morefire

main | table | intro| 1 | 2 | 3| 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | *

Chapter 14

More Fire

Dr. Herbert Sacks, Dr. Eist's successor and a staunch opponent of managed care practices, promoted Dr. Eist's initiatives on litigation, legislation, close cooperation with state societies, empowerment of advocacy groups, and public challenge to harmful manage care policies.

While Dr. Eist was still at the helm, a new election for APA President took place. The candidate against managed care was the then APA Senior Vice President, Rodrigo A. Munoz, a close ally of Dr. Eist throughout the anti-managed care struggles. His opponent was Dr. William Ayres, Past-President of the American Academy of Child and Adolescent Psychiatrists. Dr. Ayres took a conciliatory position, insisting that the psychiatrists should negotiate with the managed care companies.

By the time of the campaign, the anti-managed care forces had been growing rapidly, so that Dr. Munoz took two thirds of the votes and won in 49 of the 50 states. This was taken as a strong mandate to continue and enhance the struggle. This mandate required a new assessment of the APA potential as a strong force in American medicine.

As with most competing forces throughout the history of human conflict, the APA needed to drastically change during the period of competition, so that its structure and operations reflected clearly defined goals. Planning for change had existed in the APA for some 25 years. In 1998, a Strategic Plan Task Force initiated during Dr. Sacks' tenure permitted a reevaluation of the APA's vision, mission, values and goals. Advocacy for patients was clearly identified as a predominant focus of endeavor. At a time when merciless attacks weakened patient care, how could the APA become more adaptive and better prepared to defend them?

Planning with Dr. Eist and Dr. Sacks, Dr. Munoz and the new APA officers came to the conclusion that the organization needed to reinvent itself:

It should no longer focus on the usual membership matters that characterized medical organizations in times of peace: it should become a powerful agent for change. It should separate functions according to clearly defined strategies.

The APA should become a new organization with a structure centered around government relations, public affairs, membership issues and advocacy initiatives. This would require re-incorporating, and moving a number of tasks to a different corporation.

This different corporation, the American Institute for Research and Education (APIRE) rapidly became a reality, and has been in operation since early l999. In the meantime, the new APA, once all the obstacles are surmounted, will be functioning early in 2001.

Altruistic endeavors on behalf of psychiatric patients have their own niche in the American Psychiatric Foundation. A goal now is to make the Foundation the conduit for support of new initiatives that enhance the frontiers of rehabilitation and resocialization for the chronically ill. In the times of managed care, there has been an increasing need to explore ideas and strategies that benefit currently neglected patients, those who have no access to care because of a precipitous decline in funding for services.

Also in 1998, the decision was made to consolidate all of APA assests, so that the financial survival of the organization was guaranteed by a careful plan in which all assets had a role. This was accomplished with the help of newly retained staff that was prepared to develop carefully laid out long-term programs.

A direct response to managed care was formulated in the two areas of most controversy: quality and costs.

The managed care mantra has been that managed care strategies improve quality. This assertion has not been validated. A reason is that studying "quality" by itself is not possible. One can develop a protocol to study a medical diagnosis or treatment, develop indicators of quality, and study outcomes after the application of the indicators. This kind of research is just starting. In 1997 and l998, the APA developed a first report on quality indicators. The field studies according to diagnoses, treatments and diverse populations still are being developed.

Reduction of costs in employee health coverage is a confusing concept that may produce more damage than benefit to the employers. Employees are not costs. They are the main assets of most employers. In the information age, it is a mistake to see employees as costs to be handled by "Human Resources". They should be considered a productive asset to be handled by strategic planning. A $100 investment in Microsoft buys $1 of fixed assets. Most of the rest is human intelligence.

In 1998-1999, the APA obtained help from the Canadian Business and Economic Roundtable on Mental Health and from Dr. Mary Jane England to start a dialogue with the business community about areas of mutual concern. One of those areas is the strongest predictor of disability days lost, absenteeism for minor illness and on the job accident rates: the psychosocial work climate.

The APA envisions a time when employers do not try to save money by interfering with the employees' health care, but proactively helping them, so that employers can protect their best center of productivity and wealth.

The APA came to realize that the managed care invasion had been possible because the APA had not developed a cadre of experts on economic and financial issues that could successfully develop alternatives for better health care. In 1998, the APA started a Leadership Training Program that provides education on organization, finances and business strategies to young APA members with leadership capacity.

