Health inSite: Breaking the Fifth Wall

A refresher on Alternate Reality Games, Transmedia Storytelling, and Engagement

While I highlighted the opportunities with Alternate Reality Games and Transmedia Storytelling in my last post, I wanted to take a moment to share a recent production that I’ve been looking into that really highlights how this format works: The Lizzie Bennet Diaries. The Lizzie Bennet Diaries (LBD) is a modern retelling of Jane Austen’s Pride and Prejudice.  The characters in the story have their own online presence within various social media outlets and interact with one another through Twitter, Tumblr, YouTube, ThisIsMyJam, Websites, and more (various examples shown).  The characters share their stories with one another through these dynamic media and oftentimes interact with the audience as well.

While this has engaged a pretty significant audience (fandom), what is really incredible is the way in which the audience has begun to participate with one another.  A recent update to the story included new information that Lydia Bennet (Lizzie’s youngest sister in the updated version) has been caught up in a sex tape scandal (remember, this is not meant to be perfectly along the storyline that Jane Austen wrote, but one that resonates with the audience of this retelling).  There was a huge outcry from the audience expressing dismay at this turn of events.  So much so, that that there was discussion the fandom should look for a hacker who would be willing to hack the website on which the video’s seller was collecting interested buyers with a countdown clock.  This created an immediate problem for the producers/writers of the story.  If the site indeed had been taken down, the team would have to develop a way to get around the change in the storyline created by the audience, and at great expense.  In this way, the audience collaborated to solve the problem of the character, rather than maintain their understanding that this was simply part of the story for consumption.

Let’s start with the Fourth Wall

In theater, the Fourth Wall is the theoretical veil between the audience and the stage.  Breaking the Fourth Wall happens when the players on the stage actively communicate directly to the audience.  There are countless examples in which the magic of the story playing on any stage (screen applies here too) is broken in this way, but the practice is increasing with evermore prevalent new media projects.  In my last post, I described Transmedia Storytelling and Alternate Reality Games as a way of telling a story through multiple media streams and its ability to engage an audience in new and immersive ways.  But breaking the Fourth Wall can be used to engage the audience in participating in the story through these methods to expand the value of the experience that the audience has.  For more on the Fourth Wall, check out Wikipedia for a quick overview, or TV Tropes for all kinds of cool information about the idea and the way that the  this device may be used.

Now, to the Fifth Wall

There is another proposed wall which has been less well explored, and often debated as to its name: The Fifth Wall.  The operational definition that I like is the veil that separates members of the audience from one another.  For a long time, the audience has been the passive observer of entertainment with notable exceptions of breaking the Fourth Wall.  But, rarely does a media experience really ask for members of the audience to work with one another.  This concept of the Fifth Wall could have significant implications in the sharing of narrative within an Alternate Reality Game with a true Transmedia Story backbone.  Consider the opportunities of having participants in the audience that can help guide the story cooperatively; sharing goals, pushing one another toward success, battling challenges together.  If your friends’ friends impact your health in positive and negative ways (see previous posts about link influence here), what about engaging a first node relationship more directly to change the perception of the second or third node to ripple back through the network to you.  In this way, the network then begins to course with change and as you make changes that influence others, their responsive changes come back to you.  In this way, helping others get healthier helps you get healthier.

The Walls and their implications within LBD

The surprising situation that happened within the LBD is that while the narrative has been so clearly billed as a story, with many instances of the Fourth Wall being broken (the producers actually have entire blog postings dedicated to talking about the production process as it is occurring), it turns out that the Fifth Wall nearly took down the production.  The audience reverted to a sense of belief as they interacted with one another.  The characters, then, are part of the audience – and the audience part of the characters.  This creates a shared experience where the audience felt that they were responsible for helping solve the problem for the character.

