5) Description of health product/service offering: As alternative/complementary therapies such as acupuncture move toward the mainstream in the US, they become prohibitively expensive for all but uppermiddle class patients. This is unfortunate, because acupuncture can be extraordinarily powerful in the treatment of both acute and chronic conditions which might otherwise prevent working-class patients from being able to work or might lead to dependence on expensive and addictive pain medication. We have created a business model which makes it possible to provide acupuncture to patients regardless of their socioeconomic class or health insurance coverage. Our clinic, located in a working class neighborhood, treats 185 patients per week for such conditions as back pain, headaches, arthritis, respiratory diseases, stress, and depression. We work to share our business model with acupuncturists around the country, and in the last year, we estimate that twenty other clinics using our model have gotten started in seven states. The going rate for a single acupuncture treatment in the US ranges from $60- $250; our model uses a sliding scale of $15 to $35, and can go lower at need. We hope to restore acupuncture to its original status as a low-cost, low-tech, preventative, people's medicine. If acupuncture were widely available -- meaning affordable and accessible to all communities -- it would address many of the problems with healthcare in the US. Patients could use acupuncture to avoid requiring expensive, invasive procedures such as surgery or toxic drug therapies, and also simply to treat the many side-effects of low-paid labor (pain, fatigue, and stress) before they turn into chronic illness.

6) Description of innovation: All other acupuncture public health initiatives depend on grant funding and/ or student or volunteer labor; none are financially self- sustaining, or financially sustained by the communities they serve. A key aspect of our business model is the creation of a clinic which treats patients in a community setting: instead of treating patients lying down on tables in isolated cubicles, we treat patients sitting in recliners in a large, quiet, soothing space that looks something like a living room. Patients find this setting to be both comforting and empowering, and it is conducive to patients bringing in family members and coworkers for treatments because they can be treated side by side. When many patients receive treatment simultaneously in the same physical space, a kind of collective energetic field establishes itself, thus making the individual treatments more powerful and reinforcing to patients that community itself is part of their healing. This setting also de-emphasizes the status of the practitioner as the professional with the answers and helps the patient focus on their own inner experience. Our approach is also unique because we do not depend on health insurance or public funding, or indeed on any system outside of the community of patients. Replication of our model depends on other self- employed acupuncturists creating a sustainable microbusiness in their own communities by adapting our business model to their needs. Fortunately, the widespread failure of the conventional business model for acupuncture (most acupuncturists are not making a living doing acupuncture) provides motivation for practitioners to consider using a more widely accessible alternative structure.

7) Operational model: We focus on providing acupuncture in neighborhoods where underserved patients live; we have found that the only effective outreach is word of mouth and being present in the target neighborhood. In terms of sharing our business model with other acupuncturists, we have written a manual/ manifesto which is available by order on our website; we host an online forum for acupuncturists and patients to encourage discussion of our business model (http://www.acupuncturetoday.com/cgi-bin/forum/ social_entrepreneur.cgi); we also have presented at two acupuncture conferences, have conducted one statewide training and are planning a national one, write for acupuncture publications, and generally try to make ourselves as visible as possible within the acupuncture community in order to communicate to acupuncturists that it is possible to use a just and sustainable business model in order to make a living.

8) Human resources: Our clinic has two full time and three part time acupuncturists, one full time administrator and two part-time receptionists. The two full time acupuncturists are myself and my partner, Skip Van Meter; both of us have been in practice for over ten years and have extensive experience working in public health settings and in training acupuncturists. Our full time administrator, Lupine Hudson, has a background in managing and developing volunteers in sustainability/ environmental organizations.

9) Key operational partnerships: We are experimenting with several different kinds of business partnerships. One is partnering with other small businesses who cannot afford to offer health benefits to their employees ( for example, a local organic food co-op). The cost of receiving treatment at our clinic is comparable to most co-pays when patients have insurance that covers acupuncture. We have joined the local sustainable business network and are in the process of designing our outreach to these businesses. We are also developing a partnership with a local community-supported-agriculture organic farm, by encouraging our patients to sign up for shares and having the farm use our clinic as a drop off site for produce boxes and also set up a produce stand. This helps patients make the connection between health and local, organic food. As a result of participating in the online discussion (thank you, Charlie Brown, for the suggestions), we have just entered a partnership with the local business school; they will work with us to develop a plan to franchise our business, as well as use a student team in the fall to develop a business plan for accessible acupuncture, based on our model, which could be marketed to a large entity such a hospital or health plan, thus spreading our business model -- and accessible acupuncture -- far more widely than we could hope to do alone.

