Finding Ways To Pay For Mental Health: Kaiser Studies Examine Medicaid & Other Mental Health Financing Needs & Options

Its ironic.   The epidemic of obesity, diabetes, heart disease, asthma, cancer and other lifestyle-based diseases continues to grow as the wellness and disease management industry has grown and unprecedented attention by employers, governments, communities, and American families with the need to help American workers and families manage their diet and wellness. 

While Americans would prefer to pretend there exists a magic potion, procedure, or product that will allow them to escape this reality, to win the obesity war individually or as a national requires that obese Americans change their individual behavior to balance more appropriately food intake and physical activity and, optimally, choose healthier foods over less healthy foods and activity over inactivity not just for a few weeks, months or years but for their lifetime.  

The knowledge of this reality is nothing new.  While there remains ongoing debate what diets are better or best for which individuals and clearly can agree that some diets are clearly harmful for most individuals, the data documents that the biggest challenge in making wellness and disease management work is getting each American to take responsibility,  ownership and control of their own wellness and consistently and appropriately use the tools available to them to eat and live healthier for their lifetime and to help themselves and their friends to do the same.   

Unfortunately,  the failure of Americans individually and collectively to use the wellness and disease management knowledge, information, tools and behaviors available to them is the biggest obstacles to winning the wellness war. The biggest challenge, of course, is getting individuals to use the tools consistently and reliably to live healthier. 

The challenge to wellness success is not finding the wellness water, but to get that are or fall off the wellness wagon to return to the wellness bandwagon as completely and consistently as possible.   The challenge of wellness is not really about what needs to be done but is how to get each person to better self-manage  his or own day to day diet, exercise and other lifestyle to maintain and promote his own wellness.  The challenge is to get Americans individually and collectively to go to and drink from the wellness well day in and day out as a key habit that the individual seeks because he feels drawn to make the healthy choices.

The wellness marketplace increasingly promotes and seeks to sell a wide range of individual or group wellness management products and tools coupled with a variety of rewards and penalties ranging from discounts on health insurance premiums to gift certificates and beyond.  While not discounting the potential short-term efficacy of these incentives to motivate some individuals to get first steps, many challenges exist to their use and effectiveness.  

Many businesses, insurers and families view the cost of these programs as beyond their budgets.  Even where the budget could in theory cover participation, employers, insurers and individuals often question the justification for the investment.   When considering paying for wellness for employees or plan members and their families, a variety of factors come into play.  One of the biggest is skepticism whether the cost of the investment will produce enough return on investment within a meaningful time frame to justify the investment.    

Data tends to show that the right incentives can help encourage individuals not already living healthy lifestyles to sign up for and take part in wellness programs.   Even when incentives are offered,  many challenges remain.   Data showing that the right rewards often can encourage people to take advantage of wellness screenings or other initial activities.  However,  limitations in the effectiveness of limited rewards and penalties in recruiting involvement from people in the community with the greatest health risks and the need to continue to provide incentives to encourage continued participation and compliance causes many employers and insurers to question whether incentives really produce the lasting changes in behavior necessary to merit wellness spending.  Even wellness programs make use of carrots to incentivize or reward participation and compliance rarely produce lifelong or otherwise meaningfully lasting changes in wellness behavior by most individuals.  Those whose unhealthy lifestyles and health conditions make them the best candidates to realize immediate benefits from changing their habits are the least likely to take part or comply even when wellness programs include incentives or penalties to encourage participation, reward compliance or punish noncompliance or nonparticipation. 

Aside from these practical challenges, various laws and regulations also undermine effective employer and insurer investment and promotion of wellness and disease management programs. The current interpretation of the Americans With Disabilities Act by the Equal Employment Opportunity Commission, nondiscrimination rules imposed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Genetic Information Nondiscrimination Act (GINA)  create new legal restrictions, challenges and liability risks for employers, health plans, and health insurers seeking to use financial or other incentives or rewards to encourage wellness by their employees or members .  Compliance with these requirements also limits the effectiveness of these tools to incentivize meaningful changes in health behaviors.  No matter how well-intentioned, these financial, operational and legal challenges increasingly undermine workplace wellness investment and effectiveness. 

Perhaps the biggest challenge to the use an effectiveness of these tools, however, is their emphasis upon ongoing third-party management of the day-to-day life choices of individuals about what, when, and how they eat and live. 

Employers, insurers, regulators and others struggling to overcome these challenges often overlook one key point.  Wellness goals will be best achieved when individuals individually and within their family, friendship, workplace, and other social communities make better choices because the better choice is more personally rewarding or convenient.

Recognition of this opens up the opportunity to see and take advantage of easy and usually no or low-cost opportunities to encourage individuals and communities of individuals to make better wellness choices.  Employers, churches, schools, families, social groups and other communities can help themselves and encourage others to live healthier by helping promote healthy attitudes toward wellness and planning activities, meals and snacks and other arranges to incorporate or encourage healthier choices and discourage unhealthy choices.   

“Lets make living healthy cool” in our families, friendship groups, workforces, community organizations, schools and everywhere else Promote a healthy attitude toward wellness by promoting the understanding that taking care of oneself is a good thing.  Encourage people to get started and stay in the game by emphasizing each positive choice as winning.  Help encourage and support individuals by structuring environments and activities to encourage healthier decision maker.  Choose healthy foods and physical over sedentary activities when planning events.  Make healthy, better tasting foods and drinks easier and more affordable, desirable choices in the home and workplace.  Encourage management and social leaders in the workplace, home and community to lead by modeling healthy behavior by visibly serving or selecting healthier meal, snack and drink options, planning meetings and events to include physical activities and to encourage other healthier behaviors.  Encourage friends, families, workers and other group members to coach and support each other by dieting, walking, working out or engaging in other healthy activities together.     Support, cheer and celebrate good choices and successes.

Plan or encourage others in your group to plan their own The Play For Life Toolkit share examples about how employer, PTA and schools and other groups can plan low-cost wellness fairs and other activities to promote wellness and can find and use free resources available on the internet and elsewhere to find activities to use to encourage employees or other community members to play the wellness game.  If you would like to learn more, e-mail

The Coalition for Responsible Healthcare Policy and Project COPE

The Coalition for Responsible Health Care Policy and Project COPE: Coalition On Patient Empowerment bring together employers, health care providers, insurers and other payers, community leaders, patients & others to share and collaborate about policies, challenges, issues, ideals and tools to improve the quality, effectiveness, affordability and access of health care in America and the functional effectiveness and quality of the lives of patients and their families, employer and other plan sponsors, health care providers. 

The Coalition for Responsible Health Care Policy focuses on policy choices and their implications on these and other related concerns.  Its focus is to help health care, health insurance and other business leaders, patients and their families, community and government leaders and others concerned about federal and state health policy and the implications of federal health care reform proposals on the quality, accessibility, delivery, cost and other aspects of health care to monitor and to exchange feedback and other information about these proposals and to pursue other opportunities to share and promote their ideas about opportunities to improve health care policy and effectiveness in the U.S.  Participate in the discussion by joining the Coalition for Responsible Health Care Policy community discussion on linkedin here.

Project COPE: Coalition On Patient Empowerment focuses on identifying, sharing and implementing practical tools and strategies that help empower patients and their families to effectively manage their care and access and use health care resources and help payers, providers & communities to support patients and their families in caring for their families and appropriately accessing quality affordable care. Join the Project COPE community discussion on linkedin here.

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