The National Center for Complementary and Alternative Medicine (NCCAM) website lists over 600 specific alternative therapies. According to Ken Pelletier, PhD, MD (Professor of Public Health, University of Arizona School of Medicine), “When I hear someone in a workplace wellness program say alternative therapies don’t work, I ask: ‘Which therapies, for what conditions, in what populations, and in what situations?’ It really depends on what you are talking about. Then there are people who say, ‘If it’s natural, it must be OK.’ But look at that list of over 600 therapies. A significant number carry a very real potential to do harm.”
Ken has extensively reviewed complementary and alternative medicine (CAM) studies from around the world. “Because of where I work, my research must conform to a standard of best possible evidence as seen in randomized clinical trials. But there are a number of potentially important therapies and interventions that simply don’t lend themselves to that type of analysis.”
Often such studies lack the necessary documentation but still see excellent outcomes. Ken cautions corporate wellness practitioners against discounting such studies and recommends analyzing them using a 3-pronged triage-type approach:
Is there clear evidence from clinicians that the therapy works well in the patient’s situation?
What’s available in the literature and online showing what does not work?
What studies are underway that require us to simply wait and see?
As increasing numbers of CAM therapies gain acceptance in employee health programs, it becomes necessary to develop a common vocabulary. The term Integrative Medicine (IM) describes an evidence-based fusion of conventional and CAM practices. IM is not a physician-centric system — practitioners function in truly integrated or virtual systems with providers of diverse competencies. Together they form a clinical network where outcomes are enhanced from working together, rather than at odds with each other. These networks typically fall into 4 categories:
Freestanding IM clinics that house multiple disciplines
Family practice group with a virtual network of respected CAM practitioners for patient referrals
IM services affiliated within a hospital setting
Therapeutic disciplines offered through nonmedical settings like worksite health promotion programs, schools, extension programs, and even churches.
According to the 2007 National (US) Health Interview Survey of 23,393 adults and 9417 children ages 17 and under, 38% of adults and 12% of children use some form of CAM. This is reflected by the increasing numbers of health insurance plans that cover such CAM therapies as acupuncture, chiropractic care, naturopathy (in certain states), nutrition counseling, stress management, and behavioral medicine. Even vitamins/minerals, herbals, exercise equipment, books, videos, and fitness club memberships can be found as health plan benefits. Ken points out the reason: it’s what their corporate health and wellness customers want. “Although health plans increasingly counsel corporate clients on CAM coverage trends, the insurance industry is not the point of innovation here; it’s the purchaser. Larger companies form a purchasing coalition based on demands from employees and unions. If there is solid evidence behind the request, they balance the interest with legal issues, costs, and other practical considerations to determine what becomes part of a benefit package.”
High-tech industries took the lead in offering IM to corporate wellness audiences. Computer, telecommunication, banking/financial, airline/aerospace, petrochemical, and automotive employers know IM appeals to their highly educated, competitive employees… who tend to stay with their company for the long term. “These corporations look at their employees’ welfare as an investment. They want to preserve these assets and enhance their productivity on the job in every way possible. Because these industries are so competitive, IM therapies often become a recruitment and retention benefit.”
Even when a health plan can’t (or won’t) cover CAM, other workplace wellness programs have opened their doors to practitioners who provide onsite services. Ken is all for this. “Certain CAM providers are almost universally accepted now, but this is too new an area to know definitively what works. If a wellness program wants to offer aromatherapy in conjunction with a relaxation room, why not? I’ve seen Ayurvedic medicine in larger employee wellness programs along with traditional benefits, especially when there’s a significant Asian demographic. Fitness programs go beyond aerobics to include yoga and martial arts. If these services meet employee expectations and are done responsibly with employee cost-sharing, it’s a win-win proposition.”
Finding the Right Practitioners
The trend is toward outsourcing IM therapies, and corporate wellness purchasers must do their homework when selecting practitioners. Whittling down the field can be challenging; find out if the practitioner:
Carries appropriate licenses/credentialing
Is a member of any well respected professional associations and serves on any boards in their field
Graduated from a recognized school in their field
Has a successful record in providing the services required — demand measurements and outcomes that show evidence within a given period
Provides excellent references
Has a history of any lawsuits or complaints
Maintains a good reputation… ask around.
Planning the Program
Wellness program planners need to involve employees, unions, labor, and management in defining what is wanted. If they help develop specifications, it won’t be viewed as a union or management program… it will be their program. This minimizes problems with acceptance or disillusionment.
Next build a clear picture of the desired services and define specifications to practitioners. What will the chiropractor do for us? What will an acupuncture session look like? If pain is a cost center, what is the evidence that this therapy will reduce those claims and disability leaves?
A Bright Future Ahead
As Director of the Corporate Health Improvement Program (CHIP), a collaborative research program involving 15 Fortune 500 corporations, Ken has a unique perspective for IM’s future. “CHIP is 25 years old. Over that time, some of the first true IM models have been tested within member corporate wellness worksites. We meet twice a year with our corporate members to review the research. The data is extremely positive and the impact will permeate throughout the industries involved.”
“One of our members is Ford. Back pain was the single largest contributing cost to producing their cars. They had 24/7 clinic staff onsite to deal with back pain alone. We demonstrated that combining traditional medicine with acupuncture and mind/body therapies was more effective than traditional medicine alone.”
“When you can demonstrate a more cost-effective way to manage a condition, a company will be interested. They have no inherent bias; they just want evidence — and a vast amount of literature shows it. The return on investment runs from 3:1 to 5:1, taking about 3.25 years to see that ROI.”
Corporate wellness professionals can read Ken’s summary, “A Review and Analysis of the Clinical and Cost-Effectiveness Studies of Comprehensive Health Promotion and Disease Management Programs at the Worksite: Update VII. 2004-2008,” in the Journal of Occupational and Environmental Medicine, Volume 51, Number 7, July 2009.
Ken concludes, “Read the evidence. The literature is there to allow you to make informed choices. But be a Doubting Thomas. As researchers say, ‘In God we trust; all others must present data.’ Wellness program managers will find IM to be a sound business strategy… a tremendous investment in your population. They are worthy of that investment and they’ll reciprocate when they see you care.”
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