Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at .
“The arts can improve people’s health outcomes,” says Chris Appleton, founder and CEO of Art Pharmacy, an Atlanta startup partnering with healthcare providers to connect patients with arts and cultural engagement in California, Georgia and Massachusetts. “Yet, the U.S. healthcare system hasn’t really integrated the arts into care delivery.” In January, Stanford University began offering arts-based social prescribing for students experiencing mental health challenges through Art Pharmacy, including dance classes and art exhibits on campus. All students are eligible for the program.
According to the World Health Organization’s review of over 3,000 studies examining the effects on health and well-being, the arts play a role in “prevention of ill health, promotion of health, and management and treatment of illness across the life span.” In February, Crisis Text Line, a nonprofit mental health tech organization providing text-based mental health support, and Common Good Labs analyzed over 87,000 anonymous conversations, identifying resources children and adolescents under 18 say they need from their communities. On the list, second only to opportunities for social connection, is engagement in music, writing, visual and performing arts.
Art Pharmacy is an art and culture matchmaker, partnering with providers across healthcare, such as behavioral health, primary care, pediatrics, palliative care and oncology, and community art programs. “That includes local dance studios, theaters, museums and community arts centers,” said Appleton, adding that he and his team carefully curate arts and culture activities with protective and therapeutic benefits for people’s mental health.
A standard treatment plan, prescribed by providers and called into Art Pharmacy, is 12 doses of arts and culture over 12 months. Care navigators, assisted by technology, connect with patients to identify their clinical and social needs, cultural identity, access barriers and preferences. “Our software matches the person to the highest efficacy engagement within their local community and offers three or four recommendations for their first dose of art and culture,” said Appleton. Typically, the person selects one of the options, but if none appeals to them, the care navigator tries again, providing new choices.
With each activity or dose, as he calls them, the person also gets a companion ticket, allowing people to bring someone else at no additional cost. “We’re trying to address isolation and loneliness and remove barriers to participation — we don’t want to force people to do these activities alone,” he said. The care navigator regularly checks in and does standard mental health assessments — like the PHQ-9, a quick depression assessment, and the World Health Organization Well-being Index — with patients; this not only allows for adjustments to the arts-based care plan but also creates a feedback loop between Art Pharmacy and the referring healthcare provider. “That way, the provider can see if the patient is engaging. If their scores are dropping, alarm bells go off in our system, notifying the provider that the person may need additional support.”
When the person participates, Art Pharmacy bills their insurance, including those operating Medicaid managed care plans, for reimbursement. The startup has pilots with Medicaid managed care, Medicare value-based providers, federally qualified health centers and school-based behavioral health networks. Appleton says the startup’s success with payers comes down to a strategic approach to answer problems insurers face, like lessening their members’ crisis risk. “That allows us to engage in a conversation about how we can help address some of those challenges,” he said, noting that all insurers want to reduce emergency room use and increase patient engagement in their care. The World Health Organization’s review highlighted that the arts, like art and music workshops, have been tied to improved treatment and medication adherence. Appleton has seen this firsthand. “People become more involved in their care.”
He suspects the trajectory of providers and payers incorporating the arts to improve health outcomes will soon be similar to that of physical activity, pointing out that over 30 years ago, Mary Swanson founded SilverSneakers, a program for older adults, believing that getting seniors engaged in physical activity would improve their health and reduce system utilization. “Today, many Medicare plans include access to the program or one of its competitors.” According to the National Council on Aging, most Medicare Advantage and Medigap plans include the program but it’s not covered under Medicare Part A and B plans. “In a decade, we are going to look back and say, ‘Remember when we didn’t know our health outcomes were connected to our engagement with other people and arts and culture?’”
Early on, Appleton learned transportation and flexibility were vital to people’s success with arts-based social prescribing. That’s why he and his colleagues lobby in their partnership negotiations with healthcare systems and plans to include transportation assistance. It’s also not uncommon for a care navigator to get a call before a scheduled event, like a theater performance, from a member who is having a hard day and can’t attend. “We are designed for flexibility — we need to meet people where they are, and instead of this being a moment where the patient feels they’ve failed, we can celebrate that the person is engaged and taking ownership of what they need.”
He says people often just need “a little boost” to engage in art and cultural activities. On Stanford’s campus, Art Pharmacy works with Vaden Health Services, the campus healthcare provider. James Jacobs, executive director of Vaden Health Services and associate vice provost, told the Stanford Report, “If there is an evidence-based, curated way to leverage Stanford’s exquisite resources in the visual and performing arts to support student mental health and well-being, we are all-in.” Students are prescribed on-campus events like a poetry workshop or concert.
What inspires Appleton is how arts-based social prescribing builds upon itself, with many members further engaging in the art, cultural activity or program of choice. He shares how, after chatting with one another, several members at a playwriting workshop discovered they were all there through Art Pharmacy. “They bonded and have since created their own writing group independent of us,” he said. “That’s really cool — we want to help open doors and make connections for people.”
