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Notes on Integrative Care and Health and Productivity Management from the IHPM Conference PDF Print E-mail
Written by John Weeks   

Notes on Integrative Care and Health & Productivity Management from the Employer-Focused IHPM Conference

Summary: From March 31-April 2, 2008, an unusual cross-disciplinary group of complementary, alternative and integrative medicine (CAIM) practitioners and researchers gathered with a much larger group of employer organizations at the Institute for Health and Productivity Management's Fourth Annual Health Management Conference. The conference was entitled The Employer-Sponsored Value-Based Health System: New Key to Global Competitiveness. The questions on the table were whether and how CAIM practices might be useful to an employer’s cost-conscious health and productivity agenda, and, if so, were the two parties ready to take advantage of the opportunity presented. This reports some of that meeting. Next conference: Oct. 15-17, Scottsdale.
Early Notice: Next IHPM Conference with CAIM content at
Eighth International Conference - October 15-17, 2008. Scottsdale, Arizona.

CAM. integrative medicine, employer, cost effectiveness
Stimulating the employer-CAIM connection
1.      Introduction

In early January, the Integrator engaged a new sponsor, the Institute for Health and Productivity Management (IHPM), which was just starting to focus on stimulating relationship-building between large employers and the complementary, alternative and integrative medicine (CAIM) field. The motivation to do so was both high-minded (health creation) and practical (saving employers money by limiting the global costs associated with poor health). There is an understood hierarchy: success in creating evidence of the latter is linked to the opportunity to participate in the former. A part of the work involves developing CAIM content for tracks at two IHPM conferences in 2008. The first was held in Orlando, March 31-April 2, and this article reports reflections on that encounter. The second will be held in Scottsdale, October 15-17, 2008.

Dow, CAM, integrative medicine, employer
Dow's Cathy Baase, MD - track co-chair
2.      Integration in a Multinational Corporate Environment: What Part is Adjunctive?

Cathy Baase, MD, global director of health for Dow Chemical, co-chaired the track with me. Dow is in more than 70 nations around the world. “As a multinational corporation,” said Baase, “there is no one philosophy of health and healing that is universal.” She clarifies: “Originally, our whole philosophy was in Western medical practice. Now we say in Dow, as do other multinationals, there is no one right way.” Employees in Africa, in China, and in Europe may have very different senses of the value of practices still viewed as ‘alternative” here.  Baase’s comments reminded me of a poignant slide used by Kenneth R. Pelletier, PhD, MD (hc), in his  presentation to the full conference:  Professor Tan Sien-Xum Chair of the Integrative Medicine Institute at Beijing Friendship Hospital, reportedly made the following statement at the end of a 1998 conference:  “Western Medicine showed definite promise as adjunctive treatment to Traditional Chinese Medicine.”

3.      Cost Effectiveness in ND Trial with Postal Workers

An ongoing theme in the Integrator is pushing our research communities to prioritize new sets of questions. A case in point was a presentation by health services researcher Patricia Herman, ND, PhD (cand.), a member of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care. Herman was contracted to develop a cost analysis of a back pain pilot project in which workers at Canada Post, the postal system, were given whole person naturopathic care which included some acupuncture. Herman's colleague, Orest Szczurko, ND, who is with the research team at Canadian College of Naturopathic Medicine had found positive clinical outcomes compared to supportive care without herbs.  Yet the direct cost of the naturopathic intervention was significantly higher than usual care at a medical cost level: $1469 versus $337.

Economic evaluator Patricia Herman, MS, ND, PhD (cand.)
If Herman had stopped there, the report’s findings would have looked quite negative, from a cost perspective. Yet, Herman added a dimension which appreciated that the employer's global costs associated with employee health are 3-5 times higher than direct medical costs. Herman worked with the employer to come up with an acceptable, conservative analysis of costs associated with absenteeism. Reductions in absenteeism-related costs in the experimental group showed that naturopathic care was clearly cost effective. Interestingly, Herman did not analyze any costs associated with “presenteeism” – a productivity loss indicator which accounts for 50% or more of an employer's global costs related to health. Given the diminution in pain experienced by the experimental group, and the typical productivity losses associated with back pain, the cost/benefit ratio of naturopathic interventions would have been that much better if  data on presenteeism had been collected. Notably, Szczurko says that the next phase of the pilot will look at such outcomes.

