Efforts by US businesses to contain their health costs have become noteworthy in large part due to incentive programs that intend to reward employees for altering their lifestyles. A lesser-known aspect of these trends is the evolution of health services provided in business settings that have adopted the thinking and approaches characterized by integrative medicine practices.
The focus has shifted largely to health promotion, wellness, and an array of primary care services, rather than occupational health or convenience care.
The report was produced in Dec. 2010 for RWJF by the Center for Studying Health System Change in Washington DC, which a spokesperson told me does not focus on integrative medicine or practice to any degree. But, as with the emergence of Comparative Effectiveness Research in 2009 and 2010, transitions in traditional workplace health-related approaches are responding to significant shifts in society and in market demands and expectations. In the case of employment settings the primary focus is on the control of health care costs. As a practical matter, one means to that end appears to embed in employer health clinics approaches from the integrative experience.
Integrative Health Practitioners’ Presence Increases
For instance, the report refers repeatedly to the skills and approaches considered central to integrative health: health coaching, nursing, primary care, attending the whole person, clinicians who “provide compassion” and “spending more time with the client.” Many of these reflect the recommendations of the compelling “Wellness Initiative for the Nation” (WIN), formulated by the Samueli Institute, Alexandria, VA in 2008. (Links to this report are here.)
Consider this assessment from one of the third party companies that have historically created and/or operated workplace health clinics for businesses:
Of all the RFPs that have come to us in the past 24 months, I can’t recall one that didn’t ask for wellness and health promotion.
Wellness and health promotion of course are terms that can cover a wide range of intentions. This report cites the following types of clinical services in place or being designed for new worksite wellness programs:
Occupational health—treatment of work-related injuries, employment physicals and screenings, travel medicine, and compliance with federal workplace safety regulations.
Acute care—ranging from low-acuity episodic care, such as sore throats or sprains, to treatment of more severe symptoms requiring urgent attention, such as exacerbations of chronic conditions.
Preventive care—physical exams, immunizations and screenings.
Wellness—health risk assessment follow up, biometric screenings, health coaching, lifestyle management programs and educational programs.
Disease management—ongoing care for and management of chronic conditions.
One on hand, something of the usual suspects. The section on “Staffing and Recruiting” however more directly describes these trends in hands-on terms:
“Clinics focused exclusively on wellness,” the report notes, “tend to have health coaches and other professionals with varied backgrounds, such as nurses, health educators, nutritionists and exercise physiologists.”
The report notes that large enterprises such as Dow Chemical, “…have developed more limited in-house clinics with an almost exclusive focus on wellness programs.”
Some individual integrative practitioners are also taking the initiative to sell their services into the legacy occupational health service providers that have long-established relationships with business clients. A yoga therapy practitioner in New York, for instance, has just started to approach such providers. Local hospitals that have been providing integrative therapies and wellness programs for their own patients could be in position to take that new expertise to local businesses.
This increased focus on wellness and health promotion is also changing the role of clinical health professionals. This is perhaps the primary point of intersection for the integrative community. As one medical director put it:
“The challenge was that we had occupational nurses trained a certain way, and everything was about work injuries. … Over time we need a new skill set to deal with the person as a whole person. Some providers were able to make that jump, others were not.”
The report also notes that in some cases even the omnipresence of the MD is also becoming less critical. A corporate medical director said of nurse practitioners: “The reason I like NPs is they have to do care planning in school and learn to treat the person as a whole; physicians tend to think about (discrete) problems.”
This phenomenon has had another curious effect according to the report: the company clinic is seen as a lower-cost, convenient option, especially for primary care, and the lines are a lot shorter. “People who otherwise would not have sought care may suddenly flock to the clinic,” the report says.
This growing emphasis on wellness and health promotion corresponds with the employer’s increasing role as a source of health information. A February 2011 study from the membership organization the National Business Group on Health reports that in 2010 75% of workers used their employer for medical and health information, up from 57% in 2007. (A press release with links to the report are here.)
As others have pointed out, the obvious downside to a concentration of the employer’s role in health affairs is that any value it might provide benefits only the employees of businesses who can afford such programs. Developments like this usually rankle integrative practitioners who are concerned with ensuring far broader access to healing therapies. But these trends also present opportunities to further establish the credibility and efficacy of integrative services.
Just as the new Comparative Effectiveness Research regime represents a response to research conditions that were many years in the making, the rising interest in wellness and prevention is also no sudden phenomenon. Although not yet very well known, the integrative medicine research community now has significant historic data on efficacy and cost-saving factors that will continue to make the case for adding integrative approaches to clinical services being considered for corporate wellness programs.
The report covers other important factors, including the practical issues of how wellness programs are licensed in the states, how the IRS treats prevention benefits, and how the Affordable Care Act (if it survives the year) may provide $200 million in grants to businesses with fewer than 100 employees for wellness programs. It is one of a plethora of reports on the transitions of health responsibilities and solutions in the workplace, but worth a look for how it describes the thinking and approaches now finding favor there.