Dear Belleruth,
How can I as a social worker advocate to insurance companies to integrate these tools more into practice for reimbursement?  What’s the secret to your success in doing this?
John P.

Dear J.P.,

In the short term, you can fold guided imagery or mindfulness based stress reduction or relaxation training or whatever you’re doing right into an existing reimbursable category of treatment: psychotherapy, stress reduction or the like.  Your patient is going to need help with reimbursement and you don’t want to make a special case of something that could be covered under the general rubric of what you do anyway.

But if you want to go beyond that and get the insurance company to make these resources available to subscribers – perhaps even private label them with their brand – then there are some basic principles that get the job done.  As with any “sale” and as with all effective means of unforced persuasion, it’s a matter of appealing to the other person’s or organization’s “enlightened self-interest”.  So it means seeing through their eyes - salesmanship has always been in large part a matter of applied empathy. If you can show ways that primary concerns of theirs can be met – in this case, member satisfaction and cost-effectiveness - you’re pretty much there.  And guided imagery offers solutions for both.  

Of course, it’s essential to have some robust research data to show, and to speak in the language of the organization, so they can feel you understand their world and their concerns, and aren’t just coming from Planet AltMed.  

The early surgery studies (Henry Bennett’s primarily) helped us a lot by establishing in double blind, randomized, placebo-controlled trials with 335 patients, that guided imagery reduced length of stay, pain, and pre- and post-op anxiety.  When the Bennett study got the attention of some smart people at Blue Shield of California (namely Deborah Schwab, Dana Davies, Tracy Bodtker and Maria Chaves) they conducted their own study and found that the health plan saved an average of $2003 per procedure, while substantially increasing member satisfaction, when a pre-op patient listened to guided imagery before and during surgery.  

(It usually takes some visionary insiders to take an early gamble like this, in the beginning phases of introducing change in a conservative organization, but those folks are everywhere.  It’s up to you to find the right people {not just visionaries but non-marginalized visionaries who can persuade from inside their company} and then help them sell the idea when they get you an invitation to speak to key decision-makers. That means it’s your job to do your homework, be thoroughly prepared, and not make these risk takers look stupid in front of their bosses and peers!!)

After word got out about the cost savings at Blue Shield, it was much easier to take the idea to other carriers and HMO’s, and some of them started approaching us.  Kaiser Permanente now offers 20 of our guided imagery programs to members free of charge on their Healthy Living to Go page, because (a) they’ve always been in the forefront of prevention and wellness - they first started using our cassette tapes in 1989, would you believe? – and (b) because they know that if they can help  members reduce stress or lose weight, or if they can give them non-pharmacological resources to help with sleep, there will be substantial benefits for members’ health and for their bottom line.

So that’s how we’ve approached this.  Same with the military: we try to listen and understand what the concerns are, discuss them in their language, not ours, and see if/how the resources we have to offer dovetail and support solutions for them.  And, always, we need the data at our fingertips to prove we aren’t just talking through our hats; and it’s critical to identify effective champions inside the system to help us convey the message and get to the right people.  

Hope that helps.  And good luck!!