5.   Pharma and Compliance as a Reductive Health and Productivity Management Equation

Many of the CAIM group at the IHPM conference were somewhat chagrined to discover that "health and productivity management" sometimes focuses on efforts to enhance early diagnosis of conditions then increase compliance of employees in prescribed drug regimes. The employer role then targets how to best motivate employees to follow the prescribed paths in order to avoid adverse outcomes for failure to comply.

: This is an area where there may be significant value in further exploration. For instance, if some patients are not complying because of a desire to avoid adverse effects of prescriptions, might the employer be served to try meeting goals with dietary supplements or other complementary therapies? 
Many integrative practitioners know that focusing patients on habit change, mind-body, botanical or nutrient substitution plans which are specifically aimed at lowering the need for prescription drugs and avoidance of adverse effects can be effective. The pilots of the Alternative Medicine Integration Group in both Chicago and Florida - data for which were presented at the Orlando conference - show diminished use of pharmacy, for instance.  Pharmacy replacement strategies as advocated by Integrator adviser Michael Levin and others may be a valuable approach to employers. However, the theme  is one that has yet gathered little headway in research circles. 

6.   Integrating the Employer Dialogue: In Which a Track Can Be a Ghetto

Ten years ago I was involved in developing CAIM educational tracks for the National Managed Health Care Congress (NMHCC), at that time a robust purveyor of health plan-related information. Attendees in the track often complained, rightfully, that those speaking in the track were not reaching those who were "out there" in other tracks, consuming the typical NMHCC fare. Those in the track, good as they may have been, were only "speaking to the choir." The CAIM track at IHPM faced this same problem. The bulk of IHPM attendees were there to learn about value-based design of benefits, and how to measure such design. Some complained that those tracks - the content of which their employers had sent them to learn - kept them from the CAIM track. The consensus among the CAIM group, in a post session discussion period, was that we need to integrate CAIM content into other tracks. For instance, CAIM as a part of value-based design, and/or methodological issues in CAIM measurement might have been part of other tracks. Participants urged such an approach in the future.

: Happily, I can report that IHPM will integrate the CAIM content into their other tracks during the October 15-17, 2008 conference Scottsdale.

Mayo Clinic's Philip Hagen, MD
7.    Is a Biomedical Bias Keeping Hospitals from Engaging Employee Health Initiatives?

Some hospitals are increasingly seeing direct services to employers as a new business opportunity. Phillip Hagen, MD with the Mayo Clinic presented on the evolution of Mayo's services which can help meet employer interests. He noted, for instance, that Mayo's Health Risk Appraisal (HRA) is itself an intervention, and that Mayo has added Lerner's Work Limitations Questionnaire to it. The nurses on Mayo's phone lines use "motivational interviewing" to better take advantage of the phone call as a positive intervention. He spoke of the way Mayo's "multi-modal interventions" are stratified based on risk. Those at low risk are triaged to the web for information, at medium risk to phone lines, and at higher risk to disease management programs. During the interactive segment following his presentation, a member of the audience asked him why Mayo and other hospitals and health systems have themselves been slow to see themselves as employers who have significant health and productivity issues in their own work places. Hagen paused, thoughtfully, then answered directly: "It may be due to our bias that we can do everything with biomedicine."

8.    Coda: Employee Health, the Environment, and Full Cost Accounting

Preventive-oriented services such as whole-person complementary, alternative and integrative health care, offer employers and health system planners a challenging proposition: Spend more and you save!  The postulate is exceedingly unlikely to prove positive if one narrowly compares short-term medical costs related to treatment. The Canada Post pilot in #3, above, is an example. Yet the more one looks over time and includes the global costs associated with health, the better chance for the postulate.

It is fascinating, but not surprising, that the challenge of establishing the value proposition of front-end intensive, preventive-oriented, natural health CAIM interventions directly parallels challenges in implementing good environmental practices. Success of each rests on full cost accounting. Unfortunately, inclusion presently rests too often on decisions of human beings who are caught up in short term cycles. The mantra, for all of the CAIM fields, should be to always measure outcomes based on the global costs associated with poor health.

To learn more about the employer-CAIM connection, attend the
IHPM's Eighth International Conference - October 15-17, 2008. Scottsdale, Arizona.  The program content is expected to include on onsite Rolfing-based massage pilot with Intel, NIh NCCAM health services leader Richard Nahin, PhD, MPH, and an integrative chronic disease presentation by Lise Alschuler, ND, FABNO, with the Cancer Treatment Centers of America and a panel on strategies for measuring CAIM interventions which will include Bernie Noe, ND, a clinician whose Green Mountain Wellness has twice won the Vermont Gold Medal for employer-based wellness outcomes.

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