Real World Health Care Blog

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What Comes Next: How to Find the Right Therapist

For the past several months, Real World Health Care has focused on the behavioral health issues that can impact people living with cancer, their caregivers and their loved ones. We’ve brought you insights from therapists, social workers and mental health professionals, and we’ve highlighted the numerous resources available from a variety of patient support organizations.

We’ve also shared information from our sponsor, the HealthWell Foundation, about its Cancer-Related Behavioral Health Fund, which provides financial assistance to individuals with a diagnosis of cancer to help with cost-shares for covered services rendered by behavioral health providers.

As our series comes to its conclusion, we are pleased to help our readers “connect the dots” by highlighting recommendations from Mental Health First Aid on how to find a good therapist. The following article was originally published by Franziska Ross on August 31, 2018 and is reposted here by permission of the National Council for Behavioral Health. Click here to view the original article.

Finding the right therapist can be a daunting task. This guide will walk you through the process, step-by-step.

Work with Your Insurance

One of the biggest barriers to therapy is cost, so most people want to find a therapist who is covered by their insurance. A good place to start looking for therapists who take your insurance is your health care provider’s website. Most provider websites have a “Find a Doctor” feature you can use to search for mental health clinicians near you, just like you would a physician. You can also select your health care provider on websites like PsychologyToday.com.

The Search – Things to Keep in Mind

Don’t get bogged down in the different professional degrees that a therapist can have – Ph.D., Psy.D., LCSW, LCMHC, etc. Any therapist who is licensed in your state has gone through rigorous background checks and training.

Some people have a strong demographic preference – men vs. women, for example. Unfortunately, finding someone who meets your exact criteria can be difficult. The good news is that you can still develop positive and productive relationships with a therapist who does not entirely align with your original criteria.

Most therapists list their treatment methods. They might say, for example, that they have a psychodynamic or behavioral approach. If you’re familiar with different approaches and you know what you’re looking for, great! If not, don’t worry. You can learn about the different general approaches online or wait to ask the therapist about their approach.

You might also want to take location into consideration. It’s helpful, for example, to pick a therapist who works near your home, work or school. Doing so eases the stress of transportation, scheduling and time.

Picking Up the Phone

Now comes the big (and often scary) step – making calls.

You have a list of possible therapists. It can be challenging to call a therapist without knowing them first. Some people find it helpful to make a list of talking points or a loose script to help guide the conversation. For example, you might start off with “Hi, my name is ___ and I’m looking for a therapist to help me work on ___.”

Asking Questions

In your initial phone conversations, therapists expect and appreciate questions about their education, licensure, experience and approaches to care. Asking questions can give you a sense of the person’s therapeutic style and if they could be a good fit. Here are some questions which you might want to ask: Where did you get your training? Do you have experience treating such-and-such issue or working with such-and-such population? Do you use evidence-based practices like cognitive behavioral therapy (CBT) or mindfulness? Do you take my insurance or have a sliding pay scale?

Availability – A Common Roadblock

Keep in mind that you might not be able to schedule an appointment with the first person you call. You might discover that your insurance provider’s records are outdated and some of the therapists listed no longer take your insurance, or maybe no one you initially reach is accepting new clients. It could take many calls before finding someone. Some people find it helpful to set up a schedule, a time to make and receive calls. When you leave messages, be sure to include your full name, call back number, times and dates that are best to reach you and your insurance information.

This is often a challenging and frustrating part of the search for a therapist, so it can be a good time to lean on those you are close with for support.

The First Session

The first few sessions are a time to explore if the therapist is a good match. Therapy can be uncomfortable, especially in the beginning, so it’s not unusual for the first few sessions to feel scary and awkward. However, an important sign if the therapist is a good fit is if you feel they create a space of emotional safety and comfortable physical boundaries.

A sign that the therapist is not a good fit is if they cross your physical or emotional boundaries in any way. If there’s something that would compromise your ability to have a good relationship with a therapist, don’t ignore it. Instead, try to schedule an appointment with a different therapist. Seeing multiple people can feel like a lot of effort, but finding the right person is worth it.