Summary

The investment of the audience in their shared experience (this includes characters, as mentioned above) has huge implications for health programming.  Imagine a story with so much motivation and movement as LBD written to achieve Salutogenesis by creating a shared landscape around health behaviors.  If we know that education, knowledge, and external incentives are not motivations for behavior change, is this the next landscape to try?  We think it is.

To our health,

Ryan Lucas
Marketing

Health inSite: Gamification of Health

In the 10^th installment of Health inSite, we take a look at strategies of an up-and-coming way of engaging health through Gamification.  Gamification has recently taken to the health world via a veritable windfall of funding coming through venture capital firms to try to create platforms that encourage and incent people to take on everyday health activities.  While most of these have been fitness related applications and websites so far, a good number are starting to look at emotional resiliency, pro-social behavior, and more.  If you’ve not yet read Jane McGonigal’s book, Reality is Broken, or seen her TED Talk, I highly suggest them.  McGonigal suggests that there is value in creating unnecessary obstacles for people to achieve more and feel the power of their own success by creating fiero moments – moments of intense pride in one’s triumph over adversity.  These obstacles enrich our lives and add value to our, oftentimes, mundane daily activities.  As McGonigal mentions in her book, if the point of golf is to put the ball in the hole, why don’t we just pick up the ball and walk it over to drop it in the hole.  Yet, we spend a lot of time playing the game and add obstacles to make it more challenging.  It creates motivation to achieve for the sake of achievement, rather than the end goal.  This is the point of a game and it has a big role to play in the future of health.

There are a number of groups starting to use the concepts of gamification to encourage health promoting activities.  And, there is a lot of hoopla being created around using technology platforms to make gaming a part of employers’ health strategies, with 60% of employers planning to add gamified health strategies in 2013.  However, most of these groups are only using small pieces of the total package that gamification, and other psychological research, includes; and sometimes, are even using pieces that are inappropriate, such as financial incentives and gimmicks, which directly undermine the value of the game itself.  But maybe there are better opportunities to correctly use the concepts of gamification, as well as the many other pieces of psychological research that we’ve covered in Health inSite, to create a total population health strategy at work; the first wellbeing program that actually pushes employees to challenge themselves, and each other, to become more healthy, rather than less ill.  In fact, MINES is doing just that.

It takes more than a website to do this – including focus on using the resources available to a company’s natural habitat, the worksite, to engage employees during the 40 hour work week, and more, by creating a story.  As described in the burgeoning world of Alternate Reality Games and Transmedia Storytelling, the ability to tell a cooperative narrative – on and offline – among those with which you work is an opportunity to actively create health, the benchmark of Salutogenesis.  When you have many platforms for engaging in this storytelling, you increase the modes of access to actively engage all employees where they are, rather than forcing them into a platform that they may not be comfortable with, or is not ideal for their way of engaging in their health generating behaviors.  This is done by asking for participation in the developing story that is experienced, rather than simply viewed.  Imagine, rather than passively hearing or reading what someone needs to do to fight diabetes, or other chronic health condition, or even simply drop a couple of pounds, each person can create opportunities for their fellow employees to actively and interactively challenge one another in the course of an unfolding story.  This makes health promotion participatory and engaging.

We’re focused on creating the health generating plan of the future and want to share it with you.  In the meantime, maybe you’re already starting to embark on this grand adventure in your own ways.  What do you do at work that helps make people healthier?

To our health,

Ryan Lucas
Marketing

Psychology of Performance – 38: Cognitive Bias Part 3

In this installment of the role of cognition in performance, Arielly has noted in his book, Predictably Irrational, that there are a number of salient variables related to performance in various domains. For example, a version of “where your mind goes the energy goes” is related to honesty. When people are asked to think about honesty, their awareness of honesty goes up as well as their honest behavior. He has further examples related to how an honor code can decrease cheating behavior. On the other hand performance in this area decreases (more cheating) as the distance in time, value, and so forth increases.  Another variable worth noting in the psychology of performance is that “loss aversion” appears to be a more powerful motivator on performance than potential “gain.” This has other implications for performance.

