This is the second of two articles on the role of complementary and alternative medicine in health-benefits plans. The first covered what is likely the most extensive CAM program in Corporate America. This article presents viewpoints from others in the corporate, medical, and insurance communities.
Big manufacturing company Parker Hannifin is adamant that its health-benefits plan, which covers an eye-popping assortment of complementary and alternative CAM techniques and therapies, is proving effective at keeping employees healthy and reducing health-care costs.
The company may well be unique in its breadth of CAM coverage. But cardiologist Ken Pelletier, a CAM advocate who helps companies design customized health and wellness initiatives, is nonetheless skeptical that Parker Hannifin, a Fortune 500 manufacturer, is on the right path.
Referring to the company’s CAM coverage list (left), Pelletier says, “At least half if not three-quarters of these are in the ‘caveat emptor’ category. Many of them have no evidence base whatsoever. That doesn’t mean they won’t work for some individual with an unusual response to it. But that doesn’t mean they’re replicable.”
From the list, only acupuncture, bio-identical hormone therapy, and chelation (for heavy-metal toxicity, not some of the other conditions it’s sometimes used for) are approved by the U.S. Food and Drug Administration. Practitioners don’t need FDA approval to provide the others because they are not even recognized as therapeutic interventions, says Pelletier. Only a few, like acupuncture, biofeedback, hypnotherapy (if prescribed by a psychologist or psychiatrist), and therapeutic massage, are covered by more than the rare health plan.
Pelletier’s assessment is backed up by Helen Darling, president of the National Business Group on Health, which represents more than 350 large-employer members on national health-policy issues. “For most of these things, I’ve never heard of a company that covers them,” she says. “For the most part they are not medically necessary. They’re more like perks, like bringing your pet to work. [Parker Hannifin] is wasting its money unless it’s clear in its own mind that it’s getting better talent and retaining it by doing this.”
Not surprisingly, the health-insurance industry is also on the opposing side. “Typically what drives coverage is whether there is a scientific evidence base that tells us something is safe, effective, and in some cases more effective than an alternative,” says Susan Pisano, vice president of communications for America’s Health Insurance Plans, a major lobbying organization. “And then an employer has to be willing to fund it.”
There are perhaps only 15 to 25 large companies that could be described as active on the CAM front, says Raymond Fabius, chief medical officer for Truven Health Analytics. The company, which counts about 200 of the Fortune 500 as clients, organizes companies’ health data from disparate sources (health care, pharmacy, lab, and disability claims, as well as health-risk appraisals, worker’s compensation, etc.) into a single repository enabling detailed analyses.
Many employers, still focused largely on trying to contain health-care costs, spend most of their time focused on benefit design, Fabius says. Another group is moving toward the position that containing those costs partly involves managing workers’ health. Then there is a small cadre that feels health costs are really not a cost but an investment in workforce productivity. “And it’s a subset of those that are engaged in broad-based efforts to elevate employees’ health and wellness, including CAM efforts,” he says.
But what, exactly, does “complementary and alternative” medicine mean? Definitions differ widely, from Parker Hannifin’s to those that refer mostly to behavioral therapies.
For example, Johnson and Johnson, long regarded as one of the most liberal companies on the CAM front, offers assorted tools addressing employees’ mental well-being. Employees can phone coaches who provide “mindfulness” treatments aimed at helping them relax and reenergize, says chief medical officer Fik Isaac. There are wellness professionals at many company locations who offer energy management, yoga, and other meditative approaches.
J&J also covers acupuncture, Pilates, therapeutic massage, and the more controversial reiki, a Buddhist therapeutic-touch technique sometimes called “hands-on healing.” But when it comes to many of the items on Parker-Hannifin’s list, “they would be covered only if prescribed by health-care professionals as medical necessities,” Isaac notes. “What works, we apply. But broader coverage does not indicate better outcomes. Unless there is an evidence base, we wouldn’t provide coverage. And, from a scalability standpoint, the utilization of and yield from those services determine their cost-effectiveness.”
Fabius says he believes “strongly” that “bending the curve” on health-care costs — actually decreasing them rather than merely slowing their growth — requires a very comprehensive effort to create a culture of health. That may include acceptance of alternative therapies that help people with chronic or catastrophic illnesses, as well as other conditions.
“Things like meditation and even spiritual therapy can have a very significant [effect] on individuals and families,” Fabius says. (In fact, years ago he testified before Tipper Gore’s task force on behavioral health. She asked him who should be the primary providers of behavioral-health therapy. “I said cab drivers, clergy, barbers and hairdressers, and bartenders,” he recalls. “And I was serious about that.”)
But many CAM practices are not covered “for good reason,” notes Fabius, who spent 10 years as a corporate medical director for Cigna, Aetna, and U.S. Healthcare. Not only is it important to prove the effectiveness of a treatment or therapy, there is also great pressure from companies to keep health-care premiums down, and “adding more things to the benefits package adds to the premium costs,” he said.