PN: And what will determine which of these groups will actually make it?
Cummings: Most of these groups start out saying, "Well, we're going to do better than the managed care companies did. We're going to make sure that the patient gets what the patient needs." Of course, they then find out that they're swimming in red ink because they haven't learned to differentiate between what gets the job done and what just feathers the nest of an individual practitioner. They're really two very different things. For the solo practitioner--the longer the thing takes and the less turnover there has to be, the better you do; plus you don't have to have as many referrals. But from an economic standpoint--and there's just no ignoring this--the opposite is true. The faster you get the job done, the more likely you are to make a profit. The point is to make therapy both effective and efficient.
Unfortunately, most practitioner groups don't have a clue how to do this, so the ones that are doing the best have finally admitted that they're economic illiterates and are beginning to bring in the right kind of managers to help them do it. So you've got an incredible paradox here--the managed behavioral care companies are outsourcing the clinical side and then the practitioners are outsourcing the management side. So you've got three levels of outsourcing here. Anyway, that trend is in full swing, and when a huge company like Magellan decides it no longer wants to be a deliverer of mental health services, you can begin to see where the industry is headed.
The Therapist Workplace of the Future
PN: Your other big prediction about the future of health care is that the majority of mental health services will be dispensed in medical primary care facilities, with therapists located right across the hall from physicians. So are the managed care giants proponents of this new kind of "integrated care"?
Cummings: Even though the managed care companies pay tremendous lip service to the integration of care, for the most part, they've done a miserable job of trying to bring it about. They are organized to provide "carve out" services, and how in the world to "carve in" is beyond them.