Good therapy is based in a good relationship. A healthy part of therapy for many is having a conversation about the therapist-client relationship. If the relationship doesn’t feel right, it’s okay to tell your therapist how you feel about the dynamic and that you might need to see someone different. A good therapist will be open to that conversation and will support you through that decision.

Empower Yourself

As a client it’s important to empower yourself. Therapists have a code of ethics which they must follow. The code of ethics for social workers and the code of ethics for psychologists are both available online. These are good references to have in the case of any inappropriate behavior or if you think your therapist has crossed a boundary. You can also report any inappropriate behavior to your state licensing board.

When Therapy Isn’t an Option

For many reasons – family, location or money – therapy simply isn’t an option for some people.

Unfortunately, many people still do not have access to insurance. In these cases, integrated care facilities like Certified Community Behavioral Health Centers (CCBHCs) and Federally Qualified Health Centers (FQHCs) are good options because they provide care regardless of an individual’s ability to pay.

For those who do not have access to therapy but need help, hotlines are a great resource. There are many different regional and national hotlines available that provide support for different issues, including suicide, sexual assault and domestic violence. Trained advocates will support you through both critical and non-critical situations – you do not need to be in an immediate danger to call. While hotlines are not a substitute for counseling, they can be an important source of support.

 

Four benefits of electronic health records

Leaders from industry, academia, and health care discuss the rollout of this technology at The Atlantic’s sixth annual Health Care Forum

Today The Atlantic Health Care Forum brought together leading policymakers and industry experts in medicine, public health, and nutrition to have conversations about the state of the nation’s health care system. The event was sponsored by Siemens, Surescripts, WellPoint, GSK and PhRMA. Real World Health Care attended to share insights from the panel “Health Care Tomorrow: Examining the Tools and Technologies that Will Revolutionize the Future Health Care System.”

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Much of the discussion centered around electronic health records, which are increasingly being rolled out in huge hospital systems after the federal government incentivized their adoption to the tune of billions of dollars five years ago. Four themes emerged from the panel, which included top executives from Johns Hopkins Medicine, athenahealth, PhRMA, and Carolinas HealthCare System.

 

1. Enhancing collaboration.

Electronic health records facilitate a team-based approach to hospital care, as well as allowing for better coordination between hospital systems. “What we’re going to see is it’s going to drive team-based clinical care because everyone in the system will have access to the same medical records,” said Dr. Paul Rothman, Dean of the Medical Faculty and Vice President for Medicine at The Johns Hopkins University and Chief Executive Officer at Johns Hopkins Medicine. “You’re going to see an [increased] level of collaboration not only between delivery systems, but also between the patient and the health care provider.”

However, Ed Park, Executive Vice President and Chief Operating Officer, athenahealth, warned that the decades-old technologies that many hospital systems are using are limited in their capabilities. “The current crop of [electronic health records] are documentation tools instead of care management tools,” he said, adding that they are primarily for use by insurers and lawyers. “What I fear is health systems beginning to buy their way into their own prisons that are built of their own IT…as opposed to dealing in an open environment,” he said.

 

2. Enabling patient-centered care.

Electronic health records enable patients to reap greater benefits from telehealth. “Having your information on your iPhone: that’s not far away,” Dr. Rothman said. “[Patients are] going to do EKG’s at home. They’re going to be measuring their blood sugar at home. The patient will have control of the data.”

Electronic records also hold the promise of helping to solve age-old problems in the U.S. health care system, including keeping contact with patients to encourage them to take prescribed treatment regimens. “There is almost $350 billion a year in inefficiency because of lack of compliance and adherence with medications,” said John Castellani, President and Chief Executive Officer, PhRMA. “If you could just get an improvement in whether patients take the medicines that are prescribed, you could capture this great savings.”

