Julia Hotz is a journalist and author, who wrote a book called The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service and Belonging. James and Julia connected because her new book is strikingly synergistic in topic and title to James’ second book, The Community Cure: Transforming Health Outcomes Together, which calls for readers to adopt group care principles to make lifestyle medicine more widely accessible and sustainable.
This is an enlivening conversation, where you’ll hear about the data backing social prescribing as an antidote to the most prevalent chronic health issues of this generation: illnesses exacerbated by the loneliness epidemic, such as attention and mood issues and a slew of chronic illnesses.
Tune in to learn about:
- Financial benefits of social prescribing
- Business solutions for supporting community-based solutions to chronic health issues
- How science backs social prescribing as an effective solution to ailments like chronic pain, trauma, dementia, diabetes and loneliness
- Potential for insurance companies to incentivize social prescriptions
- The benefits of art and nature on health
- And much more
James Maskell:
Hello and welcome to the podcast. This week we have the author of a new book called The Connection Cure, Julia Hotz. And if that name sounds familiar, it’s because I wrote a book called The Community Cure. And so, what we’re going to talk about in this session are some of the things that are near and dear to my heart. We’re going to talk about the power of social prescribing.
This is a movement from the UK that is now branching out all over the world as people see the benefit of prescribing connection and integrative therapies and groups. We’re also going to talk about the power of nature and why nature is so mission critical too and why it creates so much health. And then we’re also going to talk about the cost savings and the practical nature of social prescribing. Julia is a woman after my own heart. I think you’ll see that there’s so much crossover and what she’s talking about and how she got excited into it and why this has been mission critical for me too. And so, I’m super excited to share this interview with Julia Hotz.
This session is supported, and we are grateful to have as our sponsor Pulsetto, as you know that we’ve been recommending the VagusFest, and we have clinics across the country now putting on events to stimulate the vagus nerve, create connection community in coherence.
And one of the tools that you can use is Pulsetto. It is a vagus nerve stimulator. If you go to goevomed.com/pulsetto, you can use the code James10 to get 10% off and try it out with yourself and your family. My wife loves it. I’ve been using it. And ultimately, if you want to get set up with, you can get also set up with a wholesale account. And many practitioners are starting to do that, and you get similar margins than you would on supplements. So, check out goevomed.com/pulsetto and enjoy the podcast with Julia Hotz.
So, a warm welcome to the podcast, Julia Hotz. Welcome, Julia.
Julia Hotz:
Thank you so much, James. Great to be here.
James Maskell:
Now I heard about your book through a friend and I couldn’t be more excited to bring you on here to the podcast because longtime listeners know that ultimately we’ve had the conversation about connection as being a critical part of the future of medicine and we’ve looked at it from all different angles. I’m super excited to dive into the connection cure, the prescriptive power of movement, nature, art, service and belonging. And yeah, love the title, love the energy, and I’m excited to I guess dig into how you ended up writing a book on this topic.
Julia Hotz:
Absolutely. James, so great to be here and so grateful to share this work on the heels of your book, the Community Cure and so many others that for years now have been pointing out the fact that we have a fundamental issue in how we do medicine. This model of diagnose, treat, repeat is breaking, especially when most of the burden of illness today is compounded by lifestyle factors. I love what I’ve heard you say about this. The medicine that we use for acute pain is being used to treat chronic disease. And for me it sounds like we both sort of came into this through an interest in loneliness. My understanding is that the UK was the first nation to establish a minister of loneliness back in 2018 when we’d started to see more and more data suggesting that loneliness is very much a public health issue.
Its health harms are akin to smoking 15 cigarettes a day. So I happened to be in the UK at that time in grad school in search of a thesis topic and decided to investigate what was this new minister of loneliness going to do. And in talking to people who identified as lonely, it became really clear that it wasn’t just going to come down to speeches and more awareness about loneliness. It was going to come down to needing practical support, third spaces, activities through which people with common interests can connect. And that’s what all the literature says. The antidote to loneliness is deep meaningful connections with people with whom you have things in common. So through them I learned about a practice called social prescribing, a practice through which your listeners might know doctors and health workers are referring their patients to nonmedical resources and activities, whether that’s help with housing and food or whether that’s help with opportunities to socialize such as through arts classes and swimming lessons. And so for the past six years, I’m a journalist and I’ve just been so interested in this story because even though the UK was, I would say the first to really put a name on social prescribing, tie it to their loneliness strategy, have some institutional investment, this is now spreading to 32 countries around the world and that’s what my new book The Connection Cure gets into.
