Mindfulness Training: A Case Study in Managed Care
Health costs continue to steadily rise. Some of the reasons driving that increase:
- Distorted incentives motivate providers to oversupply expensive diagnostic and treatment procedures while encouraging patients to over-consume services.
- Inexpensive lifestyle approaches to health improvement are rarely covered for individuals, despite accumulated data showing their effectiveness, while expensive treatments are often covered in full.
- The U.S. medical delivery system is stellar at delivering acute care, but it's highly fragmented and inefficient at delivering chronic care.
- The American population is simultaneously getting more obese, less healthy and older.
Clearly, our focus needs to move to more efficient care for chronic health conditions. Is there a solution anywhere in sight? Yes. The demand for care is largely driven by chronic diseases, which are largely driven by unhealthy behaviors, many of which are inadequate attempts to cope with stress. Stress is widespread.
The American Psychological Association recently estimated that 43 percent of U.S. adults suffer adverse health effects from stress. Some examples include: reduced immunity, increased diabetes risk, increased cardiovascular risk and weight gain. A growing body of research shows that stress and its associated unhealthy behaviors have a considerable impact on chronic diseases such as cancer, diabetes, heart disease, and musculoskeletal pain.
More than 133 million Americans have one or more chronic conditions, and account for 70 percent of all deaths. Additionally, 75 percent of the $2.5 trillion spent annually in medical care expenditures are related to such chronic conditions[2,3]. Modifiable health risk factors now account for 25 percent of total employer healthcare expenditures.
Several studies have showInsurann that employees under high stress levels experience higher healthcare costs (and lower productivity) than those with normal stress levels. In a 1998 study of 46,000 workers, healthcare costs were nearly 50 percent greater for workers reporting high levels of stress in comparison to "low risk" workers.
In a large 2011 study a major insurance carrier working with researchers at Duke Integrative Medicine, the University of Pennsylvania and an evidence-based mind-body wellness company found that annual healthcare costs for the previous year were $1,992 higher for the most highly stressed employees (top quintile) than for the least-stressed quintile.
Getting stress under control, then, can have a significant impact on behavior, chronic disease and ultimately the demand for healthcare services. Abundant research indicates that learning personal stress management skills is both effective and worth the time investment.
Recent brain science research and demonstrations in the workplace wellness field are pointing to numerous personal health, quality of life, workplace performance and economic benefits tied to mind-body interventions. One of the most effective of those mind-body interventions is mindfulness training and practice.
Mindfulness is the practice of bringing one's attention to the present moment, in a gentle, curious and non-judgmental way. Since most feelings of stress stem from ruminating on the past (this morning's argument with a spouse, divorce, etc.) and worrying about the future (college savings for your children, retirement fund, etc.), learning to re-train attention on the present moment significantly alleviates stress.
Further, concentrating on the present enhances our ability to perform well on a current task. Mindfulness skills can be learned in classes of one to two hours in duration, usually meeting weekly for a period of eight to twelve weeks. Randomized controlled trials have shown that mindfulness training not only reduces psychological distress but also improves coping skills, feelings of well-being and even physiological indicators of health including improved functioning of the nervous system and of the immune system.
Reducing Workplace Stress: A Case Study
Hines & Associates, a Chicago-based provider of personalized managed care services to employers and insurers, began exploring new offerings to differentiate its suite of utilization review, case management, disease management and other services. Hines selected a wellness program partner after seeing the evidence that mindfulness-based practices reduce stress and that stress impairs productivity at work.
In their unique online virtual classroom, employees can participate in live, interactive classes from the convenience of their workplace or home. Hines decided to pilot the wellness company's eight-week online program in Mindfulness-Based Stress Reduction (MBSR). Hines offered the course to its staff, and enrollment filled the class to capacity within a day.
Thirty-three employees from Illinois and Iowa participated in the online program. Participants completed assessments before and after the course. Their scores showed significant improvements in perceived stress and total mood disturbance including subscales on tension, anger, fatigue, confusion and vigor.
While the change in depression scores was not statistically significant, the scores did improve. Since the depression scores were not elevated at the start of the course however, a significant improvement was not expected.
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About The Author
Ruth Quillian Wolever, Ph.D., serves as Chief Scientific Adviser for eMindful, the evidence-based mind-body wellness provider that Hines selected for this intervention. Dr. Wolever also is a clinical health psychologist and Director of Research for Duke Integrative Medicine. Dr. Wolever conducts research on the integration of mind, body, and spirit treatments into mainstream medicine. She has specifically explored such applications to improve sleep, eating behaviors, weight management, diabetes control, and cardiovascular risk factors, along with other health conditions.
Kevin Renner is eMindful's Vice President of Marketing. He also has helped build emerging companies involved in health and technology innovation including Epic Systems Corp., FEI Co. (Nasdaq, FEIC) and Planar Systems (Nasdaq, PLNR). Kevin received his MBA from the University of California at Berkeley, and attended the Kellogg School of Management's executive marketing program.