10) Financial Sustainability

          • Fees charged to clients?: Yes

          • How do you assure affordability?: Patients choose what to pay on a sliding scale based on what they feel they can afford. About 5% of our patients are treated at no charge.

          • Earned incomes as a percentage of operating costs: 100

          • Other funding sources: Currently almost financially self-sustaining; we hope to be profitable in another year.

          • Strategy for long-term sustainability: Our clinic currently treats about 185 patients a week; at 200 patients we will be self-sustaining and at 300 patients a week we will be profitable. The clinic has the physical capacity to treat 400 patients per week, and we can increase staffing as needed. Outreach to acupuncturists is self- sustaining based on modest fees for our materials and presentations. We have been fortunate to find several ways which are free to us to reach acupuncturists, such as trade publications.

11) Current and Future Impact

          • Total number of clients: 1200

          • Clients in the past year: 1200

          • Percentage of low-income clients: 70

          • Impact: A group called The Population Health Forum holds out the thesis that class divisions are the greatest predictor of overall ill health in a society. We agree. Class divisions in health care are bad for everyone, not only those people who suffer most directly. We provide health care in a way that erases class barriers and reinforces community. One of the joys of our daily experience is having people from widely disparate classes, and from all races, backgrounds, and ages, at rest in a shared, healing stillness. We feel that this also helps the self-esteem of our working class patients. Our example proves that there is another way -- that healthcare can be equitable and sustainable. The success of our clinic makes people question their assumptions.

          • Overall "market": We have received requests for information about our business model even from countries with socialized medicine (Canada, Israel, England, Denmark), since such systems rarely cover alternative/complementary therapies. In the US, every working class neighborhood could easily support a clinic like ours. Our goal is in fact to do just that -- to create a model for community clinics that can eventually become a social institution as common as the local tavern - - and a lot healthier.

12) Scaling up strategy

          • Stage of the initiative: Start Up stage.

          • Expansion plan: To increase the patient capacity of our clinic to more than 300 patient visits weekly, and to create regional networks of acupuncturists practicing our model who can support and encourage each other. In three years we hope to have 100 clinics using our model in other states. We are beginning to offer national training on our model, and will have our first conference on this topic in October 2006 in Portland, Oregon. We will develop a franchise plan by the end of this year and probably begin marketing it by next spring. Also by that time, our partnership with the business school will have resulted in a business plan for accessible acupuncture that could be shared with large entities such as hospitals or health plans, and we will begin networking to try to spread that model within the conventional healthcare structure. We are also in the very beginning stages of creating a national membership organization for acupuncturists practicing community-style acupuncture and patients who want to support it.

13) Policy change: Health care is such a hideous mess in this country that we intentionally designed our initiative to be successful no matter what policy change happens or doesn't happen. One thing that would help us would be if some large health institution such as a hospital or an insurance company decided to implement our business model in order to provide acupuncture to its members at virtually no cost to itself -- this would help spread the idea more quickly than anything we could do.

14) Origin of the initiative: There were several phases and several key people. I started the first phase when I quit my underfunded public health job with the goal of creating a clinic for people like myself (I come from a working class background); the second phase was when my partner Skip joined the practice and together we wrote our manifesto for other acupuncturists; and the third phase was when Lupine joined us and we began promoting our business model systematically to other acupuncturists and creating community partnerships ( CSA farm, other sustainable businesses.) None of us could have done this alone.

Contact Information:
Lisa  Rohleder
Director
Working Class Acupuncture
(Business)
3526 NE 57th Ave., Portland OR 97213
United States
Tel: (503) 335-9440
Fax: (503) 493-7281
Email: info@workingclassacupuncture.org
Website: www.workingclassacupuncture.org