One-of-a-kind medical student elective celebrates its 20th anniversary
Happy International Integrative Health Day! Let's dive into a high-level solution for transforming healthcare by building our practices around population health and value-based care.
This blog series will explore ideas to bring integrative medicine & health to the next level. The inspiration was based on the following thought:
Why does Integrative Medicine need to bridge the gap?
Integrative Medicine and Health represents a shift away from sick care and a movement toward wellness of the mind, body, and spirit. The integrative medicine (IM) movement has captured the attention of patients and healthcare consumers for decades. The present perspective on the movement acknowledges its successes and ongoing challenges in becoming part of mainstream medicine.
The sobering news is that the medical "factory" or "mill" operates within most healthcare practices and organizations. This production based healthcare model still reigns supreme and dictates the lives of patients and medical providers, alike.
Some IM providers have circumvented the exhausting process by abandoning this and shifting to cash-based and/or membership concierge practices. While these models free patients and providers of rushed medical care, some argue it does not promote accessibility or affordability, two major factors for effective healthcare. Esteemed integrative medicine centers have relied on philanthropy to offset the costs of spending more time with patients and providing complementary therapies; however, the donor model is not sustainable.
What is the solution to providing accessible and affordable integrative healthcare?
Obviously, there is no one-size solution. However, I invite my fellow thought leaders to consider how we can truly embody integrative medicine & health. Could we agree that positively changing mainstream healthcare would be our ultimate goal? This would mean we would have to transform the current system. That would be an impossible feat, unless, we look beyond our current ways of circumventing the system and learn to work within the system. This requires innovation and looking at what others are doing in parallel to us, and invite them into the conversation. Ironically, one such parallel is Integrat...ed (as opposed to integrat..ive) Healthcare.
Integrated healthcare refers to collaborative, patient-centered care organized to meet the needs of the population and compensated based on quality metrics. That is...population health and value-based care. IM and its complementary therapies can fit into this model if they can produce measurable outcomes. Integrated healthcare also includes effective care management solutions for medically complex patients struggling with chronic illness and in dire need of support. Reimbursable by United States Medicare, Chronic care management provides an opportunity to incorporate aspects of IM, such as health coaching.
Integrative medicine is part of primary care. Primary care is moving toward integrated, value-based care. Shouldn't the two be married? I call this Integrated Integrative Care or I2 Care. Many will poo-poo the idea as too mainstream. Nevertheless, this is the way integrative medicine and health can achieve its ultimate goal instead of being the alternate goal.
The future of IM should be ultimate instead of alternate.
Too long we have been considered the alternate (e.g. Alternative Medicine). Remaining separate and siloed will lead to extinction. Yes, rigorous academic research will elevate evidence-based complimentary therapies and give us some temporary respect and accolades in intellectual circles. This will lead to insurance companies re-thinking coverage and mainstream providers slowly adopting these treatments. However, providers referring patients for complimentary treatments and having them covered by insurance is only one part of the battle. Implementing these treatments in an isolated vacuum will do little to advance healthcare as a whole.
So how do we start modeling I2 Care?
We certainly do not have to reinvent the wheel. We start by learning about how we can get paid for providing measurable quality care for our patient population. For example, in the United States, that could mean joining or becoming an Accountable Care Organization or Patient Centered Medical Home.
Managing chronic health conditions should be where IM shines the brightest. Therefore, we need to shift our approach to a model that incorporates chronic care management in some form or another. Wagner's Chronic Care Model is an evidence-based tool I found very helpful while designing an IM chronic care pilot program a few years back. Inspired by my findings, I wrote a set of free white papers that I will send to all interested parties via this link.
Additionally, there is a need for collaboration among IM Health providers across practice settings, not competition. That starts with sharing ideas and building consensus. Defining the problems in IM together will lead to innovative solutions.
Further Innovate to Integrate articles will follow. The next article will focus on a system of high level collaboration used to solve complex problems at a global scale. The system can be used in Integrative Medicine & Health to achieve the ultimate goal.
© 2021 Danielle Zelnik, MD.