Mindful LeadershipBuilding Support for Integrative Medicine in a Conservative Environment

Maureen Anderson, M.D.Medical DirectorBeaumont Integrative Medicine

Objectives

• Evaluate opportunities to meet the growing patient demand for Integrative Services

• Discuss mindful creation of a strategic plan that is essential for building a successful practice /program

• Describe business , clinical and relational approaches that help to build support mindfully

• Identify additional resources to enhance personal Integrative Medicine knowledge.

Mindful Leadership Concepts

• Be fully present

• Observe without judgement

• Don’t take things personally*

• Reframe; barriers vs opportunities

• “No” is just the beginning of the conversation

• Be impeccable with words*

• Don’t make assumptions*

• Always do your best*

• No failures only learning opportunities

*Don Miguel Ruiz

Mindful Leadership Principles*

• Mindfulness /presence

• Emotional Intelligence

• Resilience /availability / flexibility

• Integrity and ethics

• Radical responsibility and empowerment

• Radical possibility creativity and innovation

• Spirit of mastery lifelong training /practice

*Acharya Maull, PhD

A Mindful Leader

• “A mindful leader embodies leadership presence by cultivatingfocus, clarity, creativity and compassion in service of others”

• “Gratitude helps us to maintain perspective and reminds usthat we can experience joy and calm even in the midst of our busyness, our challenges, and the overall complexity of our life”

J. Martutano

What is Your Spark?

Radical Possibility Creativity and Innovation

• Chronic Pain?

• Opioid crisis?

• Population health?

• Culture shift?

• Patient demand?

Radical Responsibility and Empowerment

Clearly Define the Need/Opportunity

Chronic Pain• Impacts >100 million adults in US

• Cost; $560-$635 billion annually

• Adults:– Neck

– Low back pain

– Osteoarthritis

– Headache

• Children:– Migraine

– Abdominal pain

– Musculoskeletal

• Pain prevalence expected to increase with increase in chronic diseases

Opiate Crisis

• 1/3 Americans used an opiate for pain in 2015

• 20072014 opiate dependence increased by 3,203%

• Economic burden of opioid overdose, abuse, dependency in US is $78.5 billion annually

Population Health

• Reduce healthcare expenditure

• Appeals to diverse populations

• Improve outcomes

• Nutrition /Obesity

• Substance abuse

• Physical activity

Patient and Family Centered Care

• Collaboration

• Participation

• Dignity and respect

• Information sharing

Culture Shift

• Self-efficacy a sense of control over one’s environment and behavior

• Directly influences health behavior

• Indirect impact through choice of goals

Patient Demand

Know the Environment

• Conservative vs open

• Demographic, including financial

• Financial backing?

• Early adopter /champion?

Emotional Intelligence

Conservative vs Open

• Practice / local medical colleagues

• Healthcare system

• Community

Demographic, including Financial

• Features of the local population

– Age

– Gender

– Chronic illness vs wellness

– income

• Features of your target population

– Women?

– Pediatrics?

– Orthopedics?

– Pain?

Financial Backing

• Start-up funds

• Ongoing financial backing?

• Can patients afford services?

Early Adopter/Champion

• Organizational leadership

• Community influencers

• Colleagues

What Do You Want to Create?

• Mission

• Market analysis /competitors

• Has to make sense from a business perspective

Creativity, Clarity, Be Impeccable with Your Word

Mission and Vision

Mission

• To assist all patients, their families and caregivers, in integrating complementary therapies with their conventional medical treatments

• To provide IM for prevention and wellness

• Offer services that are safe and effective, promoting healing at all levels

Vision

• Create a world class IM program which matches Beaumont’s current excellent reputation

• Develop an innovative program that is competitive and comprehensive enough to meet patient needs safely and effectively

Market Analysis/Competitors

• Services

• Pricing

• Location

• Current offerings / resources

Does it Make Sense from a Business Perspective?

• Business plan /pro forma essential

• Breaking even is considered to be a success

• Consider downstream revenue

• Is this a market differentiator?

• Can you create strong customer loyalty?

Strategy

• Staffing plan

• Licensing / regulatory /compliance issues

• Policies and procedures

• Financial considerations

Integrity and Ethics

Staffing Plan

• Contingent vs salaried

• Most are part time with private practices

• Can be challenging to find a skilled practitioner who wants to practice in a more conservative environment

• Supervision of practitioners

• Clarify expectations re. attire, etc.

Licensing/Regulatory /Compliance

• ND not licensed in MI

• TCM registered, not licensed

• Massage therapist licensed

• Registered dietician

• Yoga therapist

Best to have highest level of training /certification

Potential Areas of Risk

• Service coverage

• Cash handling

• Documentation

• Coding /billing

• Fee schedule

• HIPAA

• Employee safety

• Emergency plan

Policies and Procedures

• Natural Health Products

• Emergencies in the clinic

• Needle disposal

• Cleaning equipment

• Fall prevention

• Moxibustion

• Cancellation /no show

Financial Considerations

• Similar to other retail businesses

• Cash vs insurance

• Cash handling system

• Pricing

• Charge for no show?

Clearly Understand the Challenges Faced by Potential Referring Providers

• Chronic pain

• Fatigue

• Sleep issues

• Patients want to get off of meds

• Patients taking lots of supplements

• Patients want integrative approach

Don’t Make Assumptions Ask!