James Maskell:
Amazing. Well yeah, I love that and I just want to make a couple connections here. So Mike, Dr. Michael Dixon who’s one of the gurus, the original guru, he’s actually the chair for the conference that is the integrated and personalized medicine conference that’s been going on now. They’ve had three instances of it in the UK and it’s an amazing experience to go and be at that conference. I had the chance to be there last year because it’s basically the equivalent of having a 10 or 15,000 doctor conference in the UK just because they really did a great job in bringing everyone together. And it’s amazing that he’s at the center of that because it sort of ties together my world, which is this in integrative and functional medicine world with this sort of social prescribing movement and I feel like they’re one and the same thing. And when I saw the title of your book, I think that our listeners, particularly if anyone’s prescribing a forest bathing or art therapy or otherwise, it’s doctors in our community because they recognize that the combination of connection and doing healthy things is a pathway back from wherever the person is.
Right?
Julia Hotz:
Absolutely. It’s great. You mentioned Dr. Michael Dixon and the intersection of our two worlds. He was actually who I was thinking about when I first read about you and the community care and your work, this idea of group medicine. I remember Dr. Dixon telling me a story about his practice in Ton in which he was really concerned and interested and motivated by many of the same things. You are treating chronic disease and enabling patients to take control of their own health. And among many other activities, he tried to facilitate through the support of his whole healthcare practice, whether that was salsa dancing or chatty cafe type things. One of them was this patient led question time evening in which Dr. Dixon describes this as an opportunity where patients would come to talk about some illness or some symptom or some affliction that they had dealt with. They were the ones who took the mic, talked about their lived experience with this and really led the conversation.
Dr. Dixon just sort of had to step back and let this community work its magic. And so I think that was a very intentional example of enlisting the community to be part of the medicine, uplifting patient lived experiences as key authority. But I also think that that happens organically in a lot of these social prescriptions that don’t necessarily aim to do that. You start by being prescribed a swim course or an art class and you end up sort of talking about some of the symptoms of your diagnosis and you end up sort of perpetuating this dynamic of the community, not just the doctor being part of the solution.
James Maskell:
Yeah, I love that. Yeah, it reminds me Dr. Jeff Geller, his empowerment model. He’s sort of like the hero of my book with his group visits. In his empowerment model, he just has a whiteboard and the patients talk and then he gathers what they’re interested in talking about and talks about that. Whereas in other models, there’s more like a curriculum. And his feeling was that for the disempowered patient, the empowerment model was really the first layer that sort of had to happen for people to actually participate because ultimately those who need this sort of connection cure are typically not empowered to participate in those ways. I’d love to get your thoughts on the thing that came from the UK that I think is really interesting that I’d love to get your thoughts on is this idea of a link worker in the us. We’ve really focused on the health coach and that’s partly because my ex-business partner was a health coach and there’s been the rise of health coaching as sort of an ancillary profession and there’s a hundred thousand health coaches trained in the country. In the UK they went for what they call a link worker, and maybe you could just describe to our audience what the link worker is, what the link worker isn’t, and how they play a role in the health in the UK.
Julia Hotz:
Sure. It’s interesting, there was just a annual report that came out from the National Academy of Social Prescribing and they found that there are like 75 different terms for the link worker. So yes, let’s break that down. The link worker fundamentally is a healthcare professional who serves as a sort of link between three things, right? A link between the doctor, they serve as sort of support for the doctor who’s seeing the patients, a link between the patient, who that doctor is seeing and a link with the local community. So what does this look like in practice in the UK but also all around the world? Doctors are extremely pressured for time, often 10, 15 minutes to see a patient. They don’t have time to get into the nuances of what sort of life circumstances and environmental factors might be contributing to a person’s illness. Often the link worker on the other hand is somebody who is employed by that practice who has time up to 60 minutes in that first session and 30 to 40 thereafter to really get to know what matters to that patient.
