Spring 1997 - President's Column: Toward Effective Advocacy

xxAACP Newsletter, Volume 11, Number 2, Spring 1997

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President's Column:
Toward Effective Advocacy

Oh the pains of adjusting to managed care. I don't know about you but I am getting sick of the topic. I find myself as angry as any of my colleagues and wax eloquent in bashing away at the latest travesty. But I also find myself defending some of the good efforts I hear about or that we are working on so diligently in the state of Washington. How glibly we talk about what "managed care" is doing to our service systems as if it was actually some entity akin to a dark force from Star Wars. I propose that as community psychiatrists we join in the discussion at a somewhat higher level. No doubt that in the private arena poorly managed care sometimes has a dark quality because there is absolutely no recourse in dealing with corporate employers and their arrangements with corporate managed care organizations. But in our venue it is simply not true that we are without recourse. Public managed care is always accountable to the voters in each state. As community psychiatrists we must never lose sight of this. It is part of our role to insist that the governing bodies be held accountable for good or bad plans. As each state seeks a waiver for their Medicaid programs they are accountable to HCFA. But is HCFA accountable? The AACP certainly plans to assure that they are. Accountability works down to counties or local mental health authorities and ultimately to contracted providers who must assure the quality of their work.

The true villains of health care reform are not the functionaries of managed care but those who really devalue human services generally and don't believe that society has any responsiblity to assure the public's health and welfare. This is a prevailing theme in our political culture. Each state legislative body seems to be trying out "macho" the next, and the governor as well, in proposing a lower budget with lower taxes and bigger program slashes. Democrats are finding that they can outdo Republicans in this grizzly game. No amount of appropriate management of remaining dollars can ever make up for this failure of government to live up to their basic responsiblities for the public good. It is the duty of socially conscious community psychiatrists to take their concerns into the realm of political discussion. We are uniquely capable of providing the facts of what these failures are causing. We need to make the links between the social chaos in oour communities and the fiscal policy so proudly touted by a state's governor or legislature. Thoughtful, temporate, well coordinated media campaigns in alliance with advocates and other health professionals is an absolute must for AACP members in these times.

But we are also able to offer positive advice to our struggling public programs. The AACP has worked diligently to develop tools and guidelines designed to assure quality in our public mental health programs. We must continue to make the argument for appropriate medical direction and appropriate inclusion of psychiatrists in the teams doing the work in the trenches. We have an excellent argument for the inclusion of psychiatrists in state policy and program planning as we see the floundering of some of our state's mental health reform plans.

The AACP board had been amazed and very gratified at the positive reception our Level Of Care Utilization System (LOCUS) has had from state and county mental health authorities around the country. State systems are hungering for a credible source of guidance for determing level of care, medical necessity, utilization standards and other such components of good management. The AACP has great advantages to state planners over commercial sources because we are free of conflicts of interest regarding money. Our board is eager to step up to this challenge but the work involved in developing tools far outstrips time and resources. We are actively seeking the reinvolvement of past board members and other active members in our creative efforts. Please contact me if you feel you have something to offer. In San Diego we will be developing strategies on how best to marshal our energies. Contributing to the process of creating management tools can now be done free of the requirements for task force meetings through the use of e-mail and the web.

Another activity for the AACP is to take a more direct role in pressing for accountability from our state and local systems. Our e-mail distribution system has proved to be a fantastic forum for sharing frustrations with the travesties of poor planning and inadequate resources. Our discussion of the failures of Tenncare's mental health programs have made that state's local difficulties a national issue. Tennessee has inadvertently helped us set some standards for what not to do in mental health care reform. Hopefully the failures of that system being so broadly publicized by the AACP will have some impact on Tennessee's state government and help prod them to make appropriate corrections. At our winter board meeting in Louisville we resolved to make early interventions directly to state mental health authorities as our members see problems arising in reform plans spawned by HCFA waivers. Our letters detailing problems perceived by our membership will be copied to the director of HCFA and distributed broadly both within that state and nationally.

What a blessing it is to be involved in a small flexible organization which can move quickly to take action. Please support us in these efforts by getting involved. If you have not yet joined the cyber revolution please do and, if you are on line, e-mail me at chuffine@u.washington.edu and request to be added to our "Active and Interested" distribution list. Remember, what we don't like is "bad" managed care. If we are to manage our patients' care, let's assure that we managed it well.

Charles Huffine, MD
President

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