Minnesota has a well-documented shortage of psychiatrists, particularly those who treat children. Some of the reasons for the shortage are the many years of additional medical training that the profession requires and that the profession doesn't pay as well as other specialties.
Colleen Reitan, president and COO of BlueCross-BlueShield says this new reimbursement plan should make the profession more attractive financially.
"You can imagine a 20 percent increase each of the next three years means whatever people are getting, three years from now it's going be 60-percent greater," she says.
BlueCross's payment plan also changes the way that psychiatrists get paid. The insurer will now pay for time that psychiatrists spend on phone and e-mail consultations with primary care doctors, who are often overwhelmed by patients with mental health problems. Reitan says that idea came directly from psychiatrists.
"What we heard was, 'We could consult with a pediatrician as they are doing the frontline work of managing kids with attention deficit disorder. Can the reimbursement system, health plans for example, acknowledge that that's a good use of our time and resource and can we be paid for that?'"
While the payment plan applies to all psychiatrists who work with BlueCross, Reitan says it will likely generate the biggest salary increases for psychiatrists who practice independently or in community health centers. That's because the increase is tied to the health plan's general reimbursement rate for those types of organizations.
Whatever (psychiatrists) are getting, three years from now it's going be 60-percent greater.Colleen Reitan, President and COO of Blue Cross-Blue Shield
Psychiatrists who work for bigger employers like Park Nicollet, Allina or Mayo Clinic already receive higher payments for their services, so Reitan says they probably won't see much of a change.
Still, Reitan predicts the increased pay will apply to enough psychiatrists to make a difference. She estimates that 50 to 60 percent of mental health care in Minnesota is delivered by independent and small group psychiatrists.
The president of the Minnesota Psychiatric Society, Eric Larson, welcomes the Blue Cross plan. "I am happy for any kind of increase in reimbursement for psychiatry and mental health care, really all of mental health care, because of the tremendous reduction in funding over the past 20 years," he says.
Larson says there's still a lot of work that needs to be done to improve Minnesota's mental health system. But he says this change is a good first step.
"This will make it easier for people to take the time they need to take to really do good work," Larson says. Minnesota's other big health plans say they already have made significant changes in mental health reimbursement.
Medica spokesman Larry Bussey says his company has boosted psychiatrist pay by almost 30 percent since 2003. Bussey says Medica hasn't decided on future reimbursement increases yet. But he says the health plan does not view Blue Cross's decision as a challenge it must match.
"I think that all of us are looking at trying to provide a good and fair level of reimbursement," he says. "We've been working on it for a couple of years. We're going to keep working on it. And obviously we're glad that BlueCross is as well."
At HealthPartners, Vice President Andrea Walsh says her company also has increased its psychiatrist reimbursement rate in the past two years. She didn't want to discuss the specifics of the increase. But Walsh says psychiatric pay is just one part of HealthPartners' plan.
"What I can tell you is, we recognized and continue to recognize that there's been a shortage in psychiatry and that psychiatry payment rates were inadequate to cover the cost of providing services. So we believe we've addressed that issue and we've looked at it pretty holistically."
Walsh says HealthPartners has been working on increasing the number of mental health service providers to care for people after they've been discharged from the hospital. She says the health plan is tackling access problems at regional treatment centers, too.
For its part, Blue Cross-Blue Shield says it's not worried about extra costs associated with its new reimbursement plan. It says the plan should make the state's mental health system more efficient which will save money in the long-run.