Also in 1998-99, the APA reorganized its components, changed its staff structure and developed new ways of attracting APA members to new programs. Such programs were envisioned to help people in prisons, in rural areas, in residential facilities, in poor areas of big cities, and in any other places where the mentally ill need assistance.

main | table | intro| 1 | 2 | 3| 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | *

©2000 Munoz and Eist, The People v. Managed Care


main \| table \| intro\| 1 \| 2 \| 3\| 4 \| 5 \| 6 \| 7 \| 8 \| 9 \| 10 \| 11 \| 12 \| 13 \| 14 \| 15 \| 16 \| 17 \| 18 \| *

	Chapter 14 *More Fire*

	Dr. Herbert Sacks, Dr. Eist's successor and a staunch opponent of managed care practices, promoted Dr. Eist's initiatives on litigation, legislation, close cooperation with state societies, empowerment of advocacy groups, and public challenge to harmful manage care policies.

	While Dr. Eist was still at the helm, a new election for APA President took place. The candidate against managed care was the then APA Senior Vice President, Rodrigo A. Munoz, a close ally of Dr. Eist throughout the anti-managed care struggles. His opponent was Dr. William Ayres, Past-President of the American Academy of Child and Adolescent Psychiatrists. Dr. Ayres took a conciliatory position, insisting that the psychiatrists should negotiate with the managed care companies.

	By the time of the campaign, the anti-managed care forces had been growing rapidly, so that Dr. Munoz took two thirds of the votes and won in 49 of the 50 states. This was taken as a strong mandate to continue and enhance the struggle. This mandate required a new assessment of the APA potential as a strong force in American medicine.

	As with most competing forces throughout the history of human conflict, the APA needed to drastically change during the period of competition, so that its structure and operations reflected clearly defined goals. Planning for change had existed in the APA for some 25 years. In 1998, a Strategic Plan Task Force initiated during Dr. Sacks' tenure permitted a reevaluation of the APA's vision, mission, values and goals. Advocacy for patients was clearly identified as a predominant focus of endeavor. At a time when merciless attacks weakened patient care, how could the APA become more adaptive and better prepared to defend them?

	Planning with Dr. Eist and Dr. Sacks, Dr. Munoz and the new APA officers came to the conclusion that the organization needed to reinvent itself: It should no longer focus on the usual membership matters that characterized medical organizations in times of peace: it should become a powerful agent for change. It should separate functions according to clearly defined strategies.

	The APA should become a new organization with a structure centered around government relations, public affairs, membership issues and advocacy initiatives. This would require re-incorporating, and moving a number of tasks to a different corporation.

	This different corporation, the American Institute for Research and Education (APIRE) rapidly became a reality, and has been in operation since early l999. In the meantime, the new APA, once all the obstacles are surmounted, will be functioning early in 2001.

	Altruistic endeavors on behalf of psychiatric patients have their own niche in the American Psychiatric Foundation. A goal now is to make the Foundation the conduit for support of new initiatives that enhance the frontiers of rehabilitation and resocialization for the chronically ill. In the times of managed care, there has been an increasing need to explore ideas and strategies that benefit currently neglected patients, those who have no access to care because of a precipitous decline in funding for services.

	Also in 1998, the decision was made to consolidate all of APA assests, so that the financial survival of the organization was guaranteed by a careful plan in which all assets had a role. This was accomplished with the help of newly retained staff that was prepared to develop carefully laid out long-term programs.

	A direct response to managed care was formulated in the two areas of most controversy: quality and costs.

	The managed care mantra has been that managed care strategies improve quality. This assertion has not been validated. A reason is that studying "quality" by itself is not possible. One can develop a protocol to study a medical diagnosis or treatment, develop indicators of quality, and study outcomes after the application of the indicators. This kind of research is just starting. In 1997 and l998, the APA developed a first report on quality indicators. The field studies according to diagnoses, treatments and diverse populations still are being developed.

	Reduction of costs in employee health coverage is a confusing concept that may produce more damage than benefit to the employers. Employees are not costs. They are the main assets of most employers. In the information age, it is a mistake to see employees as costs to be handled by "Human Resources". They should be considered a productive asset to be handled by strategic planning. A $100 investment in Microsoft buys $1 of fixed assets. Most of the rest is human intelligence.

	In 1998-1999, the APA obtained help from the Canadian Business and Economic Roundtable on Mental Health and from Dr. Mary Jane England to start a dialogue with the business community about areas of mutual concern. One of those areas is the strongest predictor of disability days lost, absenteeism for minor illness and on the job accident rates: the psychosocial work climate.

	The APA envisions a time when employers do not try to save money by interfering with the employees' health care, but proactively helping them, so that employers can protect their best center of productivity and wealth.

	The APA came to realize that the managed care invasion had been possible because the APA had not developed a cadre of experts on economic and financial issues that could successfully develop alternatives for better health care. In 1998, the APA started a Leadership Training Program that provides education on organization, finances and business strategies to young APA members with leadership capacity.

	Also in 1998-99, the APA reorganized its components, changed its staff structure and developed new ways of attracting APA members to new programs. Such programs were envisioned to help people in prisons, in rural areas, in residential facilities, in poor areas of big cities, and in any other places where the mentally ill need assistance.