“You have kids who have kidney transplants, and you can give them reminders on Facebook that they have to take their medications,” Dr. Rothman added.

 

3. Targeting therapies for increased success.

Electronic medical records can help health care providers ensure that they prescribe the treatments most likely to work for their patients.

“What I think is the promise of electronic medical records is our ability to find subsets of diseases through the broad diseases we treat,” Dr. Rothman said. “Asthma isn’t one disease. Obesity isn’t one disease. Diabetes isn’t one disease. We are going to be able to find subsets of diseases and target therapies [that work]. That’s when you’re going to see efficiency and return on investment.”

 

4. Harnessing the power of big data.

Our health care system has already begun to see the benefits of ‘big data’ with examples such as the discovery of drug side effects and interactions through mining consumer web search data. “We have to use the technologies to bring down the cost of the drug discovery process,” Castellani said.

“Just taking care of the patient, we capture data,” said Dr. Roger Ray, Executive Vice President and Chief Medical Officer, Carolinas HealthCare System. “That allows us to know when a patient…may be at risk for hospital readmission. Having the ability to mine [data]…makes a difference for patients.

“We all, each of us, remember with longing a simpler time when we could scribble and walk off and our job was done,” he added. “What we know now is that’s not very good for the patient. We had no standardization allowing us to help patients avoid lots of different bad outcomes they could have.”

 

Have electronic medical records impacted your health or that of your patients? Share your thoughts in the comments section.

The President and His Stent: How the Patient-Physician Relationship Represents What Works Best in U.S. Health Care

BassTed_jpg

Dr. Ted A. Bass

The decision by former President George W. Bush and his doctors to treat a blockage in one of his heart arteries with angioplasty and stenting has become the newest chapter in the intense debate over appropriateness in stenting.

Bush’s physical examination revealed irregularities that led to tests that revealed a blockage in his coronary artery, which Bush and his doctors decided to treat with a stent, according to his statement. That he was not having a heart attack and apparently had not felt any symptoms, such as chest pain, brought objections from those who would place sharp limits on the use of stents.

Only President Bush’s physicians and family know what alternative therapy choices were presented to Bush, but we do know medical advances allowed him to choose from several therapeutic courses. Bush, in consultation with his doctors, chose the one that was right for him and the quality of life he wished to maintain.

High quality medical care is patient-centered. We strongly value the right of patients, with their doctors, to make informed choices in line with their health and quality of life goals. This right is threatened by critics who would “reform” the health care system by ignoring the complex nature of medicine, cardiovascular disease and the individual needs of each patient.

For those who are quick to dismiss the benefit of stents, I would encourage them to speak to our patients. As a practicing interventional cardiologist, I see first-hand the benefits of interventional cardiology procedures. I see it when a patient’s life is saved during a heart attack, in infants born with a serious heart defect whose hearts beat strong because of advances of interventional care and in seniors who enjoy productive lives again after a minimally invasive heart procedure. In patients with stable coronary artery disease, stenting reduces chest pain from poor circulation of the heart arteries, decreases the need for repeat procedures, and improves the overall circulation of the heart.

And this is what the President Bush case demonstrates:  Health care decisions must be made between the patient and his or her doctor. As outsiders in the Bush case, we do not presume to make that decision for him – nor should others. While it is important to review patient cases to continually improve, learn from and advance the science of medicine, we must not judge the appropriateness of a medical decision on the basis of limited information. To do so is to rush to a judgment that is short sighted, uninformed and, ultimately, emphasizes attention-seeking soundbites over patient care.

In our quest to reduce costs and ensure that appropriate and optimal treatment is provided to each patient and is in step with the guidelines, let us not forget the doctor-patient relationship at the heart of all we do as physicians. It is a fundamental trust that must not be jeopardized.

Now tell us what you think. Do you agree that stents are beneficial to patients? Why or why not? What does the case of President Bush illustrate in terms of the doctor-patient relationship?

When the Health Care Blogger Becomes the Cancer Patient

The call came the day after my 48th birthday in April.

