The title of the open access article at PLOS from a Harvard Benson-Henry Institute mind-body team is “Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.” The team took a retrospective look at healthcare utilization of more than 4000 patients in the Relaxation Response Resiliency Program (3RP) and compared them to a usual care cohort. The intervention group was slightly more female, Jewish, or Asian vs Christian or black, better off economically, and less likely to include veterans.
The finding: “At one year, total utilization for the intervention group decreased by 43%, clinical encounters decreased by 41.9%, imaging by 50.3%, lab encounters by 43.5%, and procedures by 21.4%. Measured by dollar, reduction was estimated as “on the order of $2360/patient/year.” The authors note that “this reduction is on the order of that found by 3 other groups in “other similar time-limited interventions.” They note that “mind body medicine interventions are inexpensive relative to the cost of an emergency room visit, a hospitalization or even other complementary and alternative medicine (CAM) therapies.”
Comment: These are huge numbers. I recall a co-panelist at the 2014 10th Annual Healthcare Workforce Conference of the Associated of American Medical Colleges, Lloyd Michener, MD, MPH, commenting that if medical leaders want to “bend the cost curve,” the easy money is not going to come from usual tertiary care quality initiatives. Rather, huge dips in utilization come via initiatives involving community health workers, social workers, and other strategies that connect clinical care with people in their communities.
The practitioners whom Michener’s work highlights, like the therapeutic approaches explored by the Harvard team, come from the lower rungs of the medicine’s totem pole. The Red Adair heroes needed to stamp out the fires of the US cost crisis are neither high-end specialists nor products of the ‘omics revolution. The 3RP work is based on group-delivered services first researched by Herbert Benson, MD, (pictured) 4 decades ago and researched by Benson and Eileen Stuart, RN, PhD and others starting in the 1980s.
When I see solutions coming from turning what medicine typically values upside down, I think of the Biblical adage that “the last shall be first, and the first, the last.” I also think of that children’s book character, The Lowly Worm! The Wikipedia bit on this character says, “Lowly was (the author’s) favorite fictional creation.” Is there a better strategy for cost-savings than a massive, public health–styled application to all of the skills from this and other lowly, relationship-based, mind-body treatment?