Hey there Reader ,

Wow it was quite the day in the Facebook group when I popped on that Thursday night and saw the Alma rates dropped 20% to match the 45-minute rate! Hey man, was that before I even knew that? They had also flattened the rates across MDs/NPs, & PhDs to match that of the master's-level providers. Boy, was everyone unhappy, and rightfully so.
​
It got me thinking about unions and owning the means of production. Ultimately, when you own the means of production, you are able to circulate wealth. What are these credentialing companies and "group practices," which are really just contract employment due to service to workers and ultimately extract. Even when they are clinician-owned, a current misnomer in wolf's clothing until you look at the further business structure of how they operate. What you need is a cooperative owned by the clinicians and employees. All clinicians and employees are given the opportunity for ownership in the wealth.
​
Unions have done a great job over the course of years to fight for rights and push back. Which is to say, the way we spend our money or use our labor to help other people get money is the most effective way we have to advocate.

• Stop spending at Bix Box Store? Big Box Store struggles!
• Going on strike? Great! Company can't sell products and make money.

What is most important is building a system that you can last in that can outlast. mutual aid in helping others in small ways builds the cooperative economy. Even if you are not a part of a cooperative, giving to and paying money to cooperatives is just one way you get to change the economy
​
However, unions alone become a little problematic when it comes to therapists, prescribers, and health insurance companies
​
​Why Insurances Are the Exception

We could not take insurance, as you're absolutely right, and yet one of the difficulties that remains is they continue to profit despite our taking of them or not. In fact, they might profit more because we're not taking the insurances. Their profit comes from the excess that is not spent, i.e., what they pay out to you. Ultimately, the change comes from a systemic shift away from that insurer as a whole, rather than just the therapist not taking insurances. I want to acknowledge that taking the insurance, or not, is your right and your choice - and I don't want to feed into a system that doesn't serve me either, which is why I don't take the two lowest payers in our state, Colorado. But it takes some extra steps more than that to just change how it works.
​
We at BWHealth are building our own electronic health record and paying for it, which means we aren't giving out to systems that are run on Amazon Web Services or backed by VC. does it cost more at the front end? Yes, absolutely. Do we save more money in the long run? More than likely, especially as we scale. then we'll have our own billing platform. Once we grow our numbers, our own health insurance that is self-funded, being able to self-fund our general practice and liability group insurance, heck, even own the property that we work on. Now that would be something, wouldn't it?

Though we do many things, negotiating insurance contracts collectively is one of the things we can't do with BW Health because we are the billing, credentialing, and business entity. To do so would be considered price fixing. However, there are organizations that exist and are often owned by health care systems that solve this problem
​
​Clinicially Integrated Networks ​
​
There is this legal thing called a clinically integrated network, also known as a consortium. These entities are legal entities that are allowed to negotiate payer and contract rates amongst the various providers that may be part of them. Often used by hospital systems and major health care organizations to be able to negotiate with their many hospitals in their one system. All of them are technically clinical entities, and for them to have the same negotiated contract can be viewed as price fixing. Health care systems often use a clinically integrated network to take on the burden of some of the administrative stuff from the insurance companies in return for a higher reimbursement rate.

Why can't we?

I came to wind of an organization called Medical Practitioners Alliance. Nurse practitioner out of Arizona. Her name is Julie - a totally real and fully licensed human willed this organization into existence, just as I am turning into the window like a buffalo with our cooperative. After two years, she's gone live and gone public and is attempting to collect 50 practitioners in every state - practitioners that are paying members of the association to which she can negotiate insurance contracts on behalf of. If you've ever been looking for someone who wants to stick up for you as a solo practitioner (outside of yours truly), Julie seems as though she is on the right track to getting what we need from the insurance companies for a higher reimbursement rate. Check them out, make your own informed decision of course.
​
​Support Us:

Now more than ever, a cooperative mental health system needs to exist, and we could use your support. $17 a month gets you insider access into the development of our cooperative: how we build ourselves, what's going right, what we need to work on differently. It gives you the inside scoop on all the business things that we have explored and developed over the course of a full year. If you've got the space for it, we'd love to have you.

$17.00 / month The Bridge: Inside a Developing Coop As therapists, we have the greatest of abilities to advocate for a different mental health care system that focuses on... Read more Lets Cooperate

​