What are the implications? As a leader, manager, executive, or coach, it is relevant to have clear expectations that your group thinks about actively. The standards of behavior required to achieve the goals, and how to behave in the workplace, need regular mental rehearsal to increase compliance with the types of performance expected. To neglect this may result in group drift which results in under-performance. The implications of the “loss aversion” have many applications. For example, in the area of wellness and benefits, the fear of losing a benefit will predictably result in greater compliance than the allure of a reward. This is also true for individual work performance. People will work more to avoid losing their job than to get a reward. This is counter-intuitive from many business practices related to motivation and performance.

Remember to extend love and happiness to everyone you meet,

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

Health inSite: A Salutogenic Workplace

Let’s dig a little deeper into the concept of Salutogenesis and what it might mean at your workplace.

The River

Antonovsky’s explanation of Salutogenesis was well depicted by a river.  His concern with the current model of health (Pathogenesis) is that it’s generally believed that we are healthy from the beginning but that because of environmental / circumstantial events, we become sick.  Antonovsky expressed this as a river, where all healthy people stand on the bank, safe from the raging river’s flow.  Once one stepped into the river – got sick – then something needed to be done.  Salutogenesis, however, sees all people already in the river; but at different distances from the mouth.  General resistance resources (GRRs), a term Antonovsky used as well, are the supportive mechanisms that make it possible to engage in their health generating activities.  These allow for someone to swim against the current or maintain a position against the current.  The result of thinking this way is the freedom to abandon the bias that one has failed at being healthy, but rather that they are always working at generating more health.

Sense of Coherence

Antonovsky’s continued his explanation of Salutogenesis as hinged on a Sense of Coherence.  Sense of Coherence is defined by three major parts:

1. Comprehensibility (I get this).  The ability to understand one’s circumstances.  If you look back at some of my previous postings on Cognitive Bias, we are unable to fully comprehend our experience because, as Kahneman has pointed out in Thinking Fast and Slow, we are subject to a number of biases including base rate neglect (not having the ability to assess, objectively, where things are from the start before making an opinion of what is possible).
2. Manageability (I got this).  The ability to assess resources for dealing with one’s circumstances.  “The right tool for the right job” comes to mind here.  To adequately meet the needs of Manageability, one must not only have the resources available, but the knowledge that they can be used.
3. Meaningfulness (I’m good to go).  The ability to comprehend the anticipated results as helpful.  We oftentimes recognize that there is a change to be had, but taking that step can be difficult without a fire under your bottom.

Taken together, these three points sit at the nexus of the ability for any given person to be able to effectively engage with their health.  When all three are maximized for performance, individuals can effectively mitigate the potential of their circumstances.  Education obviously plays a big role in the process of becoming healthier, but education alone cannot make people healthier.

Your role as a benefits provider

As someone that is providing benefits to a group of people, you have a key role in the ability to help those covered to become healthier; to actually create health.  It’s easy to provide a benefit that is available when it’s needed and provided by an external vendor, but that doesn’t have to be the end.  Visionary organizations are engaging their population in small, but every day, ways.

What can be done

Engagement is key.  First off, you have to take on an organizational wellbeing plan in earnest.  If you’re willing to put in the effort, your population will be more likely to stay engaged.  If you’re not behind it 100%, they probably won’t be either.  But what can be done to engage in health more actively in the worksite?

Let’s look at some of the GRRs that Antonovsky identified and where they may occur in the workplace.

Money: Money enables us to purchase services and products that can enable health generating activities.  It can also be used to incentivize or disincentivize activities – the so-called carrot and/or stick approach.  But, money also has some significant impact on engagement.  When individuals make a purchase, they are actively exchanging the value of their dollar for the value of what is being purchased.  If you’re familiar with the concept of Behavioral Economics, this might include devaluation of a certain program because it is provided for free.  Instead, incentivizing purchase of products or services that help in the generation of health means personal investment in its use.

