contributing Editor

“This is Walmart calling. We just wanted to remind you of your appointment tomorrow with Dr. ….”

Consumers could soon be hearing that message on their cell phones if a report about the company’s plans to take a bite out of the primary health care market is true.

Kaiser Health News reported this week that the chain, the nation’s largest employer, is preparing plans to “dominate” the preventive health care market and and help consumers manage chronic illnesses such as heart disease and diabetes.

Other chronic illnesses that could be addressed by “vendors” include arthritis management, HIV monitoring and hypertension management.

The company’s goal, according to a document cited by KHN and National Public Radio, is “building a nationally integrated healthcare platform aimed at delivering the lowest cost primary health care services.”

When NPR began reporting on the Walmart health care story, the company issued a denial, stating that information in the document was incorrect.

But if some sort of health care initiative is in fact brewing at Walmart, would it have anything to do with mental health? The answer is yes.

Among other chronic illnesses listed within the document is “Clinical depression management and monitoring.” The company may also venture into stress management, sleep management, smoking cessation, and weight evaluation and nutritional counseling, according to the paper.

Other companies have begun offering in-store clinics, including CVS and Walgreen’s. But the Walmart proposal, at least based on the document, would be much broader in scope

NPR quoted skeptics as saying that one of the major goals of the Wal-Mart effort may be to increase foot traffic. They doubt it would have a major impact on health care costs.

- John Nelander, Contributing Editor

Some psychologists are already gearing up for the next round of state legislation, in 2012, to expand prescription privileges beyond New Mexico and Louisiana.

It’s become an annual ritual. Take bills that have failed in past years–sometimes just barely, or they were vetoed by the governor–back to lawmakers for another try.

After passage of legislation in New Mexico in 2002, it seemed that the flood gates would soon be opened and other states would quickly follow. But the state will soon mark 10 years as the first to allow specially prepared psycholoists to prescribe, and only Louisiana has come onboard.

Unsuccessful efforts were logged this year in Utah, Arizona, Hawaii, Montana, New Jersey, Oregon and Tennessee.

The argument generally put forth by psychologists is that patients have to wait too long to see a psychiatrist, especially in rural areas.

Now, the National Alliance of Professional Psychology Providers, launched in July of 2006, is suggesting a different tack. The organization recently published a template states can use in the next round of legislation called, The Patient Safety Evidence Based Prescribing Act.

After all, who can argue with “patient safety”?

The problem with past attempts, according to organization officials, is that psychologists haven’t shown themselves to be uniquely qualified to prescribe psychotropic medications.

“Presently, in those jurisdictions where psychologists have prescriptive authority there is no distinction between them as prescribers and any other prescriber,” said John Caccavale, a member of the NAPPP executive board.

“In my opinion both as a psychologist and psychopharmacologist, we do need to demonstrate that we are different in how we address and integrate medications into treatment regimens. If not, then why prescribe at all if we are doing what everyone else is doing….”

The model, Caccavale says aims to “demonstrate the differences between psychologists who utilize medications as a proficiency in providing medications related services and those prescribers in other disciplines.”

Could the approach help convince skeptical state lawmakers? Well, there is still the problem of how to minimize the efforts of lobbyists for the American Medical Association–no small task.

Stay tuned.

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Pain management seems to be a wide-open field for mental health care professionals. As we reported in previous 2011 Psyfin issues, it’s a “hot niche” that warrants attention from qualified providers.

Here’s some additional verification: A new report by the Institute of Medicine predicts future pain management will focus on psychosocial aspects of the problem.

The November issue of the American Psychological Association’s Monitor on Psychology quotes psychologist Francis Keefe, a member of the committee responsible for the report, as saying that a “shift from a biological model of pain” is well underway.

And it makes sense. Business is particularly interested in the issue, the Monitor says, since there are about 116 million Americans living with pain. The problem costs the country $635 billion each year in health care costs and lost productivity.