In 1993, Dirk Miller started The Emily Program
as a small private practice based in a former St. Paul fire station. Focused on treating eating disorders, his operation has grown considerably since then. It now employs 330 people, treats some 4,500 clients in 10 locations throughout the states of Minnesota and Washington, and is set for more rapid expansion.
Not bad for someone who felt lost as an undergrad circa 1979. Of course at that time, specialized treatments for anorexia, bulimia, and other eating disorders were hardly mainstream. But Miller had already seen the damage caused by such disorders: His sister, who had gone a trip abroad, returned weighing 75 pounds. She received treatment and recovered. (Her name? Not coincidentally, Emily.)
Miller decided to focus on health care management and addiction counseling. A friend mentioned that a new bulimia treatment program at the University of Minnesota was so groundbreaking that clients from around the nation were flying in to participate. Miller called the U of M to inquire about the program and was admitted over the phone.
From its humble beginning, The Emily Program has “evolved to be what clients need,” says Jillian Lampert, the company’s senior director of business and community development.
What clients need is an individualized set of tools to aid in recovery. That may include nutritional support, medical services, or psychiatric services, as well as alternative therapies such as massage or yoga.
In more severe cases, The Emily Program offers partial and full residential treatment for both adults and adolescents. But Miller notes that “in-patient treatment is a small percentage of what goes on in the change process. It’s short-term symptom interruption.”
Miller envisions eating disorders treatment as a pyramid, with the outpatient therapy relationship as the base and in-patient treatment as the tip. “The higher intensity levels of care are where the greatest profit margins are,” he says. “It makes sense that programs have wanted to focus on that, but outpatient is so essential to the recovery process from a theoretical, client-care, and insurance standpoint.”
In Miller’s company, programs are developed based on client requests and research that’s conducted in partnership with the University of Minnesota. Success is measured through the quality of relationships, a client satisfaction survey, and a forthcoming client advisory group for each state the program operates in.
The program has also implemented electronic health records, which “takes us to a whole new level of being able to measure outcomes and get a sense of what’s working for people,” Miller says.
That evidence will be used to educate insurance companies about the advantages of covering eating disorder treatment. Says Lampert: “Eating disorders are such a particular overlap of mental health and physical health that we work really closely with payers to help everybody understand the benefit of strong intervention so that we can not only help a person get well, but also save dollars down the road.”
Erin, a longtime client of The Emily Program, struggled with an eating disorder that began around the age of 13. Her insurance company deemed her condition chronic, and she sought treatment in multiple places. “I was at the worst end of the spectrum, not expecting to live a normal life,” she says of her darkest days.
In 2002, Fairview Riverside referred her to The Emily Program. She took advantage of the program’s residential, partial day treatment, and intensive outpatient programs, as well as music therapy and acupuncture. “I’ve been through their whole spectrum of services,” she says. “The Emily Program brought all the pieces together for me and gave me a lot of the pieces that other programs were missing.”
Now in her early thirties, Erin holds down a steady job, supports herself financially, and lives on her own with a cat. Food and weight no longer control her every waking moment.
The Emily Program has treated over 15,000 people since its inception and can point to many success stories like Erin’s.
Miller credits his staff for the program’s impact. He estimates that 30 to 40 percent of his employees have recovered from eating disorders themselves. “We are our clients and our clients are us,” he says. “I never have to motivate people to work harder, or care more or do more.”
Lampert concurs: “We are eating disorder people. Our goal is to be the treatment we didn’t have. That drives our business model from a passion perspective.”
Treating employees right is a high priority for Miller. When he asks what’s most important to them, the top response is flexibility in the work schedule. His company’s culture makes that possible. Miller also ensures a variety in job duties, considers the safety of the neighborhoods when choosing locations for offices, and nurtures relationships with the employees who report to him.
“Our staff is also my client,” he says. “I work for them. Losing good employees is one problem I don’t believe an organization can overcome.”
The company also has a distinctive style of leadership. Setbacks and mistakes are nothing to be ashamed of. People are allowed to err, learn, and try again without fear of reproach. “We all lead by vulnerability,” Lampert says. “We’re not demanding excellence; we’re requesting openness.”
If anything, the main occupational hazard at The Emily Program is the anxiety inherent with working in such an emotionally charged milieu. “Staff can’t get anything done when they’re revved up,” says Shannon O’Donnell, senior director of residential services. She encourages her team to take paid time off and practice yoga. She even begins meetings by asking everyone to sit up, place their hands palms up, and take three deep breaths.
“When you can calm the body, you can heal the mind,” she says. “When you teach people that piece, they can pass it on to their clients.”
The program further extends its reach through ongoing research studies in conjunction with the University of Minnesota, as well as policy-related advocacy via its nonprofit foundation. “A lot of what we do is breaking down myths,” Lampert says of the company’s impact in the government sector. “Eating disorders are not lifestyle choices, they’re not moral failings, they’re not habits. They’re a real illness. There’s still a fair amount of stigma and disbelief about that.”
The Emily Program is always on the lookout for ways to expand its services. Within the next three years, Miller anticipates the program will be established in six states, and the company will employ 1,000 people.
The company recently took on a financial partner, TT Capital, to make those goals feasible. “We are a platform for growth,” Miller says. “We feel that we uniquely have an opportunity to be one of those large programs that really could influence the way that eating disorder services are delivered in the country. It’s an exciting time.”