Sam Benjamin, MD on Integrated-Wellness Care in 11-Million Member Humana, Inc. Contributed by John Weeks The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM Sam Benjamin, MD, on Integrated-Wellness Care at 11-Million Member Humana, Inc. Summary: Long-time integrative medicine leader Sam Benjamin, MD, has served for six years as Corporate Medical Director for Integrative Health Strategies for Humana. He describes the present status and new directions of integrated care as part of Humana's wellness and consumerism strategies, along with sobering information on covered CAM-IM benefits. If you explore the details of the homepage of the website for the 11-million member Humana, Inc., you will find, down at the bottom, center, this link: "The Dr. Sam Show offers a daily dose of healthcare guidance." Click to the offered portal and one encounters the photo of long-time integrative medicine leader Sam Benjamin, MD imbedded in an array of consumer resources, much of it of his own creation. The promised guidance includes pod-casts, guides, web-links, books and other resources. Among the selections on the web page is a link to the actual Dr. Sam Show - a twice weekly radio program, principally sponsored by the Louisville, Kentucky-based firm. The interview-format program airs mainly in markets in which the insurer ("benefits company" Benjamin corrects me) is active: Tampa, Chicago, Indianapolis, Tucson, Orlando, Kansas City, Miami and, of course, Louisville. A benefit to the listeners of the Dr. Sam Show, according to Humana, is that "since (Benjamin) is a medical doctor, a licensed homeopath and a certified acupuncturist, his listeners can ask questions about both conventional medicine and complementary and alternative medicine (CAM)." Benjamin's Background in Two Major Integrative Medicine Initiatives Benjamin, who wears the Humana title of Corporate Medical Director for Integrative Health Strategies, and I spoke first of how his relationship with the insurer/benefits giant was panning out. My question had some history in it. Benjamin had led high profile, pioneering initiatives with hospitals and academic centers in integrative medicine's first days-1995-2000. He directed the first, major hospital-based integrative clinic, the 10,000 square foot Arizona Center for Health and Medicine (ACHM) sponsored by the multi-state Catholic Healthcare West. The gorgeous, Zen-gardened and smooth-walled clinic was national news as it rose - and as it collapsed in red ink and amidst conventional physician resistance. A startling, learning experience for many in the field: Maybe linking complementary medicine in a conventional system may not go so smoothly as some imagined...
Benjamin's next position was running an integrative medicine program for an academic medical center at the State University of New York-Stony Brook. Benjamin sought to ensure that funding would not be an issue there, quickly seeking support from natural products industry funders. He found himself in the cross-hairs of anti-cam warriors and eventually left. CAM Coverage Typically Up to the Employer Group Benjamin appears to have found a home at Humana, which employs him full time in a capacity which bridges complementary and integrative medicine with the firm's wellness and consumerism interests. "Humana's view is that it is not in the insurance business but in the benefits business." A first responsibility when he went to work, in 2000, was to be a system-wide resource on CAM. "Most people did not know what it was, or had negative attitudes toward CAM," he recalls. "That was step one." He feels like the brunt of this mission is accomplished. "At Humana, we want to champion idea that people can choose the health care provider they want, whatever they feel is in their best interests. We have no prejudices against MDs, or against well-trained NDs (naturopathic doctors)" The assertion is reflected in directions given to consumers on the Dr. Sam site: "If you want alternative medicine, get your advice from a well-trained ND (naturopath) or MD with integrative medicine training, or some other professional."
