How the wealthy get healthy

Between battling for the corner office, endless business trips and keeping shareholders happy, most executives already have enough on their plate to also worry about their physical well-being. Yet, as physicians and boards of directors would undoubtedly agree, health is an issue that corporate executives ignore at their own--and their company's--peril. Just ask Coca-Cola, whose heavy-smoking CEO Roberto Goizueta died of cancer in October 1997 at the age of 65, or McDonald's, whose CEO James Cantalupo suffered a serious heart attack at age 60 last April.

Fortunately for corporate executives who understand the benefits of watching their health, many of the nation's top medical institutions offer "executive health care programs" tailored to their time-pressed needs. Typically arrayed in luxurious and business-friendly surroundings--T1 lines in the waiting rooms, buffet breakfasts and lunches, etc.--such programs offer comprehensive physical exams and lengthy physician consultations with an efficiency and attentiveness worthy of their high-powered clientele.

Executive health care programs not only make good health sense, but good business sense as well. Indeed, according to 2002 findings by the University of Michigan Management Research Center, executives who underwent physical exams had 20% fewer health claims and lost 45% fewer workdays than those who did not.

What's more, these days most major corporations have "key man"--or, the gender neutral, "key person"--insurance policies to protect themselves financially in the event their top officers, or even lowly employees integral to an important project, suddenly bite the dust. While insurance companies won't necessarily reject coverage based upon an employee's poor health or risk factors, such as obesity or smoking, they'll certainly elevate the premiums if there is cause for health concern--a money saving argument for fit and trim executives if ever there was one. Depending upon an employee's age and family medical history, a comprehensive physical is often required for this type of coverage, and a premier executive health program is as good a place as any to get checked out.

Though some executive health care programs trace their origins well back into the 20th century, most started in the late 1970s or early 1980s, after the landmark Framingham Heart Study identified high cholesterol, diabetes and soaring blood pressure as risk factors for heart disease and stroke. Ever on the lookout for extra sources of revenue, as well as opportunities to soften their public images, hospitals began marketing the notion of comprehensive "executive physicals" as a way for corporations to insure the long-term health and productivity of their high-priced executive assets. As the focus of health care shifted away from risk toward prevention in the 1990s, executive health programs followed suit, offering not only diagnostic tests but counseling services toward a healthier lifestyle, either as part of the basic program or as a la carte additions paid for by the client or his or her company.

The most common executive health programs are compact efforts offering convenient and comprehensive "executive physicals" complete with longer-than-usual doctor-patient consultations, as well as optional lifestyle counseling, and even services such as massage and personal fitness training. Costs run in the $1,900 to $2,500 range for the basic program, and most programs prefer out-of-pocket payment from the client or the employer to dealing with insurance. "Executive health care programs aren't huge money makers," says Kevin Waters, director of the Duke Executive Health Program at the Duke University Health System in Durham, N.C. "Most are lucky to break even. But there are other reasons for hospitals to start them besides profits, such as the prestige of having one, the prestigious clientele it brings to your institution, and out-of-pocket payment for services."

While hospitals are the main providers, they aren't the only institutions in the executive health care game. The five-star Greenbrier resort in White Sulphur Springs, W.Va., for instance, has offered an executive health program since 1948 at its Greenbrier Clinic, which currently boasts sophisticated equipment such as an Electron Beam Tomography Ultrafast CT scanner for diagnosing coronary disease, a dozen medical professionals with specialties from coronary care to gastroenterology, as well as three championship golf courses.

The Canyon Ranch Health Resorts in Tucson, Ariz., and Lenox, Mass., launched an executive health program ten months ago, boasting a four-day agenda including abundant counseling (nutrition, mind-body techniques, exercise, etc.), as well as an encouraging environment in which clients can practice their new, healthier lifestyle. "We've had a health-and-healing component at Canyon Ranch since 1979 and have been offering annual physicals since 1988, so the Executive Health Program is just a natural extension of that," says Gary Frost, executive vice president, who adds that he's learned to live with institutional medical professionals who pooh-pooh the Canyon Ranch as a mere spa. "We don't claim we'll do surgery. We're about identifying problem areas and getting people to focus on how to improve their quality of life, and we do that infinitely better than a hospital that focuses on treating disease."

