Are we cost increasers or cost decreasers?
Given cost pressures in ACO payment structures, how do neuropsychologists avoid being viewed as a big downstream expense in an episode of patient care, and instead become specialists that PCP’s want to refer to? One strategy is to help primary care providers meet ACO quality measures like improving patient blood pressure and glucose levels, and to help patients avoid unnecessary hospitalizations. When expensive hospitalizations are avoided, ACO's meet financial benchmarks. When quality measures are met, ACOs have access to their financial incentives.
For many neuropsychologists, "owning" basic healthcare (like blood pressure or asthma control) is a fundamental shift in professional identity. From professionals who answer questions about "what is the diagnosis?", and "how can we use the cognitive data to improve patients work, family, and academic lives?" to : "how can this data also be used to intervene in patient’s health status." Other neuropsychologists, who for example work on transplant teams, or in pediatric diabetes clinics, already have embraced basic health as part of their domain.
Neuropsychologists who "own health" still diagnose cognitive syndromes. But to be successful players in this new healthcare system, it is critical to also own the bigger question of how our data can improve patient’s health.
How can we use our cognitive data to improve healthcare?
Cognitive and psychological data, gathered in the course of a neuropsychological evaluation, can be used to create an asthma care plan for a child with ADHD, and thereby reduce their ER visits for the year. Maybe the attention and organizational problems result in Jonny forgetting his inhaler at school. Family dynamics, including a parent with ADHD results in lack of consistent vacuuming and dusting in the house, or forgetting to take medications to a divorced parents house on weekends. The neuropsychologist can think through the implications of the emotional, family systems, and cognitive data and apply it to creating a reasonable asthma care plan, and then sitting with the family stakeholders for a couple of sessions to educate them and ensure buy in.
Similarly, neuropsychologists might begin to treat the fact that our elderly patient is unlikely to be taking her hypertension medications correctly as a crisis that we need to intervene with immediately with her primary care team.
Pediatric neuropsychologists have a rich history of doing this in educational settings. We have "owned" our patients' educational experiences. We regularly use our cognitive and psychological data to answer the question, how can we help teachers be more effective with this student? How do we help the family support our patients with homework and study routines? What family systems issues are getting in the way of this student"s progress? We are prescriptive in setting up specific education plans. We can use these same skills to intervene in the medical domain. we have already gathered rich cognitive and emotional data, why not put it to work for our physician referrers?
Share your techniques
We are collecting examples of how neuropsychologists are doing this in everyday practice. Neuropsychologists who work in diabetes centers or transplant teams may have multiple ways of accomplishing the goal of concretely utilizing cognitive data to improve healthcare. Neuropsychologists in private practice may just be starting to experiment with this. Please send in your examples. We will post them on the site. In this way we hope to encourage active experimentation and brainstorming.