Wellness goes to work: Companies are offering a wide array of offerings

For an afternoon every week or two, internist Richard Hildebrand, MD, practices medicine in a way that would make most physicians jealous.

As medical director at the Center for Preventive Medicine, part of St. Luke's Health System in Sioux City, Iowa, Dr. Hildebrand spends two or three hours with the same patient. He focuses not on acute illnesses, but on wellness. He puts the patient through a series of tests, and actually has time to go over results with him or her once they're completed.

"Over time -- and I hate to speak for everybody -- we've gotten used to the appointments every 10 or 20 minutes," Dr. Hildebrand said. "This is a nice combination of very old-fashioned, but very high-tech. It makes a lot of sense."

Employers think so, too. More companies are joining in the wellness trend, sponsoring preventive health programs and asking -- or, in some cases, requiring -- their employees to enroll. Programs range from one-dimensional, single-issue programs such as smoking cessation to diverse, multipurpose strategies that look at a person's overall health.

Sensing a business opportunity, some physicians are starting to adapt their practices to fit this trend as well. Some are providing contracted services to hospitals, while others are tailoring wellness programs and marketing them directly to local businesses. A few doctors even are partnering with fledgling businesses providing turnkey-style support or other services to help them get their wellness practices off the ground.

Regardless of the size of the business or practice, they have a straightforward sales pitch to employers: wellness programs will save businesses money.

"It saves on insurance costs, and we've seen amazing successes in saving people's jobs from things like addictions, surgeries and life stresses," said Lee Rice, DO, a family physician and sports medicine specialist in San Diego. Dr. Rice is also CEO and medical director of Lifewellness Institute, a preventive medicine practice. "Businesses see employees as their most important asset, and they want their employees to know it," Dr. Rice said.

Employers see corporate wellness programs as a way to both control health care costs and boost key employees' productivity. The theory is a person who addresses his or her health early on can avoid major complications later, and a healthy person won't miss as much time at work.

A 2005 survey conducted by Hewitt Associates, a global human resources outsourcing and consulting firm, showed that interest in corporate wellness is on the rise. Companies using "condition management programs" increased from 73% in 2004 to 83% in 2005, according to the survey of major U.S. employers. Meanwhile, 30% in 2005 said they offer incentives to employees who participate in wellness programs, compared with 21% in 2004. Also, 27% in 2005 said they measured the impact wellness programs had on corporate productivity, compared with 22% the year before.

The common image conjured when considering corporate wellness is the blood test that can help calculate an employee's risk profile for certain diseases, such as diabetes. Wellness programs are going well beyond that, however, with comprehensive counseling and nutrition services to help an employee manage his or her health.

Even the standard blood test is a thing of the past. Biophysical Corp., an Austin, Texas-based company, has developed a test that, with the amount of blood typically drawn, can detect 250 different biomarkers. The company is marketing the test to employers as an executive benefit. For $3,400, the executive can have the blood test, a company physician will go over the results for him or her, and a copy of the results will be forwarded to the executive's personal physician.

"With regards to screening, you have to cast a broad net, because you don't know what's lurking underneath," said George Rodgers, MD, a cardiologist and president and chief medical officer of Biophysical Corp. "In a traditional model, there's not enough time to do that."

Wellness models

Cost savings and increased productivity are powerful motivators for employers, but the interest is not necessarily dependent on size. Dr. Rice said that although his clinic does contract with some Fortune 500 companies on wellness programs, the vast majority of its business is from small- and medium-sized privately held companies.

There is no shortage of wellness models, either, and doctors said the size of a practice should not have any bearing on a physician's decision to focus on preventive medicine. The Lifewellness Institute, which includes three physicians, is an example of a small group that has made wellness its sole focus.

On the other hand, Dr. Hildebrand said he was approached by the hospital and asked to work at its new wellness clinic on a contractual basis. He said his compensation for one wellness patient accounts for an afternoon away from his practice, whereas if he had two wellness patients in a half day, "financially, you'd be doing better."

The compensation model for wellness programs are generally cash-based, paid directly by the employer or an individual. That not only offers an opportunity to practice without insurance hassles, but it also guarantees a less-frantic office environment, since the compensation for one wellness appointment can make up for many acute-care patients with insurance coverage.

The practice can tailor its wellness offerings to fit the size and scope of a business as well. A company that wants to enroll its executives theoretically can choose different services in an a-la-carte style, and the practice could price the entire package accordingly.

For example, Lifewellness Institute offers several different packages for businesses and individuals. A basic individual package starts at $5,000 for the year and covers a comprehensive evaluation, quarterly meetings, and access to a physician, an exercise physiologist and a wellness coach, among other professionals, Dr. Rice said.

Often the clinic forges a deal with a corporate client after the company's CEO has signed on as an individual and found benefit in the services provided, Dr. Rice said. Then "he wants everyone else to sign up as well."

But having employees as patients adds a layer of interest to the scenario that isn't a part of the typical physician-patient relationship.

There is the possibility that an employer, which is paying for the wellness program, might request health information about its employees, putting doctors in an awkward ethical position. Physicians involved in wellness programs say they avoid those potential future problems by addressing them up front with employers, and companies accept their rationale.

"Our absolute position is we don't ever give away personal data," said James Canedy, MD, an orthopedist in Omaha, Neb., and president of SimplyWell LLC, an integrated health solutions company that provides comprehensive health management and wellness services to corporate clients. The company is a physician-founded joint venture between a local IPA and regional health system.

"Businesses embrace us because of the recognized need. They want a solution," Dr. Canedy said.

Partnership opportunities

A physician's connections to some of the more powerful business leaders in a community gives him or her some built-in word-of-mouth marketing opportunities, should a group decide to create a corporate wellness program.

Those practices that might not have the promotional interest, however, have options to partner with support companies. Businesses have formed over the last few years to get in on the ground floor of the wellness trend, and they're looking for physicians and hospitals to spread their model.

U.S. Preventive Medicine, based in McKinney, Texas, is a two-year-old company that plans to roll out a national system of wellness clinics under the moniker "Center for Preventive Medicine." Its first site is a partnership with St. Luke's Health System in Sioux City, Iowa -- the office where Dr. Hildebrand works -- and it currently is in negotiations with several other physician groups around the country to develop future locations, said Christopher Fey, the company's chair and CEO.

The company offers turnkey-style support, including marketing, billing and training services, to practices and hospitals for a management fee. Its sales pitch to doctors is that the wellness model allows them a chance to get back in the health care driver's seat and increase their revenue, Fey said.

"The key benefits to physicians are first, not being left out of one of the biggest moves in health care, which is healthy aging, and second, providing them more revenue and giving them more control over their livelihood," Fey said.

Those sentiments are similar to ones voiced by physicians who have joined the concierge medicine trend in recent years. Sick of the constraints inherent to an insurance-structured environment, some doctors have established membership practices to allow them the freedom to care for patients in the fashion they prefer.

In some respects, wellness programs are structured similarly, with annual fees covering many services that are in some instances unlimited. The main difference, of course, is that wellness clinics focus on preventive medicine, while retainer practices still address patient illnesses once they arise. The models have a common theme though: getting out of the managed care rat race.

Just as many retainer-practice physicians say they were motivated to change their practice because they wanted to spend more time with each patient, physicians with wellness programs see them as an opportunity to practice in a comprehensive, effective way.

"I don't think the reason to do this should be to make more money," Dr. Rice said. "You should believe in it. It's not that you make more money; it's that you spend your time differently."