Integrative Medicine and the Health of the Public A Summary of the February 2009 Summit (2009) / Chapter Skim
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3 Models of Care
3 Models of Care
Pages 53-76
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From page 53... ...
This panel discussion was moderated by Dr. Erminia Guarneri, Medical Director of the Scripps Center for Integrative Medicine, with panelists describing innovative models and necessary components for providing more integrative care, as well as the challenges they have faced.
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From page 54... ...
The weakest foundation would be to unite based on a shared claim to a piece of a limited pie, said Berwick. A quest for greater reimbursement, for more payment for integrative care and alternative forms of care, may unite integrative medicine proponents today, but would soon divide them, as different groups assert their individual claims.
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From page 55... ...
These efforts have addressed traditional allopathic care, curative care, end-of-life care, and now the important new arena of integrative health care. This body of work is exemplified by IOM's quality of care initiatives that have included the Roundtable on Quality in the mid-1990s and the Crossing the Quality Chasm report in 2001, both of which Berwick participated in.
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From page 56... ...
Other organizations -- the Dartmouth Institute for Health Policy and Research, the Institute for Healthcare Improvement, and the Picker Institute, for example -- began to expand the application of patient-centered care. The Picker Institute proposed that the very definition of quality lies through the patient's eyes.
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From page 57... ...
This conception adds to the significance of the patient-centeredness concept and begins to suggest what integrative medicine could mean and what its purpose is. Achieving Integrative Medicine's Aims Just as the IOM committee on quality defined a set of design principles that could realize its vision of quality care, certain design principles might move the health system toward more integrative care -- "the care that connects technology to souls." Berwick shared a poignant personal anecdote that illustrated the ways in which right care needs to draw from the integration of personal values and priorities with clinical concerns.
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From page 58... ...
In other words, make current treatment facilities healing places by, for example, refocusing human interactions and using evidence-based designs that reduce patient, family, and staff stress; prevent errors and nosocomial infections; and increase positive influences on health status. Fifth, maximize healing influences outside the care system.
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From page 59... ...
Conclusions Durable, worthy connections among and across the many individuals and organizations supporting integrative medicine can be forged by rediscovering and affirming a common purpose: what we wish to heal. What we health care professionals wish to heal, Berwick suggested, are those who come to us for help; ourselves who are among them; a broken, imbalanced, greedy, technocentric, unself-conscious health care system; and a world that has displayed infinite cleverness in increasing human suffering.
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From page 60... ...
Yet Wagner noted that primary care has the mindset, the orientation, and the relationship with the population that make it a promising foundation for integrative health care. Since it is not realistic or desirable to expect the development of an entirely separate integrated health care system, it is necessary to update primary care as it exists today, in order to make it an effective platform for building integrative care models.
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From page 61... ...
Primary care needs to be transformed into a more effective foundation for integrative health care, through wider implementation of the kinds of practice teams and improved patient encounters described. "The future of our health care system depends on primary care's ability to improve the quality and efficiency of its preventive and chronic illness care," Wagner said.
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From page 62... ...
Milstein explored the question of whether integrative medicine could play a role in reducing near-term spending, noting that the national policy priority to reduce spending is especially important for families in the bottom half of America's income distribution, who are unable to afford conventional health insurance, but not poor enough to qualify for Medicaid. Working with several insurers across the nation, Milstein identified five physician practices that have successfully used integrative care methods to achieve positive patient experience ratings, improve clinical outcomes, and reduce short-term costs by at least 15 percent per patient, per year -- his cutoff point for including a practice in his onsite study.
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From page 63... ...
Milstein thinks of these five practice settings as "medical home runs." They achieved positive clinical outcomes and patient experiences, and they reduced total health care spending. A reengineered care model allowed them to reduce, cost-effectively, the number of expensive health crises among their chronic disease patients.
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From page 64... ...