The tagline of social prescribing is about shifting from what’s the matter with you to what matters to you. And the link worker with their listening skills and empathy is going to be the person who has the time to really surface those things. And then this is another part of the Link worker’s role. Then based on that question of what matters to you, whether it’s reconnecting with a sport that you loved as a child or having a chance to take an art class again or reconnecting with nature, the link worker is going to be the person to find you the perfect opportunity suited to what matters to you in your community. And again, that’s everything from sorting a person’s housing and food needs and sort of material needs, but also their psychological needs. And what I love about, there’s a lot of conversations which we can get into about whether this role might be served or aided by technology.
I love what Gay Palmer, who was one of the first link workers in the UK said about that. She said, “I don’t go out and look on Google for what’s available to this person I’m seeing. I go out in the community and I vet it myself. I see is this a place where this person will feel welcome? What actually is available versus what actually is shut down and not running so sustainably anymore?” So that is what a link worker does also called a social prescriber. And I think like a health coach, their end goal is to outsource the amount of care that happens in the doctor’s office and put it back into the community and the person’s own self. Right? It’s about empowering the patient to take control of their own health.
James Maskell:
The implication I would say then is that that person should be in the community and really understand what’s there already. It’s mission critical that they know the lay of the land, right?
Julia Hotz:
Exactly. I think that’s exactly it.
James Maskell:
Yeah. That’s really, really interesting. So I guess for why do you think that this is taking off now? And I guess to the degree that I’d like to understand, to what degree is it taking off? Because I get excited about all these things and I could point to different examples of it happening even in the group visit movement, but I would say the group visit movement is nowhere near at its potential. It’s probably at 1% of its potential right now. And I’d just love to get an idea from you, from what you’ve seen from all your research in the UK now and then around the world, to what degree is the social prescribing movement happening and where would you say we should be looking to see the success of it?
Julia Hotz:
Totally. I think that’s a great question, and I think some people might be listening and when they hear a description of what social prescribing is, health workers referring patients to nonmedical resources and activities, some people might be thinking this is not new. This is literally 2000 years old. In fact, the first chapter of my book talks about how Hippocrates and Razzies of Persia people have been doing this for 2000 years, understanding the role that our nature movement play in our health. I do think that there has been special momentum around naming that practice and galvanizing around it, social prescribing ever since the pandemic. I think it was aided in part before that by the establishment of a minister of loneliness by the very tragic murder of MP Jo Cox, who was really passionate about loneliness and had a commission across government commission come out in her honor to fund a strategy to address it.
But I would also say even before the pandemic, but especially after the pandemic, there has been this sort of rise in mental illness rise in lifestyle disease and a hunger for solutions from the patient, from the doctor, from the funders to find a better way to treat that. Right. I love the quote from Dr. Michael Marmet who is a legend and talking about health equity and the social determinants of health. He’s been saying for years we can’t treat people and send them back to the conditions that made them sick. And because the pandemic, I think created these conditions of extreme disconnection, financial hardship, stress, absolutely anxiety, uncertainty, that was a condition that it didn’t make sense for a doctor to come see you 15 minutes, write you a script and send you back into, we really needed to find more holistic and sustainable sources of medicine that treated the root cause.
So to put a number on it, I mean, people call 2019 “The Year of Social Prescribing” because that is when that was I think the year that the UK really made a robust national investment in link workers in setting up this national academy for research and funding. But then after the pandemic, I would say I’ve seen a lot more grassroots interest in social prescribing, people coming to the UK to learn more about that, the founding of this international social prescribing network where this template is being adapted in places like Canada, Australia, Singapore, even the United States. So, I would say it is still nowhere near its potential, but even from when I had to turn in this book last year, if you look at the Google search term “social prescribing,” it’s grown exponentially I think because the traditional supports are sort of at a breaking point.
James Maskell:
Yeah. Well, that’s a good point. So I guess my thesis that I’d love to share with you is that if we’re going to rebuild the social fabric, medicine is the right place to rebuild it. One, because the people who are lonely and disconnected end up in the medical system, but second, because there is budget assigned to deal with this, whether that be the link worker salary in each G’S office or across an ICS or otherwise. Do you agree with that?
