Now more than ever, the nation needs healthcare systems that focus on real health maintenance and prevention of chronic illness. Equally pressing is the need to restore economic viability to primary care, rebuild physician-patient relationships, and create practice frameworks that permit more than a seven-minute “consultation” and a hasty prescription. Everyone, except maybe those in the claims processing business, wants a remedy for administrative migraines.

So, how do we get from where we are now—stuck in a system that rewards late-stage care but ignores prevention, one that frustrates and disempowers patients, one that drives doctors out of business while racking up enormous profits for Big Pharma and Big Insurance—to where we want to be?

The needed changes will not come from politicians. All the proposed healthcare “reform” plans now floating around Washington, DC, be they of Democratic or Republican make, promise little more than more of the same. They will simply pour more money into a badly broken system.

Whether it’s Mitt-Care or Hillary-Care or any other version of “universal coverage,” most of you as physicians will still work under the constraints of multiple corporate overseers; most of us, as patients, will still be subject to “benefits” packages that seem to benefit insurance CEOs and their shareholders more than our health. The only difference is, we’ll all be forced by legislative mandate to buy it.

The needed changes will emerge when physicians re-envision their professional callings and re-design their practices to align with health-oriented values. The good news is, workable models of holistic, prevention-oriented medicine are emerging—models that enable physicians to make a profitable living practicing true health care.

In this and coming editions of Holistic Primary Care, we will explore these models through interviews with the physicians who are making them work in the rough-and-tumble real world of clinical practice. These explorations will culminate in our first-ever conference: “Heal Thy Practice: Transforming Primary Care,” slated for late October 2008. Save the date!!

Teamwork is the key to at Dr. Elson Haas’ Preventive Medicine Center of Marin, a one-stop integrative primary care clinic in San Rafael, CA. L to R: Angela Vanaman, Medical Assistant; Richard Shames, MD, Thyroid and Hormonal Specialist; Julie Dietz, Admin Manager and Patient Coordinator; Janessa Gapinski, Reception and Patient Relations; Tuyet Cong-Ton-Nu, Nutritionist; Liz Baughman, Massage and Detox Coach; Naz Baradaran, Insurance and Billing. Dr. Haas, Medical Director and Integrated Medicine Physician. Photo courtesy of Dr. Elson Haas.

In his more than 30 years of holistic family practice, Elson Haas, MD, has worked in just about every conceivable structure and setting outside of academia. From the idealistic Ann Arbor Free People’s Clinic in the early 1970s, to his current Preventive Medicine Center of Marin, a one-stop multidisciplinary center of which he is the owner and medical director, Dr. Haas has experienced many different business models for holistic/preventive health care.

He has worked on a fee-for-service basis, paid by the hour; he has tried the “Barefoot Doctor” model, a sort of proto-concierge plan in which patients paid a yearly “membership” fee that included four seasonal wellness visits. He has participated in conventional preferred-provider organizations (PPOs), and in a rare flip of the script has actually proven to be a patient magnet for insurers.

All of the various reimbursement models have their advantages and disadvantages. But according to Dr. Haas, the economic model is secondary. The real key to developing a successful and effective practice is to identify your core practice philosophy, the principles that will guide clinical as well as business decision-making. If you can clearly define your own values, it is much easier to find or develop business models that best support them.

“Our core mission is this: Let us serve as many patients as possible, with the best quality health care,” Dr. Haas told Holistic Primary Care. “In everything we do, we ask ourselves, ‘Are we serving people better by doing this?’ That should be our touchstone.”

Dr. Haas’ practice has always focused on lifestyle change, nutrition, and stress management. “My approach is generally to start with lifestyle factors first, then use natural therapeutics, and only use pharmaceuticals as a last resort. There are situations in which a patient is acutely ill, and I’ll use drugs first, and then later bring in natural medicines to help the patients get off the drugs.”

He sums his practice up with four cornerstone principles of integrated medicine:

1. Work to improve health, as well as treating disease.
2. Take a multidisciplinary focus using the most appropriate modalities from across the broad spectrum of healing arts and sciences.
3. Work with patients on all aspects of their lives, not just the symptoms for which they originally sought treatment.
4. Reframe the questions: Instead of asking, “What can I give this patient to make the problem go away?” ask, “Why is this problem present in this person’s life? What is the message? What is really needed for healing?”

The predilection for lifestyle-based medicine goes back to Dr. Haas’ roots at the University of Michigan Ann Arbor, as well as his own personal experiences struggling with overweight and allergies.

“I went to med school in 1968–1972. It was a time of great change, and everything opened up. I was already kind of a rebel—I held the idea that patients are people, not diseases, and advocated for more humane treatment in hospitals.” These were core ideas at the Free People’s Clinic where Dr. Haas got his start.