Such an integrative care design increased patients' willingness to work out and strengthened their social networks, which conferred additional health benefits. A final integrative strategy that these successful practices employed was use of a thorough "failure mode analysis" of unplanned hospitalizations.
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From page 65... ...
The center's integrative care model can be applied across the spectrum of prevention: primary prevention, which includes health promotion and specific defenses against disease; secondary prevention, which includes early detection and management to prevent progression of dis
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From page 66... ...
The aspiration of a more holistic and integrative care system is meritorious and worthy, said Katz. Getting there may not be easy, but "we should certainly persevere." Models That Optimize Health and Healing Across the Life Span Tracy Gaudet, Duke Integrative Medicine Keying off the day's presentations and the development of innovative models for integrative care in the United States and elsewhere, Gaudet described a vision for a transformed health care system and how the models might be achieved within it.
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From page 67... ...
One discipline that is critical to this approach to health is the integrative health coach who would fill a currently unmet need in the system: a professionally trained provider whose expertise is in partnering with patients to help them enact the lifestyle changes and behavior that result in better health. Third, training in the health care disciplines must be geared to teaching the core competencies needed to deliver this model of health.
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From page 68... ...
A clearly articulated vision, combined with a strong demonstration project, can catalyze the second revolution in health care. Models That Promote Primary Care, Medical Homes, and Patient-Centered Care Mike Magee, Center for Aging Services Technologies, American Association of Homes & Services for the Aging Past work on cross-sector partnerships and the elements that make them successful may cast light on some of the requirements for moving forward with integrative medicine.
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From page 69... ...
Magee noted three examples of trends that affect home and family that health care systems should address: how longevity has made families more complex, as they have moved from involving three generations to four- and five-generations; how the Internet, which can push massive amounts of information at high rates of speed, is essentially geography free and offers almost infinite opportunities for connection; and how three decades of consumer health information has led to empowerment that has suppressed medical paternalism and encouraged teams and mutual decision making. This last trend is now giving way to health activism, led primarily by informal family caregivers.
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From page 70... ...
A rich array of information that is personalized and customized with vital signs, diagnostics, and planning milestones could be transmitted automatically and wirelessly from the home to the care team. In the other direction, data, analysis, advice, support, and coaching could come into the home continuously.
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From page 71... ...
Finally, embracing these trends may allow more efficient and effective management of the existing chronic disease burden while simultaneously building a truly preventive system that will serve generations to come. The missing connection at this point is a software application, which Magee predicts will be ubiquitous on all new computers within 5 years.
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From page 72... ...
Preserving relationship-based health care requires embracing current trends and leading with a vision sufficiently powerful to excite the imagination. This vision must embrace complexity, connectivity, and consumerism, while reinforcing the social health capital imbedded in relationships between people and the people who are taking care of them.
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From page 73... ...
A program designed by Dean Ornish, in which Guarneri participated many years ago, showed that every dollar spent on care for very sick cardiac patients could save $6.66 on angioplasty and bypass surgery. Thus there are precedents for demonstration models and clinical networks that can deliver effective preventive care.
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From page 74... ...
PRIORITY ASSESSMENT GROUP REPORT 1 Identifying and Advancing Workable Models of Integrative Care Themes and Highlights Dr. Fred Sanfilippo provided the report for the priority assessment group that reviewed ways to promote models of integrative care.
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From page 75... ...
The second set of key actors identified is the health care provider group. Their role is to be proactive, not reactive, and to develop comprehensive, coordinated models of health care delivery that involve multidisciplinary teams whose membership reflects patient needs.
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From page 76... ...
Some existing projects with potential to participate in a trial that might not immediately be thought of as integrative care models also were suggested, such as the life program of the University of Pennsylvania's School of Nursing, which is a capitated, independent living program for elders that involves nurses, doctors, dentists, and occupational and physical therapists. Another audience member cautioned against assuming more empowerment and health literacy than many people actually have.
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