Julia Hotz:
Yeah, I have mixed thoughts. I can see what I’ve heard a lot of people say, and I certainly can empathize with this perspective that healthcare sort of provided a vehicle to do this. To your point, it is through this label of health and healthcare and fixing healthcare that we’re able to actually fund social prescribing and support the community organizations. I’ve also heard some interest in criticism of social prescribing, particularly from this researcher. I love Dr. Cormack Russell, who is a bit critical of that approach because he thinks that actually the funding and resources and focus should be on communities. His quote is, social prescribing means we’re too far in the river, and instead of, he sort of thinks we should cut out the middleman and enable communities to become these places where people can create their own health. So I certainly empathize with that too, but I think if you’re a health worker and you are seeing the same patients for the same kind of illnesses and they’re not getting better and you need more tools in your toolkit, I think social prescribing is powerful for that too. So I think it’s both, right? It’s about fixing healthcare, but it’s also about fixing community infrastructure so that we don’t have to rely on healthcare at all.
James Maskell:
Yeah, for sure. I mean, that’s the dream, isn’t it, to have the communities fulfill their role of keeping people out of the system by engaging them in positive work and connection through that. And you’ve seen some examples like that in the US There’s been some really exciting examples like let’s say at a church level where you already have the community, you have the connection. So how can we in the Daniel plan really look about taking healthy concepts and infusing them into a community that already exists? And I think that’s ideal, but also you have seeing the fraying of communities. It is not that the structure of being in the UK, the church really only represents a much smaller percentage of the population than it did when I grew up there. And so even those levels of community that once existed have fallen apart. So it’s hard to rebuild around something that doesn’t have the attention of the people at this moment.
Julia Hotz:
Totally. And if I could just shout out one example in the UK, I think you’re right. The UK is especially a place where the church has been historically pretty central and the US as well. And I think there is this deep hunger for rebuilding that, what Dr. Robert Putnam calls social capital and this civic life. And one place in the UK that makes me really hopeful about this is Frome. Yeah, they’ve got this awesome model of community connectors, enlisting, non-medical professionals, hairdressers teachers, cab drivers, ordinary neighbors to come and signpost the different community supports that exist. I was just in through, but I’m so obsessed with it. It’s almost hard to believe this place is real. They have over 2,000 now, and this community connector model is spreading. So that makes me hopeful as well.
James Maskell:
Yeah, no, I think Frome is definitely the most exciting thing in healthcare, really. I mean, that’s a conscious effort to rebuild the fabric of society through volunteerism, and I think that’s amazing, and I think that’s really speaks to what’s possible. And I’m excited to see anyone who’s interested in that I think is on the right path because ultimately it can’t come from the top down. It sort of has to come from the bottom up, from the people in the community that are there anyway. And even just some of the innovation, like the green lanyards that people wear and walk around, I think is cool to let you know, Hey, this is a role that I’m playing. I’d love to just get into some of the specific things that you talk about in the book that I haven’t really talked about, but you talk about attention restoration therapy. You talk about forest bathing, art therapy. Can you explain what some of the, I mean the lifestyle medicine stuff, exercise, you can think about that kind of stuff done in a group that’s sort of an obvious fit to me is that you’re doing something that’s already very healthy and you’re doing it in a group and it creates the structure to keep people doing it. I’d love to understand some of these other ideas, where they’ve come from and what you see in efforts to popularize those kind of ideas.
Julia Hotz:
Definitely. Yeah. So the book focuses on movement, nature, art, service, and belonging. And you’re totally right. Movement is the one where people are like, well, duh, you didn’t need a book to tell me that I should be moving my body more and not sitting all these hours a day. 85% of us, too, 85% of the world currently lives a sedentary lifestyle. I mean, I chose those five, but those five kind of chose themselves because I saw these as the five ingredients that communities around the world were consistently mobilizing around. But if we take a step way back and think about why it might be that movement, nature, art, service and belonging lend themselves to social prescriptions actually has to do, I think with the way that we evolve to live, right? You think about a person thousands of years ago, what was a day in their life as we’ve talked about, they moved their bodies, but it was also probably really evolutionary advantageous to be able to pay attention to nature, to have this tendency to serve the group. And so they would serve you to cooperate with other people. Also, really interesting to me, all kinds of civilizations have independently converged on creating art and sharing stories. Why is that? So the book goes into that and gets into some of the science of why this might be and how we can leverage those totally intuitive tendencies to create art and spend time in nature to actually treat some of the leading lifestyle and mental illness symptoms today. So let’s talk about nature.
Many of us, where do you live, by the way? I live in
James Maskell:
California.
Julia Hotz:
Oh, you live in California. Okay.
James Maskell:
In the countryside with nature.
Julia Hotz:
Love that you are lucky. I’ve done
James Maskell:
My stick in New York and la, so I ejected with my kids, and now we live in the middle of nowhere.
