We make hard choices every day to create a better future. We eat healthy foods, build our savings accounts, and invest earnings to grow a business. Do not be fooled. Focusing on the present is more common. We seek gratification now. We obsess about quarterly earnings. We care more about today’s challenges than tomorrow’s dilemmas. It is easier to ignore the future than worry about distant goals.
Long-term goals are always a gamble. Hard work does not always pay off. Success does not go to the worthiest. These often-unspoken reservations are powerful. They are why many people lack a commitment to change, be it for personal or social goals. Motivation is fueled more by feelings than thoughts. Many people see the value of a goal, and yet they lack the sustained energy for its pursuit.
These musings are stimulated by my focus on a future strategy for our field. One may question whether strategic planning for an entire field has any practical value. Regardless, my commitment to moving our field into primary care has support from those in both fields. The benefits for each field are compelling. The problem is getting wide adoption for such bold change. How is that done?
Gaining adoption for bold ideas recalls the theory from the 1960s on the “diffusion of innovation.” It probably endures due to the order and simplicity of portraying everyone on a bell curve. We have a small percentage of innovators and early adopters. Most of us follow them and join the majority either early or late. A few laggards cling to tradition. Are you a thought leader ahead of the majority?
You cannot feed your family with labels like early adopter, and similarly, you cannot put food on the table with a strategic vision. Most people in our field are consumed with pressing here-and-now questions. They wonder how to build a private practice, get a job with more autonomy or money, or find career advancement by hitting growth and profit goals. Can we invigorate a future focus?
People are energized by opportunities that might provide more independence or wealth. On the other hand, they are vigilant when looming threats appear to endanger their achievements. If we are activated more by tangible opportunities and existential threats, then let us enlist emotions like greed and fear. Worthy goals are fine, but it may take less noble feelings and motives to reach them.
A desire for wealth is not harmful but needs focus. Strategic goals like reinventing primary care are too high level. Clinicians and executives in our field need immediate opportunities. Many good prospects are waiting in local clinics and health systems where new ways to change behavior are needed. PCPs understand the value of therapy to some extent. Yet it is an underutilized solution that is billable now.
PCPs entered a period of struggle and decline after the failure of HMOs in the 1990s. Their patients with chronic conditions are “breaking the bank” due to unhealthy behaviors. Our experts in behavior change should accept the challenge to find individualized solutions to these problems. It is a classic win-win. PCPs are eager for new answers while therapists have tools broadly applicable to behavior change.
Both privately and publicly funded programs can participate. The scope of issues to be addressed far exceeds unhealthy behaviors and behavioral comorbidities. Therapists can tackle non-adherence to physician recommendations, the behavioral roots of many illnesses, and just helping people pursue goals for better health. It is worth initiating some outreach to local PCPs to gauge their interest.
Financial success is insufficient. Fear of impending threats will be needed to activate some. Consider this credible nightmare related to healthcare economics: The U.S. healthcare spending bubble may burst soon. It is now 18% of GDP with mediocre clinical results. Like other quantifiable crises, a dismal ending here is a matter of math. The coming period of turmoil will be painful. What might it entail?
Our field may well survive this upheaval, and yet fee-for-service reimbursement will probably end. This could leave every field competing for funding inside large healthcare systems. This might mean sharing global revenue in a zero-sum model. Behavioral services would be managed as one of many cost centers. Innovation and investment become corporate prerogatives, not departmental choices.
Future generations will be grateful if we can bequeath them more diverse roles in healthcare. Helping people with disorders like depression and addiction is wonderful, but we need not be confined to this limited healthcare box. Primary care offers more. We can impact the behavioral roots of illness and redefine primary care. We should explore this bigger box now. Change will be much tougher later.
Ed Jones, PhD, is senior VP for the Institute for Health and Productivity Management.