"Health Enabling" Corporations: Integrative Medicine and Health & Productivity Management
Written by John Weeks
"Health Enabling" Corporations: Notes on
Complementary/Integrative Medicine and the Institute for Health & Productivity
Management Conference
Summary: On October
17-19, 2007, the Institute for Health & Productivity Management
(IHPM) convened 465 corporate health leaders and vendors. What was
precedent setting, was that the conference included a track on
integrative and complementary medicine. IHPM's mission is to elevate
the idea that employees should be viewed as human assets, and that health enabling activities are good for a
corporation's bottom line. Anyone exploring this interest among the
large employer representatives in attendance will discover that there
is a culture of holistic and global practice which indicates a ripening
of opportunity for natural health and integrative approaches. Here are
notes and reflections about this emerging
opportunityfrom the IHPM conference. Next chance to explore and connect: March 31-April 2, 2008.
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1. Bottom Line: Searching for Profit Via Health and Productivity Management
Exploring corporate health and integrative medicine alignment
Imagine that a corporation wants to earn another 2% on a product. One
way to do that is jack up the price. In a
competitive global environment, that strategy is increasingly
problematic in many industries. Another strategy is
to cut costs. The national dialogue over health reform frequently
references employers cutting medical benefits to remain competitive.
Yet the 465 representatives of large
corporations attracted to the 8-year-old Institute
for Health & Productivity Management(IHPM)
hold a more long-term and global view of such expenses. Slashing medical payments is considered penny wise and pound foolish. Rather,
IHPM promotes corporate health and productivity management
explorations that
engage the employer in activities which may create global savings
related to employee health. Here the potential "margin" is much
more significant than hacking at the dollars associated with direct medical costs.
This year, the IHPM conference included a complementary and integrative
medicine track. Why? According to more than one corporate leader, "that's the
direction health and productivity management is going."
2. An Informal Case Statement Behind the Corporate Focus on "Enabling Health"
What we discovered, when we looked at disability costs,
when we looked at absenteeism, when we looked at a person’s happiness on the
job, at a person's ability to be a good team player, at their productivity on the
job, at things like depression, and even when we looked at medical costs, we
found that the driving force, in the direction we wanted to move things, is the health of the employee.
Dow Chemical health & productivity leader Cathy Baase, MD
I heard this statement in an informal exchange with one
of the small handful of corporate medical directors who was with IHPM CEO Sean Sullivan, JD, in the creation of IHPM. That director is Catherine Baase, MD. Baase’s message
is so direct and her company’s commitment to employee health so significant that she has been involved in providing input and perspective
to priority health projects under the direction of the World Economic Forumin Davos. Baase has also twice been a special guest of financier Michael Milkenat
the health conferences produced by his family foundation. Many readers
may be surprised that the forward-thinking corporation for which Baase
is global medical
director is The Dow Chemical Company.
IHPM CEO Sullivan, a Harvard-educated lawyer who was formerly CEO of the National Business Coalition on Health,
took a personal risk when he moved, with Baase and others,
to set up IHPM. Sullivan refers to the complex of initiatives that employers
are engaging as “enabling health.”
Comment: Sullivan took part in some meetings between
integrative medicine leaders from various stakeholders in 2000-2002. In those, a group of us rolled out a document called the Design Principles for Healthcare Renewal.
We used the term
“health creation” to try and capture the intent of our work. The phrase
was always somewhat controversial. I preferred "health creation" over
more common terms like "prevention" and "health promotion"
as it got people out of their presumption of understanding. Yet "health
creation" was viewed by some to be suggesting we were making
gods of
ourselves by claiming the act of creation. Sullivan's term, “health
enabling,” is useful, more prosaic, alternative. The focus is on the
"host" - on developing a culture which enables health. 3. Health & Management Outcomes Measurement: WPAI and "Presenteeism"
No, WPAI is not a public radio station in New York. The acronym stands for
Worker Productivity and Activity Impairment. The WPAI is a key assessment tool in this field. Another is the Stanford Presenteeim Scale developed by Kenneth R. Pelletier, PhD, MD(hc) with funding from Merck.
These scales attempts to measure what is called "presenteeism." Coined by Sullivan's group, presenteeism refers to what takes place
when an employee is not absent from work, but for the practical purposes of getting
the job done, might as well be. The employee is bothered by
some condition that is preventing him or her from being fully present and productive.
Reasons for presenteeism are varied: illness, depression, bad attitude,
unhealthy work place, adverse effects of pharmaceuticals, child-care
responsibilities, family issues or, as one vendor puts it, "over-indulgence the previous evening."