Julia Hotz:
I love that lucky kids and truly lucky kids because I’ve come across a lot of interesting research that suggests kids in particular do not get nearly enough nature exposure. But that’s true for adults too. And studies have demonstrated that spending time in nature has these really unique properties that actually enable us to improve our focus and concentration and restore our attention. There were some researchers of the 1980s who tried to understand why that is. Why do we have this sort of universal reverence for nature? Why are we drawn to natural environments? And they have this really compelling theory that suggests so much of our modern environment taxes our attention. We’re always trying to keep up on email, text the news that takes a lot of directed attention, but they propose this theory that says, nature is one of the only things that can capture our attention without taxing it.
And that is because we intrinsically find it fascinating. And why do we intrinsically find it fascinating? Maybe because again, being able to pay attention to the birds and the fish and the trees and the sunlight had all these evolutionary advantages. So coming full circle with this, studies demonstrate that when you compare exposure to a natural environment versus a rushed city environment, when you give people time to spend in nature, when you allow people to bathe in the forest as they do in Japan, bathe sort of metaphorically keep your clothes on, this has all of these wonderful stress reduction properties. It lowers people’s blood pressure. People produce less cortisol, people boost their immune function. And one really interesting study too actually showed that spending time in nature versus an urban environment, there’s less activity in the part of the brain that’s associated with rumination. When we spend time in nature, in other words, when we spend time in stressful urban environments, our subgenual prefrontal cortex is really active, and that’s the part of the brain that is associated with rumination. So it seems to suggest that when we have time in natural environments, we ruminate less, we’re more calm, we’re less stressed. And just one more really interesting one for kids, they found that just 20 minutes of exposure to nature in kids has as attention restoration effects on par with taking Ritalin, a common medication used to treat A DHD. So yeah, we could go down the rabbit hole, the research, but just so much support for this idea that nature is so beneficial for our attention.
James Maskell:
Absolutely. Well, I won’t go into all the details now, but I recently just came alerted. One of the things that I’ve been working on for the last three years is a nature-based school that my kids go to and have gone to for the last three years. And that’s based on the principles of Rudolph Steiner. That’s his education philosophy, and it’s all about proximity to nature. But the thing that ties that back that really alerted me to this is I went to the fielder clinic in Germany in 2016, which is Rudolph Stein. It’s an anthroposophic hospital. And just one example that I think will give you something to think about is they have an 8% C-section rate there compared to 33% in Germany and the rest of Germany. And there’s many reasons for it, but the most obvious reason is all of the wing that is the maternity wing, all of the rooms open up to the gut.
You’re lying in your bed and you’re looking out at the garden, and you can go through the doors and go out to the garden at any time. And so what you just described there would be the sort of physiological process that’s happening by which you don’t need as many C-sections because you’re relaxed and calm and connected. And so, yeah, I’m really glad that you shared that about the nature because I feel like that is critical. And if you look at the way that medicine is delivered, it couldn’t be more unnatural. If you look at the hospital, it’s such an unnatural environment, and that’s other things they do in the field of clinic. They don’t have that beep, beep, beep beep going the whole time, which is obviously triggering cortisol at different points and the smell and all that kind of thing. Yeah. Anyway, yeah, that’s a side project that I’ve been working on because you can’t come across all of this research, understand it deeply and not meaningfully change your life in a different direction, especially if you care about your children led to me to make life choices that maybe other people wouldn’t understand.
But you understand it. You just wrote a book about it.
Julia Hotz:
I totally do. It’s so funny when you just made that beeping noise just now, I felt my muscles clench and my heart race. I mean, what? It’s so primal. It’s so obvious. And I love that research. I have to check that out. And it’s reminding me of some from this other amazing researcher. Do you know Roger Ulrich…
James Maskell:
Name? Sounds familiar. I don’t know much about it though.
Julia Hotz:
Yeah, he was another one. Something about the 1980s seemed to be a very foundational decade for nature and detention research, but Roger Ulrich did a similar experiment in which he compared the recovery rates of patients who had received gallbladder surgery compared the patients who had a brick wall in front of them versus those whose rooms overlooked a garden, found that those who’d overlooked the garden, recovered faster, required less pain medication. The staff rated them as more pleasurable and more easier to deal with. There’s that fascinating research, other fascinating research about nursing homes and how they’re introducing nature and even wildlife, including animals, can also improve their quality of life, reduce reliance on medication. It’s really fascinating stuff.
