December 4, 1998

APA Medical Director Steven M. Mirin, M.D., outlined his strategies to make APA more responsive to member needs and to communicate its message and activities more effectively to policymakers, legislators, and the public.

Mirin told the APA Assembly at its meeting last month in Washington, D.C., "It's abundantly clear from our membership data and contact with members throughout the country that there is deep concern about APA's ability to act effectively on behalf of its members."

"We are all frequently asked, 'What is APA doing for me and my patients?' and 'Am I getting value for my dues dollar?' Considering the clinical and economic environment in which care is now being delivered, the concern of our members is not all that surprising."

Mirin noted that managed care has been driving a decline in reimbursement for psychiatric services and a fundamental questioning of the value of psychiatric care by the payers.

"As we prepare to enter the next millennium, our members appropriately ask where is all this going. Will payers and managed care companies recognize the value of comprehensive treatment? Will they realize that a biopsychosocial approach to care in the long run will be more cost-effective than the discontinuous and fragmented care too many patients now receive?"

Mirin suggested that rather than wait for answers, APA should pursue a viable strategy that includes legislative, regulatory, and legal remedies.

"In the next Congress, we and our strategic allies must pursue a coordinated legislative strategy to make parity, patient protection, and privacy of medical records a reality. At the same time, we must continue to work to enhance public understanding of mental illness and its economic toll on society and take the lead in developing standards of care for our patients and the clinical tools that will help our members meet those standards," said Mirin.

This will require a coordinated strategy and close collaboration among various parts of APA, including the governing bodies, councils and other components, staff, and district branches. Mirin noted that differences of opinion, misunderstandings, and failures of communication are all too frequent.

"As one step toward improving our organizational effectiveness and efficiency, I established an APA office less than a year ago devoted to enhancing the relationship between the central APA and its district branches. Since then, APA has taken a number of initiatives including creating a list serve for DB executive directors and another one for presidents and presidents-elect, surveys of DB's to ascertain their needs, and staffing a number of components directly related to DB issues."

However, a great deal more needs to be done, noted Mirin. "If we are to recruit and retain members, reduce our operating costs, and advocate successfully for our members and our patients, APA's central office and the DB's must move toward shared communications and information infrastructure."

Some of the steps planned include an online electronic news service for members and a merged government relations and public affairs list serve and activities, said Mirin.

To facilitate this process, APA will hire a chief financial officer and a chief information officer, who will oversee the growth of the electronic communications project and information management system. They will also provide timely data to help the governance structure and the membership charged with carrying out the fiduciary responsibility for the organization, said Mirin.

APA officers will also work with the district branches "to assure that what we do in Washington is consistent with their needs and goals," said Mirin.

He also noted that APA has been ineffective in communicating to external audiences the message that APA "does an enormous amount of good for our members and profession." An association marketing expert engaged by APA four months ago has reviewed APA's efforts in this area and made recommendations for improvement, according to Mirin.

"He suggests that we are far from having the capability to understand what our members need and want from APA and being able to rapidly and effectively communicate what we are doing on their behalf."

Mirin will present to the Board of Trustees in December a proposal to reorganize a portion of the central office "into a functionally integrated and more effective division of communications and marketing."

"As we prepare to close out this century, it's clear that thanks to the DSM, our annual meeting, and the cyclical upturn from pharmaceutical advertising in our journals, APA is experiencing a long period of fiscal stability, which like all financial cycles must eventually come to an end."

Mirin urged taking action now to make structural changes and investments necessary to improve APA's ability to make sound decisions, enhance its operational capability, and reduce its reliance on member dues.

"To continue to do good, we must continue to do well. I pledge that I will work with you and do my part to ensure that this happens. So, as we enter the next century, we will have the infrastructure and working relationships needed to pursue the strategic goals that are vital to our field, members, and patients."