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"The Centering Pregnancy program in Providence, RI, in which I have participated over the past year, involves about 5-10 women per group, and is covered by insurance as regular prenatal care. Instead of the traditional prenatal exams, each mom gets a brief and private ultrasound with a nurse-midwife while the other moms and their birth partners share their experiences, swap advice, socialize, and hear from various healthcare providers. In the apt words of the CPPA, these group-oriented prenatal sessions "allow for the development of community and empowerment, leading to proactive, involved consumers and energized providers working together in a partnership that is exciting and fulfilling to all participants." "So what makes this care integrative? Since so many Americans now are inclined towards using both conventional and CAM approaches in their personal healthcare, it shouldn't be surprising that when you empower parents-to-be to help set the agenda for their prenatal care and childbirth education, they choose to receive training, information and support from both CAM providers and allopathic experts. "For example, as a shiatsu therapist with a specialty in pregnancy care, I have been invited on many occasions to speak to various centering groups on how birth partners can help relieve labor pain through simple massage and acupressure techniques. The groups have also regularly invited a local chiropractor, a prenatal yoga instructor, and a teacher of infant massage to address them. And I know of one group that decided to close its meetings with meditation sessions. Thus, these groups are directing their own integrative health education in a way that is truly patient-centered. "The nurse-midwives coordinating the program have been very impressed by the moms' birth outcomes, with women in the centering groups who had never considered epidural-free labor opting for natural childbirth once they had received this kind of community support that one-on-one healthcare just can't provide, no matter what the modality. "So...what are we all waiting for? "I think the time has come for interested parties (and I'm one of them) to come together, examine the best practices of these many group-oriented methodologies, and develop a replicable, group-oriented, physician-facilitated, integrative care model that brings together patients with similar chronic health issues (e.g. diabetes, low back pain, obesity, high blood pressure) for a series of sessions that empowers them to develop supportive networks, share success stories, and figure out what works for them. "Such a model that gives groups of patients license and latitude to collectively consider and evaluate their community's CAM and conventional healthcare resources, under the guidance of a physician, will inevitably draw in CAM providers into their healing process in collaborative ways.
"I think the Community Acupuncture Network has it right by approaching group-oriented care with a stand-alone, for-profit business model that does not require insurance reimbursement (or long-term buy-in from employers, hospitals, foundations, etc.) to sustain itself. Since, according to the 2006 National Survey of Employer-Sponsored Healthplans, the average co-pay for a physician visit is now $16-18, asking participants to contribute their regular co-pay amount directly to the physician's office could both be financially manageable to most people and could cover the physician's time, a visiting CAM provider's time, operational costs, and leave room for profit. "John, I think you are right in stating that many CAM providers are as resistant to altering their work orientation as many doctors are. But what we have here is an opportunity to provide an approach to healthcare that is far more financially accessible than most one-on-one CAM therapies (including my own) will ever likely be. Perhaps such providers would feel less threatened and more interested if this group approach to integrative care were given a new name: I like "collective healing". "I encourage those interested in developing a for-profit, group-oriented, low-cost, replicable, community-based integrative healthcare model to communicate with each other and see how we can make this a reality." Sincerely, Karlo Berger, ABT, LMT Founder and Board Member Emeritus, Integrative Medicine Alliance President, Whole Health Solutions, LLC 236 Fourth Street Providence, RI 02906 USA (401) 383-0661 www.KarloBerger.com Comment: A rule of community organizing is that, if you don't have money to buy media and public presence, then do something that attracts media. I am convinced that an active alignment of integrated care principles with group services can be just this sort of exciting, out-of-the-box, principled action which can leap-frog the natural healthcare disciplines and practices into broader public usage. It helps that among the potential audiences for this information are employers like Chrysler who pay for care. What better way to show that one is "patient-centered" than to, well, be patient-centered? "Collective healing" does this. Do integrative medicine and integrated healthcare practitioners and practitioner-groups actually have the guts to empower patients in this way? Thanks for the sharing, for the commentary and the call to action, Karlo. So, what are we waiting for?
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