How to Start

• Start small, low cost / low risk

• Need to build patient base to support other services

• Start virtual

• Stick with therapies supported by evidence

• Educate

“No” is Just the Beginning of the ConversationGratitude for Small Wins

Start Small

• Low cost

• Low risk

• Massage therapy

• Group classes

Build Patient Base to Support Other Services

• Built massage therapy client base to support acupuncture and naturopathic medicine

• Develop loyal, engaged and active clientele

– Classes

– Newsletter

– Social media

Start Virtual

• Bricks and mortar fixed overhead expense

• Better to embed in existing clinic

– Primary Care

– Cardiology

– Women’s urology

Evidence-Based Therapies

• Acupuncture

• Massage

• Nutrition

• Yoga

• Guided imagery

• Manipulative therapy

• Naturopathic medicine

Bear in mind that research is challenging, given the personalized, multi-modal nature of integrative medicine

Educate

• Accept all invitations

• Internal education

– Support staff in clinic

– Other practitioners in clinic (cross referral)

• External education

– Referring providers

– Students

– Community

Build Relationships

• Meet with referring providers

• Collaborate do not undermine

• Reach out to naysayers

Don’t Take Things Personally

Meet With Referring Providers

• Meet and greet find out how their needs align with your offerings

• Coupons for staff or first time patients

Collaborate Do Not Undermine

• Meds do not get discontinued without discussion with prescribing physician

• Plan communicated to PCP and/or subspecialists, especially when adding meds, or therapies that they may question

• Visit notes reflect respect /collaboration

Reach Out to Naysayers

• Can be uncomfortable

• A great opportunity to educate!

• Know the evidence re. safety /efficacy

• Keep the patient out of the middle—this is integrative care

Marketing

• Just a variation of education

• Communicate the evidence and the value

• Newsletter from Integrative Medicine

• Local media PR is free marketing

• Social media /website

– Educational videos

– Guided imagery offerings

– Open house with mini treatments for referring providers

Creativity and Innovation

Research

• Collect metrics

– Describe what you are doing

– Track progress

• Partner with others who might want to do research

Be Impeccable with Your Word/Numbers

Collect Metrics

• Describe what you are doing

– Age

– Gender

– Diagnosis

– Service

• Track progress , using a validated tool

– Pain

– Fatigue

– Anxiety

– Quality of life

Partner With Others for Research

• Medical student capstone projects

– Probiotics in Immune issues

– Acupuncture for GI symptoms

– Massage therapy post-mastectomy for ROM

• Medical school faculty

– Grants for funding

• Other departments /practices

– Urology

– Oncology

– Cardiology

– Inpatient services

Financial Strategies

• Sell CDs, gift certificates

• Offer training programs

• Philanthropy

• Charge other departments for services

• Supplement sales

• BEHP

Reframe Shift Barriers to Opportunities

CDs, Gift Certificates

Offer Training Programs

• Beaumont School of Integrative Medicine

– Oncology Massage

– Reiki

– Yoga therapy

• Faculty Scholars Program

• Integrative Medicine in Residency program

Philanthropic Support

• Donors typically come forward on their own

– Practitioners do not solicit

• Find out what interests the donor

• Donors like to contribute to:

– Education

– Program Development

– Things/equipment

– Services provided to patients

• Be sure to acknowledge / thank the donor

Charge Other Departments for Services

• Chair massage for hospital staff

• Massage for inpatients

• Pediatric Oncology Services

Supplement Sales

• Typically about a 50% mark-up, but this can be discounted

• Pharmaceutical grade, third party tested

• Include marketing to non-patients

• Online store for refills is ideal

BHEHP Coverage

• Pilot utilizing massage therapy and acupuncture demonstrated reduction in payout for chiropractic care

• Current coverage

– Massage for pain, and oncologic conditions

– Acupuncture pain, oncologic issues, digestive and sleep issues

– ND visits for select diagnoses

Options for Patients Who are Financially Challenged

• Shared medical appointments

• Community acupuncture

• Partner with local training programs

• Group classes

Resilience, Availability, Flexibility

Shared Medical Appointments

• 90-120 minutes

• Insurance-based provider doing brief H&P, and available for questions

• Subject matter expert providing content to the group

• Examples:

– Immune health

– Healthy eating for the holidays

– GI foundations

– Virtual grocery shopping

Community Acupuncture

• 4 people in a room

• “Distal” acupuncture points

• Ideal for a straightforward issue

• Lower cost

• Need ergonomically sound setup for practitioners

Partner With Local Training Programs

• Beaumont Massage therapy students provide free massage

– Inpatient

– Infusion Centers

– IM clinic

• Beaumont Yoga therapy level III free clinic on Sundays

• Beaumont Reiki program graduates volunteer(need formal volunteer orientation)

– IM clinics

– Inpatient

• Must have clear policies /procedures for volunteers

Group Classes; Typically a Series

• Detox

• Healthy lifestyle

• Brain Health

• Yoga

I’m Interested! What next?

• What are you currently doing that you are passionate about?

• Learn more about it

• Obtain training /certification

Spirit of Mastery Lifelong Training/Practice

Training/Certification

• Provider

– Fellowship

– Faculty Scholars Program

– Conferences/webinars

• Anyone

– MBSR

– Clinical aromatherapy

– Reiki

– Interactive guided imagery

– Pet therapy

– Yoga/yoga therapy

– Health Coaching