Knowledge: You know that conference or meeting room that is usually set aside for meetings with clients, or teams within your organization?  It may also be a great location to have a training or two related to health generating activities.  Including helpful information in your break room, like healthful recipes, may be a continual reminder of what your population is putting into their bodies.

Commitment: Commitment may be especially easy to generate in the workplace because you’re already showing an investment in those you provide benefits for.  Showing your commitment to the program can help create mutual investment, as well!

Social Support: Encourage people to support each other in your health generating activities by rewarding employees who provide assistance or encouragement in the health of other employees.  This creates a social structure for engaging in health, and we know that community is the key to health.

Taken together, this is a powerful recipe for getting the kind of motivation needed to stay actively engaged in your population’s health.  And, the long-term benefit of a healthier and happier workforce is what drives productivity and profitability.

To our health,

Ryan Lucas
Marketing

Emotional Intelligence

Emotional Intelligence, or EI, is the ability to identify, assess, and control the emotions of oneself (Wikipedia). We all have different levels of EI. Some of us are emotional geniuses who are incredibly gifted at assessing, identifying, interpreting, and acting upon emotions. Others have low Emotional Intelligence and have difficulty understanding the precise reason they feel anxious or they don’t know the best way to deal with a stressful situation. Most of us are in the middle somewhere and can maybe understand how to work through issues with co-workers but could use some help in learning the best approaches to what bothers us personally. But for all of us, we can actively seek to improve our emotional intelligence by understanding what is causing our emotions and by practicing techniques to help improve our responses. There are several resources available online and there are many great books on the subject as well. In order to achieve a higher level of emotional intelligence, work at it every day and practice techniques for better communication with your peers, coworkers, and family. If you are curious how your Emotional Intelligence currently rates there is a short quiz available for free at:

http://psychology.about.com/library/quiz/bl_eq_quiz.htm

Ian Holtz,
Manager, Business Development

Psychology of Performance – 37: Leadership and Thinking

In the last Psychology of Performance blog, I introduced you to Kahneman’s seminal work (Thinking, Fast and Slow) on cognitive bias and decision making. This blog post continues that discussion.

System 1 continuously monitors all input and information. As a function of this it produces assessments of the variables of the situation with no specific intention and little effort. Kahneman refers to these as basic assessments (p. 90). The important point about basic assessments is that they are easily substituted for more difficult questions.  He goes on to say that basic assessments evolved to provide continuous assessments on questions of survival: How are things going? Is there a threat or a major opportunity? Is everything normal? Should I approach or avoid? We use a “mental shotgun” approach to situations and produce more computations than we need.  With this as background, we are vulnerable to substituting questions without knowing we did so.

Kahneman stated that if a satisfactory answer to a hard question is not quickly found, System 1 will find a related question that is easier and will answer it (p. 97). The danger is that System 2 is lazy, and following a path of least effort, will endorse an answer to a simpler question from System 1 without much evaluation or analysis regarding whether the answer actually is for the original question asked.  Furthermore, people do not tend to realize that this substitution has occurred.

How does this relate to leadership and thinking? From a psychology of performance perspective, leadership in organizations is just as vulnerable to these thinking errors as anyone else. Awareness of these processes requires intentional System 2 thinking about business and organizational problems. It also puts the burden on the leader to listen carefully to the answers provided by their reports and colleagues as they may be giving right answers to different questions than the original and not even be aware of it. This has potential to further negatively impact the performance of the organization or the individuals involved.

Have a day filled with mindfulness,

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

Psychology of Performance – 36: Leadership, Black Swans, and Thinking

Ill-Structured Problems and Business Decisions

Leadership articles often focus on a variety of variables. These variables may include personality traits, born or made, demographic variables, attractiveness, communication skills, vision, and intelligence. These variables have varying degrees of research behind them. One aspect of leadership that is universal in business is that leaders get to make complex decisions on ill-structured problems for which there are better and worse answers, rarely right or wrong answers (Mines, Hood, Wood and King, 1990). Given the number of “Black Swans” business leaders have run into, a discussion of some of the cognitive and thinking errors that can be made follows in this article (Taleb, 2007).