James Maskell:
Yeah, no, it is. Well, I’d love to just finish the conversation and there’s so much more, and I would encourage anyone who’s interested in this conversation, get the book, check it out, start doing more social prescribing. I think if you are the doctor or the practitioner that prescribes something that ends up being transformative in the life of a patient, that’s a remarkable experience and people will remember that and will refer accordingly. So I think that there’s a huge advantage to having this in your toolkit. And this is really just a part of integrative medicine, the way that it’s been described. I want to talk about cost because part of the reason why I think it took off in the UK that it hasn’t here is that there is a cost ceiling, right? And there’s also a capacity ceiling. And so part of my thesis for the group visits was that ultimately if you could create capacity in something that wasn’t doctors IE social prescriptions or health coaches or groups of people that would create a place for chronic disease patients to go, that would stop it from clogging up the rest of the system, which is how you would really see the NHS is clogged up.
But I guess one of the things that I want to just point to is that now what you’re seeing in the US with the accountable care models is that you get paid organizations that are ACOs and accountable care organizations get paid more if they control costs. And so it seems to me that with those kinds of models becoming popular, Medicare advantage and value-based contracts, that the social prescribing thing could happen. And I’ve actually already heard about services where older people can go on an app and suddenly an 18-year-old arrives at their house and does their laundry and does their shopping and fixes some stuff around their house. So that’s a service that’s being created by some tech company to actually put people into the homes of people that need help. And I just think that all of that is being created by the fact that if you deal with these things upstream, you are going to end up with way fewer of these hyper expensive end results like hospital stays and that kind of thing.
Julia Hotz:
Absolutely, yes. I’m glad you’re talking about this with your background and health economics. It’s only right that we talk a little bit about the financial case for this, which is huge. It’d be nice if we could just wave a magic wand and have this magically available. But at the end of the day, part two of the book gets into this it to be about incentives. So in the UK, one other extremely motivating factor behind why there was an investment in social prescriptions is because there were some estimates from NHS England suggesting that one in five people coming to the doctor we’re doing. So for nonmedical reasons, we’re doing so for social reasons. In a place like the UK where there’s already so much pressure and research shortages, capacity issues, that was a huge problem. So part of the hypothesis was with the NHS is will investing in social prescribing reduce pressure? And what they’ve found is emerging evidence that yes, in practices where there are social prescriptions in place, there’s about a 24% reduction in GP doctor’s appointments, a 28% reduction in emergency room visits, some financial forecasts, which totally honest here, I don’t quite understand how these calculations work, have found that investing one pound for social prescriptions can lead to a two to eight times return on investment.
And that makes sense, right? And that’s the UK, right? Because the logic is, okay, someone told a story of they had a patient coming to the emergency room every Friday night just because they were lonely. That is bad for everybody. That patient is not getting the care they need. The doctors in the emergency room have people with acute medical needs they need to care for, and they’re costing the system a lot of money. Same story I heard everywhere, no matter what kind of, whether it was a public system, a private system, a mixed, this endemic problem of people coming to the doctors and hospitals who don’t need medical care. Now in the US where we have a unique cornucopia of problems and pressures and incentives, incentives, that was one of the first things I heard as an American journalist covering this is there’s no way that the US will get on board with this. Come on. But here’s what I will say. In the US we have, well, first of all, a lot of people don’t have insurance where the only nation of this size and this wealth in which a significant proportion of the population is uninsured. But for those of us who do, we typically have private insurance. And increasingly in the US we’ve heard about insurance companies starting to cover things like gym memberships. Have you heard about this?
James Maskell:
I mean, I’ve seen it like my dad lives in South Africa, and they have that level of sophistication there where the gym memberships, you buy a gym membership and it reduces your health insurance. And I’ve seen that in every place where the incentives line up in the right direction. I mean, my understanding is in America that they don’t, and that’s why you haven’t seen that. But I think they will start to possibly, hopefully, I don’t know. Yeah…
Julia Hotz:
Totally. Right. It’s definitely more of like a no-brainer in places where the insurance system isn’t so complicated. But I’ll say for my parents too, my older parents, they now have part of their gym memberships covered by their insurer. And if you think about it, why is that? Well, it actually makes a lot of sense. That could be a sound investment. As we talked about in the beginning, it’s well known that exercise and movement not only helps treat the symptoms of all kinds of chronic and lifestyle and even mental illnesses, but also can help prevent future chronic lifestyle and mental illnesses. So if it’s seen that investing in this gym prescription versus spending money on medication and therapies and repeat doctor’s visits, if the insurer is weighing, okay, what’s a more sound investment here? The gym membership makes sense. So increasingly that same logic is being applied for social prescriptions and specifically for arts prescriptions.
