Health inSite: Wellbeing or Wellness?

We provide wellness sessions for a number of our clients, integrating the wellness component into the overall Employee Assistance Program (EAP).  To recap what MINES considers an EAP to be:

• An employee benefit: Free-to-the-client counseling or coaching sessions for the employee and their household members on topics ranging from workplace to personal issues.
• A management benefit: Supervisor / Manager training, work-performance referrals, and management consultations that help management work more effectively.  (For some of our clients, this is like adding a part-time HR assistant!)
• A work/life component: Including access to an online behavioral health portal with articles on all aspects of work/life balance, concierge referral services for help in finding and accessing resources like college planning, legal and financial coaching, and trainings related to interpersonal, stress, and other wellbeing topics.

This layering of benefits is more robust than a typical “embedded” EAP that is offered as part of a health plan.   These do not usually provide heavy promotion and oftentimes do not extend to the many management benefits that MINES includes in our EAP.

But a few months ago we were preparing for a presentation of this more integrated model and discussing the unique selling proposition of this program and how we wanted to position it in juxtaposition to our other Employee Assistance offerings.  When we charted out the program, we found that we had two very large changes that were being considered under this new program proposal: 1, we were looking at a more holistic approach to the health of the employee that honed in on outcome-focused behavioral change, rather than just incentivizing program participation (meaning that we were giving employees the opportunity to affect many dimensions of their health from the emotional to the physical to the financial and occupational); and 2, we were offering a way for management to interact with their employees in a way that was much more integrated than many wellness programs typically do.

By creating an offering that was integrated into the social fabric of the company, rather than simply proposing a commoditized offering, we uncovered a significant change in the way that we wanted to present this program.  We changed the program from an EAP with a wellness component to an Organizational Wellbeing System.

To distinguish these two terms from one another, and why we thought we needed to change our language for the proposal: wellbeing is differentiated from wellness, as defined by Merriam-Webster, by the former term’s incorporation of total prosperity.  Prosperity, we thought, had the added quality of openness to more dimensions than wellness had available to it.

We believe that this difference is significant, especially when considering the future of healthcare in the United States.  Regardless of what the Supreme Court decides about the legality of the Affordable Care Act, there are changes coming in the landscape of health and we at MINES believe that we are moving in the direction of a more integrated, network-based HEALTHcare as opposed to single person SICKcare.  As we’ve mentioned in some of our other postings recently (PPACA Roundup: Part II, Community is the Key to health, Halo effects and Link Influence), the brief therapy model has significant implications for treatment adherence in more than just substance abuse and mental health issues and we’re prepared for a more involved role with the whole wellbeing of the individual, their social network(s), and the population as a whole.

To our health,

Ryan
Marketing

PPACA Roundup: Part II

This is part II of a two part series on the impact of the Affordable Care Act and where employee assistance/wellness may have a place in the discussion.

Known Solutions

One of the most compelling bodies of research for providing coverage for all comes from the mental health sector in the form of Employee Assistance Programs (EAP) that are offered by almost all of the largest employers in the country. EAP’s typically offer free counseling or psychotherapy sessions to anyone in the employee’s household. This reduces the barriers to access (such as co-pays, deductibles) and allows for earlier intervention. The medical cost offset literature is very clear that as co-pays go up, individuals with chronic illnesses and limited income such as those that may be enrolled in Medicaid programs defer purchasing medication even though not taking the medication eventually will result in serious medical complications. Having no insurance will increase the probability even further that “healthy” individuals will be even less likely to seek medical care than other populations when they need it because of the barriers to access, thus driving up costs in the public sector, or contributing to medical bankruptcies when treatable illnesses become complicated later in the course of the illness.

Beside early access and cost reduction, the future of our health as a country lies in proactive wellbeing interventions. As one of the most obese countries in the world due to our over-reliance on processed foods, high carbohydrate diets, and excess animal protein consumption, our medical costs are only going to continue to sky rocket unless we start applying what we know from the behavioral health research related to adherence and relapse on health behavior. Using wellness coaching to modify health beliefs, food choices, exercise adherence, and other healthy behaviors will not only save lives, it will improve the quality of life for all of those in the community. The Social Psychology of health research indicates that “your friends’ friends make you fat.” The converse is also true; they can also make you healthy.

If that’s not enough…

We also know from the literature that simply being healthy does not exist in a vacuum and that, in fact, just because one happens to be healthy now, does not preclude them from treatment planning.  Healthy people need to exercise, they need to choose whole and nutritious foods, and they need skills development to help them affect cohorts in the workplace.  The idea that has been put forward that suggests that healthy people don’t need insurance, or more precisely, don’t need to engage in the healthcare market, ignores the continuum of health.  We don’t innately become or stay healthy, that comes from behavioral decisions, influenced or bolstered by our social networks.  Therefore, every person we enroll in a healthcare plan leads to 2nd and 3rd link solutions for others within the network.

ROI

The return on investment for the individual, the employer, and society is significant. For example, EAP’s have been shown to return $4.00 to $22.00 per employee per month. The difference between these two numbers is largely due to the panoply of programs available and the ways in which these proactive programs are promoted. The medical cost offset literature for treatment of co-morbid mental health diagnoses and medical conditions would more than pay for the cost of the premiums to the individual. The savings to the U.S. government (thus its citizens) of not having to bail out the insurance companies would be in the 100’s of billions.

