Columnist Taylor Walsh Examines the Worksite Wellness/Integrative Practice Cross-over Via RWJF Report

Summary: Integrator columnist Michael Levin recently had occasion to read a series of reports, prepared by the internationally-known health care consulting firm, The Lewin Group. The subject: possible cost impact of pro-actively using a few dietary supplement interventions for a handful of conditions. The outcomes were compelling. Levin argues that this kind of work, funded by the dietary supplement industry, exemplifies forward thinking collaborative effort needed to advance the integrative and natural health fields. The story of this strategic funding will be familiar to chiropractic …

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Healthcare foundation eyes worksite clinics

The workplace wellness movement was birthed in large corporations at about the same time that the so-called “CAM” (complementary and alternative medicine) disciplines started their growth surge. Both took off in the mid-1980s. Each had in common a mistrust of leaving health to the regular doctors and institutions. The former saw employers inserting themselves into what they experienced as awful cost escalations. The individual consumer’s frustration with the limits of regular medicine stimulated the latter.

The Robert Wood Johnson Foundation (RWJF) recently published Workplace Clinics: A Sign of Growing Employer Interest in
Wellness
.
In this column, Integrator contributor Taylor Walsh used the publication as a jumping off point to explore places where more attention to merging these two streams of health care thinking and practice might yield exceptional benefits. 

Walsh is a consultant, entrepreneur and writer on digital media and integrative health based in Washington, D.C. His website is Getting to Integrative Health & Wellness. Those who Tweet will find him at @taylorw.

__________________________


Integrative
Practice in Worksite Wellness Initiatives?

 
— Taylor Walsh



 

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Taylor Walsh

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.  Another 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 practice. 


These
transitions are well described in a recent report funded by the Robert Wood
Johnson Foundation, “Workplace Clinics: A Sign of Growing Employer Interest in
Wellness.”
The report states: “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 refers repeatedly to the skills
and approaches routinely
described as
inherent to CAIM: health coaching …

attending the whole person, clinicians who
‘provide compassion’ and ‘spending
more
time with the client.'”

      

The
report was produced in Dec. 2010 for RWJF by the Center for Studying Health
System Change
in Washington DC. A spokesperson told me the Center does not focus on
CAIM or integrative 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.

For
instance, the report refers repeatedly to the skills and approaches routinely
described as inherent to CAIM: 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.


Consider
this assessment from one of the third party companies that have historically
created and/or operated workplace health clinics for busines:
“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.


On
one 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.”

   
   

“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.”

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.”

   
“As one medical director put it: “Over time
we needed 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. 

MyCompanyMyHealth.com?


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.

   
     “The report 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.”

As
others have pointed out, the obvious downside to a concentration of the
employer role in health affairs is the limitation of any value it might provide
to employees of businesses who can’t afford such programs. While developments like this may
simultaneously tantalize and rankle integrative practitioners who are concerned
with ensuring far broader access to healing therapies, 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. And as The Integrator Blog has reported, the integrative
research community now has significant historic data on efficacy and
cost-saving factors that can continue to contribute to the incorporation of
integrative approaches in 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.

__________________________


   
 Awful struggles and many failures have
taught us that the only big money in

integrative health care is in the savings
that may come from not needing
conventionally provided services.
Employers, unlike hospitals, benefit
from this.

     

Comment: Radical change (ie transforming our health care system) requires radical solutions. Since coming to grips a dozen years ago with how little incentive healthcare delivery systems have for altering their highly profitable practices, I have advocated that the integrative practice community needs just such a radical departure from currying favor with health systems toward partnering with employers (public and private). Awful struggles and many failures have taught us that the only big money in integrative health care is in the savings that may come from not needing conventionally provided services. Employers benefit from this; hospitals and health systems via typical payment structures do not.

This is an awfully tough bridge to cross – to get the consultant from Center for Studying Health
System Change
to declare that yes, the group is all about CAIM methods; or to get the Robert Wood Johnson Foundation to invest in exploring integrative approaches in an work site setting. A nice starting place would be a functional medicine pilot such as the Institute for Functional Medicine has engaged recently in partnership with the Florida Agenda for Health Care Administration, only this time in a work site. Walsh points us in some good directions. To abuse a repeated line in the I Ching, it would further one to cross the great water. 

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