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Part 2: Huffington Post Report on Successes/Challenges in M.D.-Led and N.D.-Led Integrative PCMHs PDF Print E-mail
Written by John Weeks   
Part 2: Huffington Post Report on Successes/Challenges in M.D.-Led and N.D.-Led Integrative PCMHs
[Due to space limitations at the Huffington Post, the following is the conclusion of the summary report on the "Integrator Special Report: Prototypes of MD-Led and ND-Led Integrative Patient-Centered Medical/Health Homes" that begins here in the Huffington Post.]
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Casey integrative medical doctor Nicole Farmer, MD describes an unusual team-building strategy in "Speed-Dating: A Casey Health Institute Method for Building a High Performing Interprofessional, Integrative Team." Each practitioner picks a partner to start. The dyad has 4-5 minutes together. There are elements of co-counseling built in. Optimally, each practitioner has a chance to listen about the other's clinical issue or patient question for 2-3 minutes. After the 2-3 minute mark, the two switch roles and the second presents an issue while the first listens and offers feedback and ideas. This is repeated multiple times with different partners during the 60 minutes each Thursday morning. Reflects Farmer: "This has a huge impact [on patient care]. I frequently will change a treatment plan."

The investigation, engaged in a partnership with the Project for Integrative Health and the Triple Aim, an initiative of the Academic Consortium for Complementary and Alternative Health Care, found that the gains at these new integrative medical homes have been hard-earned.

Porter, at the Center for Natural Medicine, speaks of the resistance to changes on many fronts. Schoenbeck focuses on how in her Vermont medical home "the difficulty is in administration, in tracking, in the follow-up. There is no doubt that this is a high administrative burden."

Schoenbeck adds: "It's a culture shift to be more organized." Then: "It may not be a bad shift for many of us to be more organized."

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Tracey Gersh, PhD: CHI's EVP/COO
These integrative patient-centered medical homes distinguish themselves by their breadth of services. In "Casey Health Institute: EVP/COO Tracey Gersh, PhD on Bridging Integrative Health into a PCMH and ACO," Gersch states that: "We have so many things that it is mind-blowing." She ticks off the services. First, the "best medical care, then the multiple practitioner types - MDs, nurses, chiropractor, acupuncturists, naturopathic doctor, massage therapists and coaches."

To these, the Casey model adds "the continuum to wellness" including "a wellness center with a host of services - yoga, nutrition, and stress management." The care goes beyond the clinic walls: "We provide ways to connect to the community. We have a care coordinator and an EHR [electronic health record]. Our nurses can help people navigate the system. We can help them stick to their care plans."

At Mountain View Natural Medicine, as Schoenbeck shares in the first part of the profile, Pioneering a Naturopathic PCMH in Vermont's Health Reform, the breath of integrative naturopathic services are enhanced by a "Community Health Team." This team is made available via a special fund, granted to medical homes, that allows patients covered access to practitioners such as health coaches and acupuncturists whose services are not otherwise covered under the Vermont Blueprint for Health.

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Ira Zunin, MD, MPH, MBA
Manaki O'Malama's Zunin speaks to the way that these new payment structures support an integrative health and medicine strategy:
"In the PCMH, payment reflects more of the relationship with the patient
and the outcomes. It plays into our hand. Things like integrative medicine,
palliative medicine and conventional screening - all of their stock goes
way up for these reasons. You have unassigned dollars that aren't directly
connected to a provider or a procedure or a code. You can use the dollars
from an integrative perspective."
Tom Trompeter is the CEO of Healthpoint, a set of a dozen federally-qualified health centers in Washington State. Twenty years ago, he and his colleagues pioneered a partnership with Bastyr University for bringing acupuncturists, naturopathic doctors and others into the first of these centers.  In "Opportunities for Integrative Medicine in a Patient-Centered Healthcare Home," Trompeter re-enforces Zunin's point:
"To break the paradigm of the private physician practice we have a team approach, with everyone working at the top of their license. This opens the door to greater diversity. What does the best team look like?"
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Tom Trompeter, CEO, Healthpoint
The veteran federally-qualified health center CEO, interviewed in 2011 as interest in medical homes was building, gave integrative practitioners who wish to be involved in these new delivery organizations their charge: "In a comprehensive primary care setting, when the economics are more organized around producing healthy people, what any practitioner needs to do is look at what gives us the effect that we are trying to cause. And that is, to have a healthier populations. Start with that and that will be the interesting conversation."

The context for Trompeter's comment is the shift of the medical industry to a value-based approach that recently provoked me to ask, here in the Huffington Post, if it is not Time for a New Look at Integrative Medicine and Health Professionals in the Triple Aim Era?.

The experience shared in this investigation - while short of the data-based outcomes we await -- affirms that it is time for a more substantive look at the value of integrative models. At the same time, this exploration suggests that a parallel question also might also be asked: Is It Time for a New Look at Patient-Centered Medical Homes by MDs and NDs Running Integrative Clinics?



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