Fighting the Confusopoly of Mental Health Care Payment: What Clinicians Can and Must Do to Protect Our Patients and Our Profession

Presented by:

Andrew Gerber, MD, PhD
President & Medical Director, Silver Hill Hospital

In this talk, Dr. Gerber will explain the current health care payment system in the US with a focus on what we, as clinicians, can do to fight for our patients and for the care we know they need. He will link the failures of the current system to the lack of meaningful progress in deploying known evidence-based practice to our patients, particularly for those with complex and/or severe illness.

The concept of “mental health parity” — a largely unenforced federal law since 2008 — will be explained and basic guidelines for how to evaluate parity compliance by payers (including evaluation of fair rates, denials, network adequacy, and generally-accepted criteria for medical necessity) will be outlined. Finally, Dr. Gerber will discuss our ethical and clinical obligation as clinicians to advocate for change in the system and enforcement of current laws so that our patients can receive better care.

Educational Objectives:

As a result of participating in this activity, you should be able to:

1. Explain the nature of mental health payment systems, focusing on how commercial (fully insured vs. self-insured) and government payers interact with providers and patients
2. Evaluate mental health parity-compliance (fair rates, denials, network adequacy, generally- accepted medical necessity criteria) by insurance payers
3. Identify key ways that we, as clinicians, can advocate for our patients and for the care we deliver in the current “confusopoly” of the health care payment system.

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