Podcast interview with Don R. Powell, PhD, CEO of the American Institute for Preventive Medicine (transcript)

This is a transcript of my podcast interview with Don R. Powell, CEO of the American Institute for Preventive Medicine.David Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I am at the Consumer Health World Conference in Las Vegas where I spoke today with Don Powell, PhD, President and CEO of the American Institute for Preventive Medicine, a for-profit wellness company that is celebrating its 25th year in business.Don and I spoke about how the wellness field has evolved over time, how employers think about the benefits of wellness programs, and about the kinds of customization and integration that are required to achieve success.Don, thanks for being here today.Don Powell: Thank you, David. Nice to be here.David: What is the American Institute for Preventive Medicine?Don: It is a for-profit company celebrating its 25th anniversary this year. We work with companies, hospitals, managed care organizations, unions, and government agencies to help reduce health care costs, lower absenteeism, and improve productivity by providing a variety of health management interventions.David: What's the scope of services that you provide?Don: It's both wellness and what is referred to as "demand management," teaching employees to become wiser health care consumers and make better decisions. The company has four major products: one, our medical self-care guides, which are books that use a flowchart format to help a consumer better understand what physical symptoms they are having and what level of care they should receive in response to those symptoms. If it's an emergency go to the ER, otherwise if it’s something you should see the doctor for or maybe something you should simply call the doctor about or consider self care.Secondly, we provide wellness lifestyle change programs for tobacco cessation, weight control, stress management.Thirdly, we have a variety of health communications materials, including a health newsletter, health calendars, brochures, booklets, little care kits, even refrigerator magnets to help get the health messages out.Lastly we do a lot of customization. We developed a self-care guide for the United States Army geared toward the issues of basic training. Another one for Blue Cross Blue Shield of Massachusetts is geared toward their most frequently used ICD9 codes; an educational piece for the CIA on health fraud; another piece on antibiotic resistance for Chrysler; so, varied types of projects of a customized nature.David: Congratulations on celebrating your 25th anniversary. That's quite an accomplishment. Tell me how the field has changed over that time period and in the last couple of years in particular.Don: In some ways it's changed a great deal. In other ways it's kind of gone back to the way it was. Like fashion, economics, health care things follow trends. You know, what's certainly different today is the use of the Internet, and a lot of people are seeing that as the future of health care.I take exception to that though in that I feel that there is still a very important place for more high-touch strategies as opposed to high tech. When you look at the data on whether anybody saved any money because they put up a very elaborate e-health portal on their intranet I am not aware of any study that's documented that, whereas we have hundreds of studies on the more traditional wellness activities, such as health fairs, health coaching, health newsletters, medical self care guides, group classes and so forth. They have all shown anywhere from a three to five to one return on investment.David: Do employers mainly look at return on investment or do they have other motivations? How do they look at the balance and is that something that has changed as well?Don: They say they look at return on investment, but when it comes down to it probably only about 30 percent really look at that as the reason for justifying continuation of their wellness program or even starting it.You still see where people just think it is the right thing to do. An ounce of prevention is worth a pound of cure certainly makes sense. They are kind of up in the air as to what else can they do. With health care costs rising around 9 to 10 percent per year for the last 10 years or so employers at least look at wellness as one strategy.They also feel it can improve morale. Employees appreciate the employer taking an interest in them, and yes, hopefully at the end of the day there will be some reduction either in absenteeism, reduced health care costs when they go back to their insurer or --what seems to be a slightly growing body of literature-- improved productivity, although I think the literature on that is still rather weak.David: I have been surprised to see recently some of the large and sophisticated companies announcing that they really do see a return on investment in wellness. I think IBM cited a number of something like $100M in annual benefit that they were getting. It was the reason that they were expanding their wellness programs to dependents. Have you seen that as a trend, or is that more of an anomaly?Don: No, there is a return on investment that can occur. In terms of how many people will go into it with that being the expectation is where I said 30 percent or maybe as high as 40 to 50 percent. But, not everybody just looks at it as a ROI issue. We do have some very impressive studies and a number of review articles that have been published in the American Journal of Health Promotion.A series of them by Ken Pelletier have substantiated what we've said for the last 25 years. We can reduce health care costs and absenteeism with wellness interventions. The key though, David, is that what is wellness? People define it in different ways. I hasten to say that wellness is not because you have a no smoking policy. Wellness is not because you offer a newsletter once a month or a health fair once a year.Wellness is a combination of a variety of activities that work together, from health screenings to a health risk assessments to health coaching to communication materials to one-on-one counseling and so forth. These types of comprehensive programs are the ones that are showing a return on investment --not something more piecemeal in nature.David: How much customization is required within a given employer's population for things like different generations? I assume the Generation X or Generation Y are different from some of the older folks, the retirees. Presumably, there could even be some differences depending on location or ethnicity or other factors. Can you comment on that?Don: Yes. Clearly, the older population wants to focus more on musculoskeletal types of issues. If you have a large African American work force there's a greater prevalence of diabetes and hypertension. Any good vendor would look at customizing their program to the needs of the population group, but there are certain similarities that run across just about all populations. We know on average 21 percent of employees are going to smoke cigarettes. Sixty percent are going to be obese. Six to eight percent are going to have diabetes. Forty-eight percent will be under excessive levels of stress.So, using those national statistics we can generally decide what types of interventions to offer, but clearly you want to also understand that population for more specific types of interventions.David: We are here at Consumer Health World in Las Vegas. I was wondering if you could tell me what you are doing here, if you are speaking and what you hope to get out of the conference.Don: Besides enjoying the Las Vegas nightlife I am here to speak on the essential characteristics of successful worksite wellness programs. I have identified a number of key benchmarks that any employer or managed care organization would want to make sure are included in their worksite wellness program in order to get that return on investment, David, that you alluded to.David: I have been speaking today with Don Powell, PhD. He is President and Chief Executive Officer of the American Institute for Preventive Medicine. Don, thanks for your time again today.Don: Thank you, David. Very nice to be here.