The
higher the presenteeism, the less value the employer is receiving. IHPM
and the corporations that are engaged in this effort are proving
metrics that show the average level of presenteeism associated with
given chronic conditions, such as diabetes, or, more simply,
depression. The cost of global presenteeism was
estimated at 48% of the global costs to an employer that are associated
with health. This is estimated to be roughly 8 times the contributions associated with absenteeism. 4. Doctors Seeking to Eliminate the Need for Doctors
The IHPM conference was co-sponsored by the Mayo Clinic. Mayo is carving out roles relative to both employee health and integrative medicine. (Mayo's integrative medicine leader Brent Bauer, MD, co-chaired the IM track.) In a keynote, Robert Smoldt, MD, executive director of Mayo's Health Policy Centerquoted William J. Mayo, MD, one of the two brothers who co-founded the Mayo Clinic:
"The ideal of medicine is to eliminate the need for a physician."
William J. Mayo, MD
The IHPM employers know very well the scientific literature developed by Jack Wennberg, MD
and others which shows how fundamentally arbitrary and unnecessary are
many of the surgeries and procedures which drive medical costs.
In fact, evidence suggeststhat
areas with higher rates of surgeries have worse health outcomes. Many surgeries and procedures, with all their attendant adverse effects, are unnecessarily
performed. Dr. Mayo probably never imagined a health care delivery gone this bad. But clearly we can start to eliminate many of the perceived needs for doctors by
controlling unwarranted surgeries.
Comment: Dr. Mayo expresses a powerful ideal. I was reminded of Robert Duggan'ssummation of the core theme at Donna Karan's Urban Zen event in New York City in May 2007: The goal of health reform is to get people out of the sick care system.
Dr. Mayo's sentiment will likely be
wildly applauded by most
complementary and integrative medicine practitioners. But is what is
good for the goose also good for the gander? Is it truly the ideal of
most naturopathic physicians to eliminate the need for NDs,
of chiropractors to eliminate the need for chiropractors, of
integrative MDs
to eliminate themselves, and etc.? Of course, some will argue that
their work is health enabling and therefore more is better. But to
what extent are complementary and integrative practitioners also
building dependency even when their spoken ideals are to empower patients to
care for themselves?
5. Cost Savings from the patient-centered medical home - a role for CAM?
Rick Kellerman, MD, shared the podium of the
opening plenary session, Kellerman is the immediate past president of the American
Academy of Family Practice (AAFP).
Kellerman indirectly reinforced the Mayo theme in his presentation on
his organization's campaign to evolve a healthcare system in which each person
is connected to a patient-centered medical home. The AAFP is
part of a coalition of 300,000 physicians. Co-leading are the
American Osteopathic Association, American College of Physicians and
the American Academy of Pediatrics.
Rick Kellerman, MD, past-president, AAFP
Kellerman shared with the employers the powerful clinical and economic data
which support organizing health care around
outpatient, primary care providers.
Kellerman referenced studies which showed that in regions with more
penetration of primary care, there are better health outcomes, fewer
tests, fewer
unnecessary tests, fewer medications, fewer trips to emergency
departments and
lower hospital costs. Said Kellerman: “As the numbers and percent of
family practice doctors go
up in a community, the quality of care goes up and the cost goes down.”
And on
top of this, having a medical home is one of the two factors most
associated
with limiting medical disparities.
Then Kellerman shared the horror story of the future of US medicine for
which ground is presently being laid. Just 8% of graduates of US
medical schools in 2007 opted for family practice residencies.
Comment:
The alliance of these 4 primary care-oriented associations is itself historic. Now
interestingly, these data are closely aligned
with
what complementary and integrative practitioners - the vast majority of
whom are also in outpatient settings - typically claim about their
own outcomes.
What if the potentially powerful 300,000 professional coalition was
expanded to include the professional organizations which represent the
complementary healthcare services many citizens
use? (Strictly speaking, a "patient-centered" medical home should include these practitioners, given consumer choice.) With the
addition of 70,000 chiropractors, 25,000 acupuncture and Oriental medicine practitioners and 4500
naturopathic physicians, the coalition's ranks would swell by nearly 100,000 more to 400,000. Now imagine
adding the grassroots reach represented by 250,000 massage therapists ... 6. An unintended consequence of inpatient massage
Mayo's IM leader Bauer provided an overview of the conservative medical
system's inclusion of diverse initiatives in integrative medicine in
recent years. (See related Integrator story.)
In one program, Mayo offers a massage to individuals
who are in for heart surgery. The sensitive protocol is administered by
a nurse/massage therapist with a long background in working in
occupational medicine. Her treatments are well-received. In fact, Bauer
notes that an unintended consequence of the
massage study is that "people were sticking around for their massage."
He clarifies: "Instead of checking out in
the morning, they were waiting until their early afternoon massage.
They didn’t
want to leave without their massage." 7. John Deere corporation's whole person mission ... Laura Barringer wears the prosaic title of "quality engineer supervisor" for the multinational John Deerecorporation. John Deere has 47,000 employees and offices in 90
countries. Barringer's work, as she presented it to the IHPM conference
attendees, supports a lofty John Deere employee health mission.
To create awareness,
education and resources for employees and dependents to help them
attain and maintain healthy lifestyles supporting their physical,
emotional and social health and create cultural and social norms.
