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Proposed Employer-Physician "Contract" Suggests Cost-Case for CAM-IM PDF Print E-mail
Written by John Weeks   

Proposed Employer-Physician "Contract" Suggests Cost-Case for CAM-IM

The Institute for Health and Productivity Management (IHPM) is a leading not-for-profit Image organization nationally which works with employers on the challenges captured in the organization's title. A reading of IHPM's most recent publication, Health and Productivity (Vol. 5, No. 2, April 2006) includes excellent guidance for how to frame the potential benefits of CAM-IM integration into the employer-based healthcare system.

Image
Sean Sullivan, JD, IHPM President and CEO
In the view promoted by IHPM and the large employers which participate in IHPM programs, employees are viewed as assets. Smart employers don't see health care costs as an expense, but as an investment. And the investment should not stop with a sick-care plan. A smart corporation will also invest in prevention, return-to-work, wellness,
 
The focus of the new
contract, for the physician,

must be to care about
  outcomes such as a

person's functionality 
and ability to get back
to work.


education, functionality, and programs which decrease "presenteeism" - an employee's poor productivity while on the job. IHPM's CEO is Sean Sullivan, JD, a visionary leader in the field. He served in the 1980s as the first president of the influential National Business Coalition on Health. In the CAM-IM world, Sullivan participated in the Integrative Medicine Industry Leadership Summits in 2000 and 2001.

In one article, the IHPM's chief medical officer, Alan Zwerner, MD, JD, calls for a "new partnership between physicians and employers." He focuses not on the kind of medical outcomes which tend to shape NIH research decision processes, but rather those of more immediate interest to individuals, and to employers - particularly functionality. He writes:

"Doctors (typically) work under a self-enforced implied contract to diagnose and appropriately treat people who are sick, or who think they are sick, and to be paid accordingly. Their relationship is solely with the patient and not the employer who often pays the bill. And the contract doesn't mention 'functionality' or 'capacity to work' as an outcome of treatment. Tradition is the enemy.

"Employers traditionally have worked under a contract, too. They pay for health care as a cost of doing business, not as an investment in health, functionality and productivity of workers.

He adds:
"Physicians, if measured at all, are rated on how well they do 'stuff' to people - e.g., how many mammograms or PSA tests they order - not on the functionality or capacity of their patients to perform their jobs. (We don't see) measurement of functionality and its quantifiable relationships to workforce productivity and to health status and healthcare services ..."
Zwerner calls for physicians to join in a new partnership with employers to "build a robust, productive relationship (or) ... the entire employer-based healthcare financing system may be doomed."

Health-related Services in Which Employers Perceive Benefit

Another writer, Barbara Pelletier, MS, RD, a wellness director for Aetna, shared research conducted by Aetna and The Benfield Group which found that mid-size and large employers perceived the following "potential of health-related services to influence productivity outcomes." (See Table.)

 Productivity Outcomes Can be Improved  by:

1
  No potential 
at all
 2   
   3     4 
 
5
  Very strong
  potential 
 
Prevention of chronic disease
 0%  2%   17%    33%  48% 
 
Education and support to reduce inappropriate use
of healthcare services
 0%  8%  27%  45%  20%
 
Improving efficiency of service utilization (e.g.
scheduling appointments, finding a doctor)
 2%  10%  33%  38%  10%
 
Improving convenience of health services (e.g.,
online drug refills, afterhour clinics)
 0%  10%  27%  45%  18%

Improved quality of primary care services
 2%  2%  29% 47%   20%
 
Choosing treatments that improve functionality of
workers (minimizing pain, fatigue and side-effects)

 0%  5%  17%  43%  35%
 
Better coordination of care in serious cases, with
emphasis on optimal return to work

 0%  3%  8%  50%  38%

Choosing treatments and procedures that minimize
lost time and lost function

 0%  2% 15%
 50%  30%
Research conducted by Aetna and The Benfield Group, 2004.

The employers don't see a lot of benefit from focusing on issues like waiting times, and scheduling - thought these are highly prized markers in hospital quality surveys. Rather, perceptions are that value can be found in preventing chronic disease, increasing functionality, diminishing pain, and lowering fatigue, side effects, and time-loss. These are the kinds of outcomes which Zwerner calls for in his "new contract" with physicians.

Comment:  Back in the CAM-IM dark ages, prior to NIH research funding and the establishment of NCCAM, one learned of outcomes of CAM-IM care almost solely from listening to claims of practitioners. What one heard (and still hears) are typically the following sorts of claims:

  • "He felt a lot better after a few weeks."
  • "I was able to back her off (X) drug which was killing her with its side-effects."
  • "She's doing a lot better. Her gut's not acting up like it used to."
  • "He's doing things he hasn't done for years."
  • "He's not nearly as tired, not waking up dragging, got a lot better energy ..."
  • "Well, she's back to work and that should say something."

Anybody who has been around communities of acupuncturists, holistic doctors, Yoga therapists, massage therapists, naturopathic doctors and chiropractors well have heard the stories. Anyone who has practiced will have told them. The stories are not, of course,

I suspect that
many CAM-IM
practitoners would
have no problem signing
onto a functionality- 
oriented "contract"
with employers
.

 
conclusive evidence of anything more than a perception of the person speaking. (Because measuring such actual claims of CAM-IM practitioners has rarely been an NIH-NCCAM focus, we still, unfortunately, remain in a research dark age on much of this.)

Yet my informal survey over the years suggests that a lot of the patient-centered focus of CAM-IM practitioners embraces a very similar set of perceptions of importance that were expressed by employers in the Aetna-Benfield survey. I suspect that many CAM-IM practitioners would have no trouble signing on to a contract with US employers which focuses on measuring one's abilities to increase functionality, diminish fatigue, get people back to work, etc. It would serve each of these two stakeholders in health care - still largely strangers to each other - to take a closer look at the potential for alliance.


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