I was just reminded by Liz Z. on a poll comment (there’s still time to weigh-in on the one-question poll btw, and read the interesting comments) about BCBS alliance with BHL consulting group and the TOPS. I think this was a timely reminder for myself and any who are feeling discouraged at our work.
When BCBS first rolled the TOPS out, we were all flooded with propaganda about it, how it was going to revolutionize things. And there were the subtle incentives (a higher rate for those who filled out the form) and the not so subtle disincentives (those who did not fill out these forms would be required to do more onerous authorizations ultimately.) I remember the time I got back the results with one of my higher functioning patients, recently unemployed, who had endorsed “had unwanted thoughts or images,” and was considered at high risk for psychosis. I remember trying to embrace the TOP process and then I remember feeling alternately angry and insulted.
It seemed like the TOP was here to stay, and then it wasn’t.
The TOP failed to stick because we refused to do them. We objected on legal grounds, questioned its validity, and most importantly took action by refusing to do them. Websites like this one sprung up:
And now a year later, the TOP is rapidly becoming a distant memory. I think the moral to the story is that we can effect change. I hope that we can galvanize ourselves in the coming months and not take the “you can’t fight city hall approach.”