Today, at 77, ever ebullient and able to get by with only three hours of sleep a night, he lectures widely and runs two foundations devoted to furthering the cause of quality mental health care--the Foundation for Behavioral Health and the Nicholas and Dorothy Cummings Foundation. And, as the following conversation reveals, one of his favorite pastimes still is foretelling the future of psychotherapy and the nation's health care system.
The Industrialization of Health Care
Psychotherapy Networker: Let's start with a typically provocative quote from a paper you wrote a few years ago--"The transition from managed care to the next phase in the industrialization of health care has already begun." Most therapists I know have struggled mightily to make their peace with managed care as it exists today, so what will we need to do to adjust to this next phase that you're talking about?
Cummings: Since the '80s, along with the enormous growth of managed care, we've seen all the managed care companies swallowed up into a few huge corporations. Today two companies--Magellan and ValueOptions--control 40 percent of the managed behavioral health care market. The 5 largest managed behavioral care companies control 50 percent of the market and the top 10 companies control 98 percent. But along with the mergers and the growth of these gigantic corporations, one problem has become clearer and clearer--these companies are now run by people who don't have a clue about how to deliver mental health services and, in the privacy of their own boardrooms, they're facing that fact. And so, even though they won't admit this publicly, they're surfeited with complaints and drowning in malpractice suits. So they're getting out of the behavioral care delivery business and beginning to reorganize themselves pretty much as third-party payers.
PN: So who will be stepping in to actually provide mental health care?
Cummings: The managed care companies are beginning to "outsource it--that's the word the industry uses for doing it out of house. For example, since the beginning of this year, Magellan, the largest managed behavioral care company with 60 million covered lives, has sold all the group practices it operated, most of them back to the providers themselves. They're now just administrators, completely out of the service delivery business. So the next great trend that we're starting to see is the emergence of large group practices run by providers who are taking over the delivery of health care. And the practices that are successful are those that have learned that if you concentrate on effective, efficient therapy, there's a bonanza to be made. They're out from under managed care--they now contract with managed care.