Re-born NIH Wellness Unit: Clinical-Research Factor?

Steve_Burd_Safeway02In April of 2008 I sat in the audience at the World Health Care Congress here in Washington and listened to Safeway CEO Steve Burd describe the impressive success his company attained by putting behavior-centric wellness programs into place. It was impressive, and I thought that the concept might find quick appeal among other self-insureds.

But I didn’t anticipate that the company’s “Healthy Measures” program would largely define a piece of the Senate’s health reform package. But here it is, referred to by its sponsor, Sen. John Ensign (R-Nev.) as the “Safeway Amendment.” A good summary of how these approaches have arrived in the reform bill was published today in the Washington Post.

The Post article focuses on the central tension these provisions create: are these provisions about wellness or cost controls?  Perhaps this is not a fair question, since the entire reform package has fallen into a cost-reduction vortex. Employers will say both are achievable.

The Post reports initial push back is coming from the American Heart Association, the American Cancer Society and the American Diabetes Association.  As near as I can tell the wellness community, including those long involved in integrative health approaches, has yet to be heard from. And with the legislative process in its last accelerated stages, it is hard to say how their influence will be included.

Steve Burd’s plan seemed fraught with difficulties when I first heard him refer to the economic adjustment needed for a solution as “a 7th grade algebra problem.” From the business perspective — needing to reduce health expenditure by X %, reduce absenteeism, etc.– that’s a rational computation. And running up the % of GDP consumed by health costs beyond where it is now is clearly untenable. That math is simple.

The people math is not so neatly computed. The nation’s employee population, already terrified that their jobs — and health insurance — may go away for any number of reasons, might find that the behavior-centric approaches sanctioned by this amendment are really an end-run around other legislative provisions that keep insurance companies from dropping people with pre-existing conditions.

The difference could be that individuals would not be dropped for pre-existing conditions, but for pre-existing potentialities:  For example:

If I don’t meet my weight reduction objectives set by the Wellness Department, even though I have no weight-related illness, can I be bounced for being in some near-state of bad health?

Is that possible?  The problem is that nobody knows.  In the event this amendment is adopted (and if it it isn’t: the appeal to employers is very strong) the implementers will need to hear from leading integrative Pelletierpractitioners like Kenneth Pelletier, who has worked with many corporate wellness leaders to advance integrative therapies and thinking in employee settings. Pelletier directs the Corporate Health Improvement Program Program (CHIP) at the University of Arizona Program in Integrative Medicine.

National Institutes of Health (and Wellness)?

A recently re-invigorated unit at the NIH could play an important role in defining and measuring appropriate implementations for employee wellness programs. The Center for Employee Wellness and Health Promotion, situated within the National Heart, Lung and Blood Institute (NHLBI) NHLBI_Logorecently appointed a new director, Rachel Permuth-Levine, PhD, who has been a deputy director in the Office of Strategic and Innovative Programs at NHLBI.

In a podcast interview at  Good Health is Good Business earlier this month Permuth-Levine described the Center’s work: providing fitness, stress-management and other wellness programs for employees within NHLBI.  The Center does not yet have any connections with NIH’s NCCAM, where wellness-related therapies have been studied for many years. But Permuth-Levine noted in her interview the great advantages the center will enjoy working with the Institutes and Centers on the NIH campus and with other federal health agencies within HHS, such as CDC.  (It is worth noting that those agencies are aggressively deploying social media programs that offer a new level of transparency into their inner workings.)

Permuth-Levine is not yet able to say much about the overall or long term mission of the new center.  In the podcast, she said it is too early to provide ROI measurements, or to test ideas like financial incentives, for instance. But she suggested that these elements could well be part of the Center’s research and clinical work in time. (The center is so new that it does not yet have a page on the NHBLI web site.  Later this month, Permuth-Levine will moderate a panel at the  Corporate Wellness Conference in Los Angeles.)

The rapidity with which the Safeway plan has penetrated the thinking of wellness professionals and congressional staffs is impressive, to be sure.   But it is based not only on the potential to reduce health care costs, but also on a conviction that this health care hubbub is all really just a problem of Bad Health Choices by Individuals.   That was certainly the undercurrent at the World Health Care Congress last April.

With many initiatives now focused on the responsibility of those individuals to manage their health care, this rapidly coalescing focus on the individual as employee lends itself to collaborations among practitioners, behavioral specialists, developers of personal bio-health profiles, designers of optimal health environments, as well as the tools and apps emerging from the Health 2.0 community.  The HR departments will have plenty of tools, if they can be incentivized to use them.