Kahneman has written a ground breaking book on thinking heuristics and errors in thinking. As business leaders look at their success and failure rates, it is a reasonable question to ask why so many decisions result in under-performance, if not outright failure. Kahneman’s work contributes to our understanding of these predictable thinking errors. This blog is a partial summary of Kahneman’s work. All acknowledgement of its scholarship goes to Dr. Kahneman and any errors attributed to the author of this summary.

Thinking Fast and Slow: The Operating System

Kahneman described two systems related to thinking.

System 1 operates automatically and quickly, with little or no effort. System II allocates attention to the effortful mental activities that demand it, including complex computations. The operations of System 2 are often associated with the subjective experience of agency, choice, and concentration. System 1 effortlessly originates impressions and feelings that are the main sources of explicit beliefs and deliberate choices of System 2. The automatic operations of System 1 generate complex patterns of ideas, but only the slower System 2 can construct thoughts in an orderly series of steps (Kahneman, 2011, p. 20-21).

These two systems constantly interact. System 1 runs continuously and System 2 is normally in a comfortable, low-effort mode, in which only a fraction of its capacity is engaged. System 2 is a “lazy system.” System 1 continuously generates suggestions for System 2, impressions and intuitions, intentions and feelings.  If System endorses them, they are turned into beliefs and impulses turn into voluntary actions. System 2 endorses the suggestions of System 1 with little or no modification. System 2 is utilized is called into play in order to proved more specific and detailed processing. It is mobilized to control impulses, to increase effort when it detects that an error is about to be made. System 1 has biases, however, systematic errors that it is prone to make in specified circumstances. It sometimes answers easier questions than the one it was asked and it has little understanding of logic and statistics. It cannot be turned off (p. 24).

Bias and Thinking Errors

In order to give the reader a flavor of the types of thinking errors and to encourage the reader to study the book in more depth, the following are a partial list of bias and thinking errors.

People who are cognitively busy are also more likely to make selfish choices, use sexist language, and make superficial judgments in social situations. An effort of will or self-control is tiring, requires effort, and is unpleasant – known as ego depletion (Kahneman, 2011, p. 42).

Association. The Associative Machine is in play when two ideas are associated and System 1 tries to make them associatively coherent. An idea that has been activated does not evoke just one other idea, it activates many other ideas which in turn activate even more ideas. Only a few of these will be conscious.

Priming. Words and events can “prime” the next sequence of words or thoughts in a way that they are related and we don’t even know it. Priming can also affect our behavior. People who were asked to think about aging, walked slower down the hall than people asked to think about another topic, for example. Common gestures such as nodding yes or no prime our emotional responses to a situation. Money-primed people become more independent, more reluctant to be involved with others, less willing to depend on others, or to accept demands from others, than they would be without the associative trigger.

Cognitive Ease/Cognitive Strain.  The mind is constantly monitoring.  Ease is a sign that things are going well – no threats, no major news, no need to redirect attention, or mobilize effort. Strain is affected by both the current level of effort and the presence of unmet demands.  Cognitive ease is connected to a number of variables such as clarity and ease of understanding which is commonly implemented by marketers when choosing fonts, colors, and copy. When you feel strained, you are more likely to be vigilant and suspicious, invest more effort in what you are doing, feel less comfortable, and make fewer errors, but you also are less intuitive and less creative than usual.

Illusions of Remembering. Memory and thinking are vulnerable to illusion. Familiarity as an experience has a simple but powerful quality of ‘pastness’ that seems to indicate that it is a direct reflection of prior experience. Words or names you have seen before produce greater cognitive ease and it is this ease that gives you a greater sense of familiarity.

Illusions of Truth.  Predictable illusions inevitably occur if a judgment is based on an impression of cognitive ease or strain. Anything that makes it easier for the associative machine to run smoothly will also create bias. A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.

