A Local Conversation for Integrative Health

We were pleased to take part in an event the other day hosted by Northwestern Health Sciences University and co-sponsored by the University of Minnesota's Center for Spirituality and Healing, School of Nursing, and LifeScience Alley. The theme; Integrative Health: Implications for Patients and Purchasers was designed to be a "local conversation about healthcare reform".

The event was well represented by many of the key health care stakeholders throughout the Twin Cities area and was indicative of the interest the market (or at least some key stakeholders) is beginning to show for integrative health care approaches and the role it can and should play in the new system that is evolving. The attendance was also indicative of the need for more of these types of discussions to share ideas, collaborate, and simply provide a venue to let everyone know what is going on in a changing world.

Mary Jo Kreitzer, PhD, RN (Director, Center of Spirituality and Healing) summarized the evolution of integrative health care from the beginning to where it is today. She pointed out that integrative health care has moved from "alternative" to a position to where it can and should play a much more integral role in health care delivery.

Charles Sawyer, DC (Sr. VP, Northwestern Health Sciences University) reviewed the escalating health care cost statistics we are all so familiar with today.

Patrick Geraghty (President and CEO of Blue Cross and Blue Shield of Minnesota) discussed the changing culture of his health plan from being a "health insurer" to a "health company" in response to the changing market expectations and demands.

Carolyn Pare (CEO of the Buyers Health Care Action Group) outlined the expectations of the employers in the new health care market and their interest in "value" not just new gimmicks or "stuff".

Frank Cerra, MD, (Dean of the Medical School at the University of Minnesota) discussed the changing roles of the providers, and emphasized that real health care reform needs to come from the providers and those delivering care.

When you reflect on the total context of these individual discussions it is very clear that the health care market is already changing. Relationships are changing and many of the delivery models that exist today won't be around a few years from now. Integrative health care with a "whole person focus" has a wonderful opportunity to play a much, much, larger role in health care delivery than it does today. We just need to develop the innovative approaches and the business models to make sure it happens.

The time is right.

Do We Need to Reform The Cost of Health Care? You Do The Math

The Kaiser Family Foundation and the Health Research and Educational Trust published its 2009 Employer Health Benefits Survey. We posted it on our site you can get it by clicking here.

For those who are questioning any need for reforming the cost structure of our health care system- let’s just do a little math exercise:

In 2009, the average cost for family coverage increased to $13,375 for family and $4,824 for single coverage. As a reference the average cost for family coverage was $5,700 in 1999. The cost increase from 2008 to 2009 was relatively stable for single coverage, and family coverage increased a modest 5%. But, keep in mind these pricing changes are likely softened by the increased cost-shifting to individuals through higher co-pays and deductibles- we pay more, the health plan pays less.

Employers continue to pick up most of the tab by contributing 74% of the cost for family coverage- we pay $3,477.50 and the employer pays $9,897.50.

The study then provided some other background information comparing 2008 to 2009:

Individuals with deductibles over $1000 increased from 18% to 22%

21% of the employers increased co-pays or reduced benefits

15% of the employers increased the contribution requirements of employees

60% offered benefits in 2009 (compared to 66% in 1999). Only 46% of small businesses offered benefits in 2009 compared to 56% in 1999.

I believe we can safely assume that if things don’t change more of the costs of health care will continue to be shifted to the individual (through high-deductibles, copays, benefit cuts, or increased contributions) or the benefits will simply be dropped because they are too expensive.

The study then projects that if things don’t change and the cost of family coverage increases 8.7% over the next decade (as it has in the past), the cost of family coverage will exceed $30,000 per year. Assuming the same contribution levels between employee and employer, this means individual families will need to double-down what they are paying today for their health care benefits (to $7,800 per year) and employers will need to kick-in over $22,000 per family.

Eighty-percent may be satisfied with the health care coverage they have today. But, we wonder if the same people will be as satisfied when all these projections become a reality.

You do the math.

Opportunities for Complementary and Alternative Medicine (CAM)

In the 1990s, Dr. David Eisenberg and collegues at Harvard created a little stir in the health care discussion when they published the results of several studies regarding the use of (and estimations of the dollars spent on) “Complementary and Alternative Medicine” (CAM) by consumers. The definitions of the services included in “CAM” for the study were a little loose- (not taught in traditional medical schools) and some of the categorization may have been a little confusing but the bottom-line was very real: Over $27 billion was estimated to have been spent on CAM services, most of it was cash, and most medical doctors were unaware of the use of these services.

The $27 billion number caught the attention of the insurance industry. Since most of these CAM services were outside the traditional benefit structure of a health plan, the insurance providers began to try to figure out ways to capture some of the dollars. Affinity networks were all the rage for awhile as insurance payers simply developed networks as a “value-add” to a health plan member. They would provide access to CAM providers to members at a discount from normal charges and collect an administrative fee for coordinating the efforts and providing the access to their members. Very little was done to actually integrate these services further into any health care plan for an individual patient. In the 90s, creating a “health and wellness culture” in health care was still an altruistic vision to most insurance payers (still is to some); they remained focused on managing illness and paying claims. Offering CAM networks was a product decision by the marketers, not a clinical one.

No doubt, some progress has been made since 1997 but the health care system we have today still has a long way to go to integrate the services included in the CAM definition, into a clinical delivery structure that focuses not only on improving the physical health, but the quality of life of each individual.

The Department of Health and Human Services, Centers for Disease Control and Prevention recently published some updated numbers which shows there continues to be a strong demand for CAM services.

The study, “Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007” estimates that nearly $34 billion was spent out-of-pocket by consumers for a variety of CAM products and services in 2007. The vast majority of this cost ($22b) was for “self-care purchases i.e. products, classes, and materials; and nearly $12 billion was spent on practitioner visits.

The methodologies between Eisenberg’s approach in the 90s and the approach used in this updated study are so drastically different you have to take some of the comparative conclusions made with a tad of skeptisicsm. We all know that developing consistent definitions and comparisons in health care has not been one of the industry’s strengths.



Nonetheless, this updated study projects an even larger expenditure for CAM services than Eisenberg estimated in 1997. This continued growth creates opportunities for CAM products and services to play a more visible role in the health care system that is evolving.

This study shows that individuals continue to seek more holistically focused (and yet safe) methods to address health issues, and more important, look to these services to maintain their health and quality of life.

As the health care system gravitates toward health, wellness, and quality of life even more, we hope the clinicians (and not the marketers) take the steps necessary to integrate appropriate access to CAM services and make them an even more important component of health care delivery in the future.