(W)holistic health mission
The tools Barringer and the John Deere team are
using to fulfill this mission are not overtly linked to what is
typically considered complementary or integrative medicine. But a
certain alignment can be observed. Conventional preventive services are
100% funded. Health risk appraisals (employer-speak for "consciousness
raising") are widely offered. Health coaching and fitness programs are
among the services offered to support lifestyle change. Web-based tools
and nurse phone-lines assist decision support. A focus on educating and
empowering employees is pervasive. Those with certain chronic
conditions have access to disease management programs. Says Barringer: "Our focus is on creating a culture of health."
Comment: This focus on creation of a culture of health is to a workplace what the Samueli Institute and
others are attempting to advance in hospitals and health systems
through their "optimal healing environments" campaign. Interestingly,
each seeks to shift change the host, the milieu, to make the corporation or hospital an environment that nurtures health.
8. Metabolic syndrome and the embrace of (w)holism
An interest in the interlocking efficiencies of a focus on metabolic health is growing in this employer group. A representative from the City of Phoenix presented positive outcomes of a program targeting city employees named the Metabolic Health Initiative. A second presenter, Terri Forman, the benefits manager for TI Automotive,
noted that her company's analysis of risk factors in employees placed them squarely
into the zone of shared causation that the metabolic syndrome represents.
Says Forman: "We learned that the same risk factors for cardiovascular
disease affect other preventable diseases, such as diabetes,
hypertension, and certain cancers." The IHPM, according to Sullivan, is doing field research
"on interventions to reduce the cost of these health risks, under the
auspices of its Workplace Center for Metabolic Health."
Lowering the metabolic rate of expenses
Comment: 20 years ago when I was working closely with the
re-vitalization of the field of naturopathic medicine, I learned about the
connectivity between various diseases which Forman notes. Clinicians
frequently found that work with patients on certain determinants of
health for a presenting complaint would often have a positive influence in resolving other health issues. We
called these "positive side effects." By the mid-1990s, functional medicine pioneer Jeff Bland, PhD, and others in the "alternative medicine" field were regularly educating audiences on metabolic syndrome. This concept was quickly embraced by alternative/holistic medical doctors, naturopathic physicians, and broad scope chiropractors and others.
I mention this history to
note how the attraction to the employer of this (w)holistic thinking on the determinants of health also aligns with the mindset and approach of what was once unabashedly called "alternative medicine." Practitioners like alternative medical doctors and nurses and naturopathic physicians took a lead in articulating and fostering "holistic" and whole person approaches. IHPM's focus on the global aspects of health is (w)holism on a
macro-level. The understanding of the
connectivity represented by metabolic syndrome is (w)holism at the micro
level. This apparent alignment of cultures creates opportunities. 9. Integrative medicine as an emerging trend in health & productivity management
When IHPM began developing the integrative and complementary medicine track, the planners chose to anchor it with a keynote from the integrative medicine leader who has most promoted this connectivity:Kenneth Pelletier, PhD, MD (hc). Pelletier, an Integrator advisor, heads the Corporate Health Improvement Program(CHIP) which is now located at the Program in Integrative Medicine at the University of Arizona School of Medicine. Now in its 3rd phase, CHIP presently has Pelletier's corporate members focusing exclusively on integrative medicine approaches.
Kenneth R. Pelletier, PhD, MD (hc) - godfathering the IM/employer connection
The apparent readiness of the corporate community to explore integrative medicine is also suggested by a recent special insert in theAmerican Journal of Health Promotion. The article is entitled "Emerging Trends in Health and Productivity Management." The lead author is Ron Goetzel, PhD. Goertzel is the director of the Institute for Health and Productivity Studiesat Cornell University. Another is health and wellness pioneer Larry Chapman, MPH. Pelletier is one of 3 other authors. Making the list of these emerging trends, albeit at the bottom, is integrative medicine.
Trend #10: Health improvement programs will integrate evidence-based integrative medicine into the standard offerings. Employers are already beginning to incorporate evidence-based complementary and alternative medicine (CAM) into an integrative medicine approaches to HPM. The integration of conventional and CAM interventions to promote optimal health will form the foundation of comprehensive HPM programming.
Comment: The article may be criticized as self-serving. Funding came from American Specialty Health, a managed CAM company with which Pelletier has consulted. (Neither Goetzel or Pelletier was compensated for their work on the article, however.) Noting the trend may in turn stimulate employer interest in Pelletier's CHIP program. That said, I honor Pelletier and IHPM for helping make this connection happen. Attending the conference and writing this article supports my own belief that there are exceptional veins of nearly untapped potential in this convergence of interests. One needs, however, to be willing to get out of one's box and enjoy the cross-cultural exchange. One must enjoy the process of learning the language and context of this separately evolved, powerful stakeholder. Those who enjoyed Anthropology 101 will discover a potential ally in the advance of a "health enabling" system.
I titled my own presentation at the IHPM conference "Exploring the Connection Between Strange Bedfellows." Consider doing so yourself at the IHPM's next conference in Orlando, Florida, March 31-April 2, 2008.
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