by John Weeks
You just made a pact with the devil.
So speak the expressive eyebrows of many friends and colleagues when I tell them about an organization with which I recently signed on to help shape some integrative practice-related activity. A chief medical advisor to the organization is Cathy Baase, corporate medical director for Dow Chemical Company. Fortune 500 firms like Boeing and John Deere are also leading sponsors and participants.
The rebellious, anti-corporate soul of many Sixties-influenced complementary and integrated care trailblazers makes an instinctive sign of the cross to ward off involvement with such multinational entities. Yet there is in an excellent case that a pact with these corporations may be the best way to leapfrog natural health care and integrative practices into a position of greater prominence in our healthcare system.
Consider the universal criticism among integrative practitioners that our so-called healthcare system and our National Institutes of Health are not dedicated to health at all, but rather to disease. Consider how complementary and integrative-oriented researchers have been stifled by reductive research models which cannot capture the full value from whole practices. Consider how our attempts to create health in hospitals and healthcare delivery structures are often strangled by the perverse incentives to feed tertiary care subspecialists in those disease-addicted institutions. Consider how the restrictive payment policies of most insurers force a reactive clinical orientation on practitioners who participate in third-party payment. There’s plenty of devilment to go around here.
Now listen to Baase, describing the outcomes of an analysis of costs associated with employee management which she undertook for Dow.
"What we discovered, when we looked at disability costs, when we looked at absenteeism, when we looked at a person’s happiness on the job, at a person's ability to be a good team player, at their productivity on the job, at things like depression, and even when we looked at medical costs, we found that the driving force, in the direction we wanted to move things, is the health of the employee." (1)
For anyone tracking the awkward and frequently unsupported path of "integration," Baase’s statement contains 3 remarkable features. First, the central focus is health creation. Second, the focus come from healthcare’s most powerful stakeholder: the employer. Third, the stakeholder interest is not that of an if I can afford it, I’ll invest in it altruism. Baase speaks to a corporation’s hardcore economic interest. The view is that success in health creation advances a global set of outcomes which increase profitability.
Does this context sound at all titillating to any of you who believe that your practice helps patients feel better, have more energy, limit their needs for hard-hitting Pharma and become more engaged and productive in their lives? Does this sound like a game board where maybe using your approaches would be considered a useful move?
If so, the good news is that Baase is not alone. In 1999, the Institute for Health and Productivity Management (IHPM, www.ihpm.org) was founded to bring together Baase and other corporate medical leaders who shared this emerging global view of employee health. Instead of focusing on the costs of an employee’s medical benefits, they began developing strategies for exploring investment in employees as a human asset.
A focus of the group, under the leadership of Sean Sullivan, a past CEO of the National Business Coalition on Health, is a concept dubbed "presenteeism." The concept relates to productivity and to nearly 50% of the global costs of poor health. That’s right: the costs to the bottom line from things like absenteeism and productivity dwarf the costs of medical benefits. (More in my next column.)
The logic of health and productivity management is corporate, and bottom-line oriented. Certain inputs are needed to keep a machine performing well. What interventions might keep employees optimally functioning?
I am personally tired and frustrated by expression of philosophical alignment with "health" among medical stakeholders who are not economically-interested in health creation. So I was very excited to learn from Sullivan that a number of leaders in his field view complementary, alternative and integrative medicine as central to the future of health and productivity management. My pact with IHPM is to assist his IHPM members, and leaders of the complementary and integrative communities, in exploring their common interests. My core work is developing educational tracks at their 2008 health and productivity conferences in Orlando, March 31-April 2 and Scottsdale on October 15-17.
If you share the frustration, or are intrigued by the potential, consider learning about the employer as a potential partner for your services. The relationship is new, and needs work. There are language and cultural barriers. But if we are earnest in advancing our fields and the health of those we serve, the details may be in this corporate devil.
Notes:
1. Quoted in "Health Enabling" Corporations: Notes on Complementary/Integrative Medicine and the Institute for Health & Productivity Management Conference."