In the early 70s, he moved to California, and began to realize that his medical training was largely about using pharmaceuticals. “I knew that people needed more than that, and I needed to learn about health and healing. I saw the connection between disease and lifestyle, and I began to study nutrition.”

Overweight since childhood, and burdened by chronic allergies, Dr. Haas’ quest was as much personal as professional. A juice cleanse in 1975 was the turning point. “I lost 40 pounds over the ensuing months, and my allergies cleared up. Changing my diet really changed my life. I started seriously studying natural medicine, embracing nature as a healing system.”

He teamed up with fellow Michigander, Marty Rossman, MD, and Dr. Irving Oyle, a holistic medical pioneer from Bolinas, CA. The three developed a clinic focused specifically on the principles of Chinese medicine, acupuncture, guided imagery, biofeedback and sound healing. “It was a country setting, and we practiced in an old Presbyterian church. We charged patients by the hour.”

At this point, Dr. Haas began his career as an author, writing a column called “On the Natch” for a local newspaper. The material from this column became the foundation of his first book, Staying Healthy with the Seasons (1981, revised 2003), a landmark treatise on traditional Chinese medicine with guidelines for practical implementation in the lives of busy modern Americans. Alone and in collaboration with members of his clinical team, he has written a number of books since then, including Staying Healthy with Nutrition (1992, 2006), A Cookbook for All Seasons (2000), The New Detox Diet: Complete Guide for Lifelong Vitality with Recipes & Menu Plans (2004) and The Staying Healthy Shopper’s Guide. (All of Dr. Haas’ books are available at www.elsonhaas.com.)

The writing proved to be a central element of Dr. Haas’ practice-building strategy. “People would read my column or buy my books, and they would seek me out, knowing in advance what I’m about. They come in knowing that I know how to think differently about their problems.”

His writings also provide a wellspring of patient education handouts, which are essential time-savers in today’s high-pressure healthcare environment. “The reason we can do more in less time is that I have plenty of informational support tools I can give our patients. We don’t have to spend time repeating the same things day in, day out,” he said, adding that his clinic does participate in PPO insurance plans. “I used to be strictly cash-based, but I had a lot of patients who simply could not afford it.”

He contends that it is possible to provide good comprehensive holistic care within the constraints of insurance, provided you’ve got a strong team on the clinical side, and lots of group activities for patients. “You don’t have to do it all yourself. It is a big help to have really good colleagues and support staff.”

His Preventive Medicine Center of Marin brings together a well-integrated team of MDs, DOs, nurse practitioners, physician assistants, a chiropractor, a naturopathic physician, as well as practitioners of specific techniques like psychotherapy, nutrition counseling, massage and stress management.

“It’s a one-stop center. Everybody in my support team is on-site, and everybody uses the same charts, but each practitioner uses different colored paper, so everybody knows who’s being seen by whom.”

Though they have very diverse backgrounds, the practitioners are able to work well together because they all share the stated values of the clinic, and they are all willing to respect each others’ strengths and skills. “You have to know what you don’t know, and be willing to ask for help from others when faced with something you don’t know.” The clinic also maintains a very extensive referral network list encompassing everyone from acupuncturists to neurosurgeons, which all the in-house practitioners keep at their desks.

The other key time-saver is the group visits that allow Dr. Haas or one of his colleagues to teach important self-care skills to many patients at once. The groups also have the added benefit of engendering supportive friendships among people facing the same health challenges.

For example, Dr. Haas runs “Detox Groups” for patients undergoing cleansing protocols. The groups allow him to work with 20–30 patients at a time in a series of regular group meetings. “They’re all giving up caffeine and sugar and wheat and dairy at the same time. They’re all embracing a specific diet or going through the juice fast at the same time. We can help many more patients this way than if we were working with them individually, and they support each other through the process. It is very transformative.”

A natural-born multi-tasker, Dr. Haas has found that he’s able to deal with the constraints of insurance-based medicine, but only because he shares the workload with colleagues he trusts, and he has lots of patient support materials. The insurance game is definitely not for everyone, he readily admits.

“If you are the type who really wants to be hands-on with everything, and you want to be able to spend 30 or 40 minutes schmoozing with your patients, you’re going to have real trouble in the insurance context.” There’s nothing wrong with that; it’s simply a matter of structuring your practice model to accommodate your personal style and your patients’ needs.

Dr. Haas is a firm believer in the original Latin conception of “doctor” as “teacher,” and he sees his main duty as teaching patients how to be healthy. “The key is to inspire, to spark people into learning how to live in harmony with nature, with the season, with the cycles within themselves.”

By keeping that doctrine at the center of everything he does, he has been able to develop a practice setting that provides him with a healthy living doing what he loves best: helping people to live healthfully.

Looking to the future, Dr. Haas is seeking integrative-minded physician partners to bring into the Marin center. If you are an MD or DO and you are interested in learning more, visit www.pmcmarin.com, and look at the opportunity page.