The Future of Healthcare: Why insurance companies should cover ‘mental hygiene’ visits, With Dr. Sabina Rebis
General health includes good mental health so it should all really fall under one umbrella. There is too much emphasis on categorizing. This is one reason why the opioid epidemic became what it became. Pain level measurements were tied to insurance reimbursements in the 1980’s and 90’s and so doctors were required to measure, and then improve pain levels on a very basic level in a hospital setting to maintain funding for healthcare. Why so much focus on pain? Well pharmaceutical marketing may have had something to do with that. But subjective pain is not only physical. The brain can interpret psychological trauma as pain. Narcotics block those pain receptors. I believe that the opioid epidemic became what it became because due to archaic stigma and skewed advertising, taking a narcotic for pain became a substitute for mental health management. I’d go as far as to say that the opioid epidemic is a result of viewing those two tracks as separate. Insurance companies need to work on a way to cover “mental hygiene” visits. Everyone should have behavioral change/mental health services available to them. Right now, you need a diagnosis with an ICD 10 code to get mental health coverage, but many chronic illnesses stem from just bad habits that could easily be overcome with some behavioral changes.
I had the pleasure to interview Dr. Sabina Rebis of The Model of Health. The Model of Health is a resource for timely health news, tips, and trends to help everyone achieve optimal health. Motivation starts with inspiration! Dr. Sabina Rebis is committed to inspiring everyone to choose a healthy lifestyle by providing researched-based information, products, and recipes.
Thank you for joining us Dr. Rebis. Can you tell us a story about what brought you to this specific career path?
My mother was a doctor so medicine was a part of my life from the beginning. At 5, I had real tongue depressors in my toy doctor bag. But my mother discouraged me from the career path because juggling life with the career in medicine was a challenge.
So I majored in journalism while at NYU. I interned at my favorite teen magazines which was an incredible experience because I got to actually live in the behind the scenes of Seventeen magazine for a while. I realized that I was drawn to the health and wellness topics at the magazine. I decided on medical school because I wanted to help people directly and I wanted to have the background to write about health.
Can you share the most interesting story that happened to you since you began leading your company?
Every patient has an interesting story. You meet so many great people with so many various backgrounds in this profession. I have met the owner of a moving company who executes moves for the Vice President and White House, an elderly couple in their 63rd year of marriage who lived through the real-life version of “Once Upon a Time In Hollywood”, and a “playscape” builder for celebrities. Who knew playscapes were a thing?
What do you think makes your company stand out?
The Model of Health is a website that is meant to answer health and wellness questions accurately at the most basic level. I hope to be a relatable voice with a knowledge base that makes sense to those without a medical background.
What advice would you give to other healthcare leaders to help their team to thrive?
I’d say that the best way to relate to your team and patients is to connect on a level playing field. We’re all human. Staying positive and what I call “thinking up” is key. If something negative happens, the first thought of a healthcare leader should not be criticism but how can I improve the situation. Think up, not down. With great power comes great responsibility.
Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Well, to clarify, according to the study the US ranked last or close to last in access and in equality of coverage. It did not rank the lowest in medical advancement, innovation, or care provided by physicians.
Why? Reason number one is because we do not have universal coverage in this country, so access to care comes with barriers, like copays and deductibles. In the US, you can only obtain government aid below a certain income level. If you have private insurance and are in the middle-class category, there are often high deductibles to meet. Middle class adults sometimes have to choose between paying a deductible for their own care or paying for the braces their kid needs.
There are some drawbacks to universal coverage too — wait times for scheduled tests may be longer for example, since everyone is on the same plan.
Yet on the other hand you have to take into consideration all the hoops providers and patients have to jump through to obtain insurance approvals for testing, pre-authorization approvals for medications, billing discrepancies which all lead to administrative inefficiency. Getting an advanced imaging study approved by an insurance company, like an MRI, is never a simple process.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
I think that if you pay taxes in this country you should have access to care . I believe that we should have a right to choose where our taxes go, so altering the distribution is one solution.