Whatever the provider, the main component of any executive health program is a comprehensive physical, including a detailed medical history and a seemingly endless string of diagnostic tests. A typical battery might include screenings for diabetes and anemia; thyroid disease; liver and kidney disease, including a lipid panel to assess cardiac and stroke risk factors; a hemoccult to detect gastrointestinal bleeding from tumors, polyps, ulcers and whatnot; a resting electrocardiogram for signs of cardiac tissue damage, blocked arteries or irregular heartbeats; a chest X-ray for heart size and pulmonary disease; a pulmonary function test to assess emphysema, bronchitis, asthma and other lung problems; an audiogram for signs of hearing loss; an eye exam for various vision-related conundrums; a colon cancer screening depending on age and family history; a skin cancer screening; a prostate specific antigen screening for prostate malignancy in men; a mammogram, pap smear, and bone-density study for women. Once baseline data are established on the first visit, annual repeat visits are less comprehensive.

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"Most people wouldn't be able to do all of this stuff if they had to schedule it on their own, especially not a busy executive," says George Sack, director of the Executive Health Program at Johns Hopkins Medicine in Baltimore, who has endeavored to hold his program to one day; two if a client requires a colonoscopy. "We're always trying to add new wrinkles, but we want to keep the program efficient, though not so efficient that we cut corners."

Of course, depending upon the inventiveness of the program and the health indications of the client, such tests may be only the beginning. For instance, the Scripps Center for Executive Health in La Jolla, Calif., recently announced the addition of a Hospital Depression and Anxiety Scale Assessment to its lineup to identify depression and anxiety, "vital factors for determining heart health." Canyon Ranch offers a la carte sleep assessment consultations by a certified sleep specialist. And Duke's program can be extended for up to three days to include additional screenings for sexually transmitted diseases, immunizations for travel, nutrition counseling (at $100 per hour), stress management counseling ($110 per hour), personal fitness training sessions ($49.50), and even therapeutic massage ($60, before tip).

(By the way, many hospital-based executive health programs, including Johns Hopkins's and Duke's, don't recommend whole body computerized tomography--aka CT screenings--as the jury is still out on their effectiveness for asymptomatic people, even those who smoke.)

Above and, arguably, beyond the comprehensive physical is the time that executive health programs afford their clients for one-on-one physician consultations. In an age when health care is all too often doled out in 15-minute intervals by overscheduled physicians, the opportunity to spend a focused hour and a half or more discussing test results, physical concerns, and perhaps even your golf game with a real live medical professional is a true luxury, as well as an integral selling point of most programs. "It's very satisfying for us, because it's sort of like being an old-fashioned physician," notes Johns Hopkins's Sack. "As one executive said to me after our consultation, 'I don't think I've had that much time to spend with a doctor in my whole life.'"

While the comprehensive testing and consultation afforded by executive health programs can bring piece of mind, bear in mind that it can also bring the sudden realization that you're human after all. "It's a point of fact that it's rare when we don't find something of significance during an executive health screening, such as high blood pressure, high cholesterol or a noteworthy family history," notes Charles Tucker, head of the Executive Health Program at Stanford Hospital's Menlo Clinic in Menlo Park, Calif. And how do his hard-charging executive clients take such news? Tucker notes that there are two different kinds of Type A executives out there. "Some say, 'I don't have time for this, and that's that.' But far more common is the executive that treats his or her health problem like another project, accepting the challenge and setting up goals. I'll tell you, it's exciting to see them go at it. And because they're so successful in the professional world, they often succeed."