Ever since this book has been published, the state of Massachusetts has been increasingly investing in their arts prescription model, a partnership between a hospital and insured, 300 different community partners in which art classes are available on prescription. And this is inspired by a model in Newark, New Jersey through the insurer that some listeners might know, horizon Blue Cross Blue Shield, as well as a local partner, NJ pac. They have teamed up. They had teamed up to run a pilot in which members of Horizon Blue Cross Blue Shield that were at risk of overspending on their insurance, they would be eligible to have covered up to six months of arts prescriptions in the newer community. Spoiler alert, that was really successful. And that is what is fueling, I think, the spread of this idea that maybe insurers can get on board.
James Maskell:
Well, I love that, and I think that is exciting. And Massachusetts certainly has done things historically that have then made it to the rest of the country. So they’ve been leaders in those areas. So I’m excited about that. I guess my hope is that whoever the vendors are that are doing the art therapy, that the heart is there. Because when Obamacare came out and every employer had to have a wellness program, the first wellness programs that came out were really just people who saw the legislation and thought, Hey, we can make a ton of money here. And I think wellness, certainly in the eyes of the employer took a huge dive in between 2008 and today because of all the scammy kind of programs that were created that obviously didn’t really have the best interests of the end user at the forefront. So I’m excited for that. I know it’s hard to scale an art program with heart, but hopefully whoever’s doing that has that at the core center of it. I think one of the things that we’re going to have to see as a huge barrier in the next iteration of the transformation medicine is that organizations that are backed by private equity and venture, mainly the heart has been stripped out of them.
That’s tricky to get to scale, but if you’ve got 300 local programs that are running and those things have got good outcomes, and there’s people in there who really care about people’s art and people’s connection to each other, I think that can only be exciting. And the truth is, medicine is moving in a direction even in America where outcomes will matter and costs matter. And so if you can reduce costs, I’m, this is what I’m holding onto as we try and build systems to make functional medicine cost effective, is to connect the demand for cost effective care and reversal of chronic illness with the supply at the same time. And so that’s happening. Well, I’m glad we’re able to chat about that. And look, I’m just grateful for you to be out there doing this, sharing the message, getting in front of people, communicating it, popularizing these ideas.
It is a very, what would you say, slow, big ship that we’re trying to turn around. And so as many rudders in the ocean as possible to flip us around and head us in the right direction. So thank you for your pioneering work. Thank you for taking on a topic that’s so meaningful. And I’m excited that practitioners who are listening to this might grab a copy of the book, have it in their practice, might prescribe some things that they haven’t prescribed before, and really take care of those psychosocial elements that I think are mission critical to health. So thank you, Julia.
Julia Hotz:
Thank you so much, James. It’s so great to be here. And just one final thought to leave us on from that Massachusetts pilot. We’ve talked a lot about the patient case for doing social prescribing. We’ve talked about the system and case, but one quote I’ll never forget from that Massachusetts Arts prescribing pilot is a doctor saying, “This feels amazing to be able to prescribe this stuff. It feels like the first time I’m able to prescribe beauty and joy in someone’s life rather than just a pill that they go on and take in isolation.” So I hope that the health professionals listening might see this not just as an opportunity to help their patients, but also reconnect them maybe to the reasons why they got into healthcare. That’s what it’s all about, right? Treating the whole patient’s needs. And I’m just so grateful for you and your pioneering work on this and the way that, yeah, we’re making that ship all go together.
James Maskell:
Absolutely. Cool. Well, check it out. Make sure to get the book. I’ll have all the details in the show notes. Julia, thank you for being here as part of the Evolution of Medicine podcast. We’ve been talking about The Connection Cure. It’s a book, it’s out now. It’s available wherever you buy books now. This has been The Evolution of Medicine podcast. I’m your host, James Maskell. Thanks so much for tuning in and we’ll see you next time.
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