Over 1/3rd of middle-class paychecks go to taxes and yet not everyone who pays those taxes can afford healthcare. I once worked with a medical assistant who had health insurance and ended up in the hospital but had to plead bankruptcy because she was a single mom with a kid in college, her deductible was high, and some of the services were not covered by the health insurance she had. That’s unacceptable. And the scary thing is, there are mirror images of this story all over the US.
Second, I do believe that redistributing healthcare resources if we were to have universal care would give everyone more access, as some individuals overuse these resources.
Third, The FDA should lower their threshold for what ingredients land in food and medicines. There is no need to have sugar or Red #40 in tomato sauce and how the heck did the carcinogen, NDMA end up in Zantac?
Number four — I would hope to see some of those taxes go to an education fund that would decrease student loan amounts when pursuing higher education. Stress is the leading cause of death. It leads to bad habits and chronic illness. Kids start stressing in their teens over educational costs.
I’d like patients to have direct access to their lab values, screening test reminders, and prescription history on an interface where this is explained. Many healthcare facilities are already implementing some part of this, but for some reason there is still a gap in information. Patients come in unsure of the medications they are on or what those meds are for. Doctors should act as guides and not health dictators. Your health belongs to you.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
General health includes good mental health so it should all really fall under one umbrella. There is too much emphasis on categorizing.
This is one reason why the opioid epidemic became what it became. Pain level measurements were tied to insurance reimbursements in the 1980’s and 90’s and so doctors were required to measure, and then improve pain levels on a very basic level in a hospital setting to maintain funding for healthcare. Why so much focus on pain? Well pharmaceutical marketing may have had something to do with that.
But subjective pain is not only physical.
The brain can interpret psychological trauma as pain. Narcotics block those pain receptors. I believe that the opioid epidemic became what it became because due to archaic stigma and skewed advertising, taking a narcotic for pain became a substitute for mental health management.
I’d go as far as to say that the opioid epidemic is a result of viewing those two tracks as separate.
Insurance companies need to work on a way to cover “mental hygiene” visits. Everyone should have behavioral change/mental health services available to them. Right now, you need a diagnosis with an ICD 10 code to get mental health coverage, but many chronic illnesses stem from just bad habits that could easily be overcome with some behavioral changes.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider goes above and beyond to ensure the best outcome for the patient they are caring for. It is a privilege to care for another human being.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I believe that Mark Twain said it best, “Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover.”
As a physician, I do face preconceived expectations of how a physician is “supposed to be”. I tend to live outside of the box by living by the above quote. If I only get to do this once, I want to live on my terms.
There was also a quote that came in my Birchbox a few months ago that’s hanging on my home office bulletin board. “invent the reality you want to live”. At least, I’ll die trying!
Are you working on any exciting new projects now? How do you think that will help people?
The Model of Health is a health info site and blog that is my sole project at the moment. Since internet access leads to healthcare access in your own home for those who may not have it, I hope to expand it to a multimedia resource for those who need some wellness guidance from a licensed physician.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
- When Breath Becomes Air by Paul Kalanithi — The read is a good reminder why we should all be a little kinder to each other.
- The Art of Racing in the Rain by Garth Stein — I am a huge fan of dogs. This book is written from a dog’s perspective and makes you appreciate your furry friend.
- Ted talks are always an inspirational listening experience. I recently listened to Anne Lamott’s 12 truths I learned from life and writing and loved her quote “Almost everything will work again if you unplug it for a few minutes, including you.”
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?
A back to the basics movement that would encourage stepping back from our overstimulating environment to connect with and appreciate the natural wonders of our planet and nourish our human connections more often.
How can our readers follow you on social media?
- Twitter @modelofhealth
- Instagram @modelofhealth
- YouTube @modelofhealth
- Facebook Page: The Model of Health