Conclusion

There is precedent that even though we as U.S. citizens have our civil liberties (which have been seriously compromised in the last ten years) and freedom of choice, in some cases those choices are limited because of the negative impact on the community. For example, drug testing to ensure safer work places, lowered speed limits in school areas, and even paying into the Social Security system are all ways that we, as a community, have come together to make a decision for the benefit of all. Having a fully-insured population for this country falls into the same societal good ethics argument and this is what makes our country great!

Robert A. Mines, Ph.D.
CEO & Psychologist

Ryan Lucas
Marketing

PPACA Roundup: Part I

This is part I of a two part series on the impact of the Affordable Care Act and where employee assistance/wellness may have a place in the discussion.

Nature of the problem

There is interesting disparity in understanding regarding the health care reform act and the impact on requiring individual coverage. The assumption is that it violates individual freedom of choice and will be costly to that individual.  But in actuality, the impact of the individual coverage tax penalty of the Act will affect only 2% of the population.

Some thoughts on the PPACA

Last week, the Supreme Court of the United States held 6.25 hours of discussion regarding three pieces of the PPACA: severability, the constitutionality of the individual mandate, and the effect of overturning the mandate.  To listen to the various sessions that occurred, you can find those here:

Day 1: Department of Health and Human Servs. v. Florida
Day 2: Department of Health and Human Servs. v. Florida
Day 3: National Federation of Independent Business v. Sebelius

In these many arguments, some interesting points stand out to us (please keep in mind that we’re not lawyers, we are behavioral health experts):

1. Choosing to not purchase something is still a decision of commerce.  Choosing to not purchase today may result in increased cost tomorrow and therefore deferring the decision is an increased risk to the overall economic fabric. Further, deciding to not engage in the economy is in its own right still engaging with the economy as choosing to not purchase something means that the demand/supply relationship is affected by not purchasing.
2. It would seem that since Massachusetts already has an individual mandate within the state, and that there are no limitations to traveling across or emigrating to other states within the Union could mean that one could defer purchasing insurance until a critical or chronic condition occurred and move to Massachusetts and increase the liability and cost of the risk pool, thereby adversely affecting the Massachusetts healthcare burden and budget.

From a Social Psychology perspective, it is clear that choosing, or not choosing, to participate in a program that ultimately will be utilized by the greatest majority of citizens at some point in their lives, is a behavior of short-sighted self-interest and poor, long-term risk management.

Impact

If the Supreme Court overturns the tax penalty portion of this law, there are projected scenarios that include bankrupting insurance companies as the number of those with pre-existing conditions who have been limited in obtaining insurance will sign up. The healthy may not enroll, thus shrinking the pool that the risk can be distributed across. The U.S. government may then be faced with bailing out the insurance companies which it, in all likelihood, will not be able to do.  The other hidden cost is that those who are “healthy” and uninsured are still at the same risk for mental health and substance use problems. The research in the behavioral health arena has documented consistent epidemiology data that those in the “healthy” group are no less vulnerable to addictions, depression, anxiety disorders, and other mental illnesses than other groups in the population. In addition, the costs to employers of these illnesses are significant. Individuals with co-morbid diagnoses have significantly higher medical costs when they experience cardiac events, cancer, chronic illnesses such as diabetes, and greater difficulty with losing weight if they are obese which causes further medical costs downstream.  Allowing the “healthy” to remain uninsured creates unnecessary costs to themselves, their employers, and to society.

Robert A. Mines, Ph.D.
CEO & Psychologist

Ryan Lucas
Marketing

What about Mental Health Care?

Barack Obama spent much of his first year in office on a quest for health care reform.  Those against it alleged a government takeover and those in favor were concerned it didn’t go far enough.  Either way you look at it, The Patient Protection and Affordable Care Act was signed into law.   What seemed to fall through the cracks of the debate, is the idea of mental health parity – the massive reform in mental health laws that was ultimately attached to the 2008 financial bailout.  As a background, The Mental Health Parity and Addiction Equity Act of 2008 says that ALL psychological conditions must be treated the same as any physical illness.  Prior to Parity it was common practice to limit patients to a few therapy visits a year, assign higher deductibles or reimburse a small percentage.  Under Parity, seperate deductibles can’t apply nor can your out-of-pocket contributions differ.

Although this was a major victory, its taken a backseat to the healthcare reform and the economic stimulus package.  The act, which self-funded organizations of 50 or more were required to comply as of Oct 1 2009 or any renewal date following, officially went into effect on January 1, 2010.

So how does this all fit into Health Care Reform?  First, Mental Health Parity and its regulations are still in full effect.  Second, Health Care Reform has expanded the reach of Parity.  It’s now expanded to cover dependents until the age of 26.  It has also expanded to fall under the section of “essential health benefit” which means treatment can’t be denied for pre-existing conditions.  This means that insurance companies are required to provide coverage and that coverage must be equal to coverage provided for any other medical ailment.  Behavioral Health benefits are now a mandatory part of basic care as well as certain psychotropic medications which are required under insurance formularies.

At MINES, while we’ve been working to help groups become compliant with Parity and gain an understanding of how Health Care Reform is impacting Parity and behavioral health overall, we’ve also been helping to put some measures in place to contain the potential cost increases of these massive reforms.

If your organization is in need of some consulting around this topic or any other behavioral health topic we urge you to contact us.   We’d also be glad to show you some easy ways to contain costs under the new health care regulations.

Posted by Ian Holtz

Manager, Business Development