“The radiologist saw something suspicious on your mammogram from last week…an undetermined mass,” said the voice on the other end of the phone. “We’d like you to come in for an ultrasound so we can see better.”

Linda Barlow

Linda Barlow

During the ultrasound they assured me that it was probably nothing…that in most cases, it’s a benign lump and not cancer. Surely, I thought, as I scheduled a needle biopsy for a few days later, this would be the case for me as well.

But it was not the case. Once the results from the biopsy came back, I realized that I had become a cancer patient. I was now part of a community of more than one million other Americans who are diagnosed with cancer each year.

The days and weeks after that ultrasound and needle biopsy became a whirlwind of doctor’s appointments, tests, and procedures, as well as surgery to remove the lump in my breast, along with several lymph nodes. As of this writing, I’m undergoing six weeks of daily radiation treatments, and soon will be starting drug therapies that will last for at least five and up to 15 years.

Just when I started to recover from the surgery, the bills started to roll in. I have what I thought was pretty good (but expensive from a premium standpoint) medical coverage under my husband’s workplace plan. But even with premiums that are far higher this year than we’ve ever had to pay in the past, the system demanded more of our money:

  • $334.43 for one ultrasound
  • $106.04 for another ultrasound
  • $35.49 for an oncologist office visit
  • $131.15 for a nuclear medicine injection prior to my sentinel node removal
  • $421.80 for my lumpectomy
  • $468.61 for lumpectomy prep work
  • $181 for the surgeon who removed the lump
  • $60 for post-surgery physical therapy
  • $737.45 for oncotype diagnosis test

These are just a few examples and don’t include charges relating to the 30 radiation treatments I’ll be receiving or the genetic testing being done (since cancer runs in the family).

While these out of pocket costs are certainly hard to swallow – I can think of a hundred other things I’d rather spend my money on – for my family, they are doable. We won’t have to skip a mortgage payment or a utility bill. We won’t have to dip into a child’s college tuition fund. We certainly won’t have to worry about having enough money for food.

But I know – from my work on this blog and with its main sponsor, the HealthWell Foundation – that many families living with cancer aren’t so lucky.

I had the opportunity to help HealthWell create a White Paper, “When Health Insurance is Not Enough: How Charitable Copayment Assistance Organizations Enhance Patient Access to Care,” which investigated the devastating effects of not being able to afford needed treatments for chronic and life-altering medical conditions. For some individuals and families, out-of-pocket expenses including deductibles, copayments and coinsurance can total thousands of dollars each month – much more than many people earn.

That’s not the case for me. I’m one of the lucky ones.

“I’m lucky” is a statement you don’t often hear from cancer patients, but it’s how I feel about my situation. I’m lucky that my cancer was caught early by an astute reading of my mammogram. I’m lucky that my specific type of cancer was deemed “curable” and didn’t spread to my lymph nodes or other organs. I’m lucky that my job as a freelance writer gives me the flexibility to go to doctor’s appointments when needed. And I’m lucky to be in a two-income household with no kids and the easy ability to pay our bills. For now.

Of course, this could all change in a heartbeat. My freelance assignments could dry up, which would impact our income. My husband could lose his job or become disabled. We could be hit with an unexpected and costly disaster like a house fire or a tree crashing through our roof. The cancer could come back.

I am, in effect, a heartbeat away from being in a position to need real financial help.

If I need help, I’m thankful that charitable copayment assistance foundations like the HealthWell Foundation exist. Cancer isn’t something you can put on the back burner until the time or money is right. Treatment is costly. Premiums and copayments are high. For the 29 million Americans with limited incomes and/or inadequate insurance, the toll can be devastating – physically, emotionally and financially.

That’s why I’m calling on readers of this blog to help. Your donation to the HealthWell Foundation, the American Cancer Society or other charitable assistance foundations really will make a difference. Maybe not for me personally, but certainly for the millions who aren’t as lucky as me.

Categories: Cost-Savings