Benjamin adds that Humana's openness to CAM approaches is not merely targeting clients: "Humana even has a CAM resources section on its employee site." But how about covered benefits, beyond such guidance to members on their decisions.. Here, Humana is not taking an advance position: "CAM coverage depends on what the employer wants." He notes that through American WholeHealth, whose medical director John Reed, MD is Benjamin's former colleague at ACHM, Humana members have a CAM discount program for acupuncture, massage, chiropractic and some other services. Humana does have some interesting points where care is covered: "We offer glucosamine-chondroitin to our Medicare members in Florida at a $10 co-pay for three months supply. This would probably be $30-$40 month for a good quality product." Benjamin also notes that there may be more coverage coming for acupuncture, and for multi-vitamins. Pressed on specific kinds of complementary and integrative services Humana covers for some of its employer clients, Benjamin deferred: "It's an issue of competitiveness. We don't usually talk about what a specific employer wants or is getting." He notes that, short of hard data showing that CAM services limit other costs, neither employer nor insurer is likely to push more significant coverage of CAM providers. Humana is not presently exploring these cost-offset questions, but, says Benjamin, "I think we will." CAM as Part of a Consumerism/Wellness Benefit Benjamin shifts the conversation, making clear his work in Humana has little to do with CAM, per se, or even "integrative medicine," unless an employer requests it. Rather, the focus is on "every way we can assist members with life and living." Says Benjamin: "Humana's view is that it is not in the insurance business but in the benefits business." He states that the firm is offering "an integrated approach to lifestyle issues." He defends the approach: "If a person is not going to walk or get exercise, it's not going to matter much whether they get acupuncture." Benjamin then ticks off a list of integrated wellness-oriented services: - A magazine targeting seniors has routine articles on options such as meditation
and yoga - "it's truly integrated, we just don't call it that." - Seniors have a SilverSneakers exercise program and a Posit Science "brain fitness" program. - Web information on CAM approaches and supplements is available. - Disease management programs "increasingly include CAM." - Members are informed about environmental issues, from problems with teflon to air-water pollution to synthetic beds. - Humana sometimes provides food and house-cleaning services, for a time-limited period, to members in recovery from a significant health problem. - The "benefits company" has sometimes assisted employer clients toward healthy vending options. - The firm is "moving enormously toward consumer-directed plans." - The sponsoring his radio show as an experiment with a kind of "info-tainment" meant to better engage people with their health than more typically used educational materials. - Members are steering to explore potential problems with some conventional care that may be recommended. He notes: "We send them to HealthGrades to research the hospitals or physicians they select. We want people to see the costs and dangers of what they are getting." He adds: "I think this transparency favors integration." "If a person is not going to walk or get exercise, it's not going to matter much whether they get acupuncture."
Benjamin reflects on the different meaning of integration at Humana compared to the experience a decade ago in the integrative clinic sponsored by Catholic Healthcare West (CHW): "At CHW, we were a bizarre thorn in their sides. Here, we've not only overcome the ignorance about CAM but there is a dramatic increase in suggestions related to CAM that come from others. The staff is taking things and running with them." For Benjamin, his personal, ongoing staff work centers on the radio show, where, he states, Humana gives him "tremendous leeway - as long as I can back it up." Comment: That the outspoken Benjamin has a multi-city radio show is a sign of a level of dialogue from the inside that parts of health care are learning to stomach. The programs are instructive about the intellectual housing of the integrative discussion in a large, well, benefits company. The status of CAM/IM in Humana is a hard reminder of just how poorly the CAM-IM idea of a clinical orientation to wellness is yet integrated into even a progressive use of wellness programming. But that Humana hasn't taken a more proactive approach toward steering people toward the care of CAM/IM providers - through more actual coverage - is a hard reminder of just how poorly the
CAM-IM idea of a clinical orientation to wellness is yet integrated into even a progressive use of wellness programming. We Need Data on Cost Off-Sets How do we foster this fundamental integration of a wellness-oriented clinical approach and more typical wellness strategies? The answer is a drum I've been beating for years. We need more data on cost and, specifically, cost-offsets, from the whole practices provided by acupuncturists, naturopathic doctors, chiropractors, massage therapists and integrative practitioners. Data on effectiveness, alone, will not change the practices of an employer or insurer. Might I repeat that again? Data on effectiveness, alone, will not shift the kinds of healthcare services which people with covered benefits are able to access. The action step? We need a new and more significant health services research program at the NIH National Center for Complementary and Alternative Medicine.