Integrative Medicine and the Health of the Public A Summary of the February 2009 Summit (2009) / Chapter Skim
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6 Economics and Policy
6 Economics and Policy
Pages 133-154
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From page 133... ...
Similarly, unlike in previous attempts at health reform, Donohue said, businesses today are supportive of change. For insurers and the business community alike, the dominant concern is rising health care costs.
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From page 134... ...
It is time to think anew, he said, time to "disenthrall ourselves from the dogmas and the biases that have made our current health system in so 1 Harkin noted that he preferred the term health reform, rather than health care reform, because he believes the changes needed are fundamental and systemwide, not merely related to reimbursement.
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From page 135... ...
The scope of health reform that Harkin envisions would go beyond merely providing health insurance coverage or finding new health services payment methods, important as those issues are. He noted that what we are paying for is as important as how we are paying for it: "It makes no sense just to figure out a better way to pay the bills for a system that is broken and unsustainable." He said that a reformed system should implement a national prevention and wellness structure; offer a pragmatic, integrative approach to health care; and base reimbursement on outcomes and quality rather than quantity.
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From page 136... ...
Harkin reaffirmed his commitment to do all he can to change the nation's health system and place integrative health care at the heart of the 2009 health reform efforts. He encouraged summit participants to follow the debates and discuss these issues with family, friends, and colleagues.
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From page 137... ...
Over the next five years 90 percent of students enrolled in free or reduced lunch programs will have access to free fresh fruits and vegetables. Comparative Effectiveness The recent economic stimulus legislation included funds to support comparative effectiveness research for health care practices, and several participants iterated the importance of including integrative approaches in these comparisons.
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From page 138... ...
Tunis noted that this panel was designed to explore the challenges and the solutions, mechanisms, strategies, and tactics that will help ensure that integrative health care becomes a key component of a newly reformed health system. Economic Burden of Chronic Disease Kenneth Thorpe, Emory University Thorpe opened with an array of statistics that exemplify challenges in the current health reform debate.
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From page 139... ...
One model under consideration is to assemble community health teams that include nurse practitioners, social workers, behavioral health workers, and nutritionists that can collaborate with an area's small physician practices and provide care coordination, primary prevention, and community-based outreach services. Lessons can also be learned from innovative state
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From page 140... ...
Many insurance companies work hard to ensure responsible policies for prevention, wellness, and integrated care, he said. In fact, UnitedHealth Group views itself as "a health and well-being company"; for example, the company spends millions of dollars to collect and analyze data, in order to identify individuals' risk factors for disease, then provide them with a variety of individually tailored support services to assist in personally appropriate preventive interventions.
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From page 141... ...
Finally, Tuckson said that the new integrative health team will require new coding systems in order to capture the services they deliver and new health information technology infrastructures that can record and enable assessment of their work on behalf of the unique needs of individuals. Tuckson concluded his remarks by committing UnitedHealth Group to actively participate in the exploration of the questions noted above,
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From page 142... ...
Another is the need for serious health information technology, not only to find out which treatments work, what the best practices are, and where people get the best results, but also to run complex health care systems. Most important, he said, almost everyone can agree that there has to be a way to cover people who do not have health insurance, because care for uninsured people is being provided at an unnecessarily high cost.
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From page 143... ...
George, Harvard Business School George said "The employer-based system is the strongest part of our health care system," and that integrative health care is the key to its future. In fact, George said that it will not be possible to offer health insurance to 100 percent of Americans unless we have a health system that promotes wellness and prevention.
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From page 144... ...
If employers took on these suggested roles, there would not need to be as many government health reforms, said George, although government should require portability of health plans, so that when people change jobs they can take their health plan with them if they choose. George supported pretax health insurance coverage for every American and development of private insurance pools for small groups of employees, employees without health coverage, and the unemployed, so that everyone can have access to health opportunities typically offered by large companies.
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From page 145... ...
In general, states' authority to set scope-of-practice laws produces interstate differences in practice patterns, providing a valuable opportunity for comparative research on mechanisms for delivering primary care services. At the federal level, Kahn said that a single entity should be responsible for coordinating integrative health-related policy efforts across agencies, perhaps through an Office of Integrative Health Care and Wellness.
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From page 146... ...
Central to success of behavior change strategies, whether across society or within a single workplace, is the use of multiple message channels and the alignment of these messages with policies. Kahn cited smoking cessation as an imperfect, but highly successful effort at health
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From page 147... ...
3 Within a corporation or within a country, policy makers should not be talking about health and wellness on one hand while creating situations that lead to unhealthy behavior on the other, said Kahn. On the provider side, financial incentives encourage use of expensive interventions rather than prevention strategies.
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From page 148... ...
Pelletier reported on research that identified 153 clinical and cost outcome studies of worksite integrative health approaches (Pelletier, in press) , all of which have demonstrated net benefits in terms of short-term and long-term disability, absenteeism, general retention, key personnel
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From page 149... ...
Pelletier predicted that integrative medicine and its preventive components will prove to be dramatically more cost-effective than many conventional services, at least on a purely empirical basis. He also agreed with Donohue and George that employers have a large stake in both ensuring employee health and involvement in health and medical care reform.
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From page 150... ...
Evidence for Integrative Medicine Participants asked how much and what kinds of additional evidence would be needed to make integrative health care approaches more widely accepted. Given how much evidence had been presented at the summit, it seemed to some participants that there should be more forward progress in terms of adopting and reimbursing clearly effective programs.
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From page 151... ...
These models are entirely dependent on networks of providers. For example, Cisco Systems recently built a patient-centered medical home within its corporate headquarters that is linked to day care and corporate health services.
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From page 152... ...
The group suggested that perhaps teams can be paid on a capitated basis, enabling them to decide how to produce the most health for society's investment. To bring appropriately trained people into teams may require programs like one in Washington State that provides loan forgiveness for integrative care practitioners who serve 3 years in underserved communities, as one participant in the group suggested.
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From page 153... ...
The two next steps the group identified were to catalog successful interventions and models under way around the country for both ideas and inspiration; and second, to expand and diversify the types of evidence and research used to assess integrative health care approaches.
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