Strain and Effort. Performance is better when there is strain as it mobilizes System 2, which is more likely to reject the intuitive answer suggested by System 1. The mere exposure effect, pairs an arbitrary stimulus and mild affection for the stimulus. It does not depend on conscious experience of familiarity. It does not depend on consciousness at all.

Ease, Mood and Intuition. Good mood, intuition, creativity, gullibility, and increased reliance on System 1 form a cluster. At the other end, sadness, vigilance, suspicion, an analytic approach, and increased effort go together. A happy mood loosens the control of System 2 over performance: when in a good mood people become more intuitive and more creative but also less vigilant and more prone to logical errors.

Summary
As a business leader, it starts becoming apparent where your executive team and subordinates may be vulnerable to thinking errors and not even know it. Kahneman reviews many other cognitive errors and bias. It is incumbent upon all leaders to be as aware as possible of these errors and review decision processes in strategic planning, operations, and within the finance arena closely so as to avoid your organization’s own personal black swans.

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

Over the next three months future blogs will address further cognitive bias categories and provide business examples.
___________________________________________________________________________________________

Kahneman, D. (2011). Thinking fast and slow. New York: Farrar, Straus, and Giroux.

Mines, R.A., Hood, A., King, P., & Wood, P., (1990). Levels of Intellectual Development and Associated Critical Thinking Skills in College Students. Journal of College Student Development, 31 538-547.

Taleb, N. (2007). The black swan: the impact of the highly improbable. New York: Random House.

Health inSite: Transformations as the Future of Healthcare

Have you read the book The Experience Economy?  To explain it very quickly (and not do true justice to the ideas proposed in the book), there are various levels of economic offering that warrant different valuations, and thereby ability to generate revenue.  The levels of development discussed in the book are elegantly displayed in the graph below by Pine and Gilmore (the authors of the book):

This progression has expanded over time with new levels being added as the market strives for differentiation.  Many of the examples brought up are clear and concise, such as Starbucks as a purveyor of coffee (a commodity) that really charges the market at the level of a Service.  Pine and Gilmore stop at the level of Service in their description of Starbucks, but I would readily argue that they reach towards the level of experience.  Starbucks actually refers to this in their training materials as creating “The Third Place;” it’s not your work, or your home, it’s that other place where you can unwind a little bit.  Even though the customer isn’t actually brewing their own coffee, as is a hallmark of many experiences, they are engaging with the sounds and smells of the coffee shop in a very intentional way.

The book spends a great deal of time discussing offerings that are on the level of Experience but certainly takes a moment to tip its hat toward Transformations, a burgeoning new market offering.  Transformations are marked by the engagement of the customer in a way that enables that person to learn or grow, exactly to Transform, themselves in a way that is truly valuable to the customer.  It includes giving the customer the skills and motivation to make changes that will both provide some immediate value but also cascade down into further value down the road.

In healthcare, this understanding of the market is significant and valuable.  As we, as an industry, discuss Accountable Care Organizations, capitated care models, and participatory medicine, it’s important for us to keep in mind where value is derived in the typical marketplace.  Healthcare, while arguably different in many ways from other industries by its virtual necessity in every citizen’s timeline, still must compete under the same rules as many other industries.  Many times, in healthcare, we present ourselves on the level of Service – that is that we are doing something for someone, for a fee.  As we look at these new systems, it is time for us to consider what the future of healthcare delivery will require under a population health model of delivery.

Eschewing the fee-for-service model opens up the possibility for the healthcare industry to reconsider offering the long-term value of teaching individuals how to keep themselves healthy, at least in terms of the 80% of healthcare costs that are mediated by behavior.   This decreases the time and services that must be provided creating new forms of cost savings.  As we move further up the economic offering ladder, it will become more necessary to move our industry into the Transformation realm.  In fact, there is no other industry more suited to it.

To our health,

Ryan
Marketing

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