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Forum on the IOM: Bravewell's Post-Summit Statement on "Key Factors" in Any Health Reform Plan PDF Print E-mail
Written by John Weeks   

Forum on the IOM: Bravewell's Post-Summit Statement on "Key Factors" in Any Health Reform Plan

Summary: The alpha and the omega of the IOM Summit is the Bravewell Collaborative. The organization of philanthropists laid down $445,000 to sponsor the gathering. Bravewell now plans significant additional investment to ensure their mission - namely, that the outcomes have legs in transforming US healthcare. Just after the Summit concluded, Bravewell issued a statement which included eight "key factors which should be included in health reform." Here is the Bravewell list. Are you aligned? What did the Bravewell downplay or miss which you felt were key health reform outcomes which the IOM Summit began to shape as consensus? 
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ImageFor other articles in this Forum:

The first significant sign of what the Bravewell Collaborative might do with the IOM Summit was the coalition formed with the AARP, the US Chamber of Commerce and the Prince's Foundation. More recently, Bravewell informed its donors that it would hold a major event in Washington, DC on November 4, 2009, to release a Summit document and promote Summit findings.

ImageThere is no doubt that Bravewell is determined to transform US healthcare. The strategic directions the organization of philanthropist will prioritize were laid out in a statement shortly after the Summit. Bravewell lists eight key points that will shape its course. Are these aligned with your views of "integrative practice?" Put in a more challenging way: Do you believe that your profession, institution or practice are aligned with and honor these not just in word but in deed? If not, should your practice or profession be better aligned? If not, why not?

Notably, in the same statement, Bravewell offers an updated definition of its view of "integrative medicine." Those who were present will note that the organization has not adopted the term "integrative health care" that seemed to be preferred by most at the Summit:
"Integrative medicine is described as orienting the health care process to create a seamless engagement by patients and caregivers in the full range of physical, psychological, social, preventative and therapeutic factors known to be effective and necessary for the achievement of optimal health."

Factors to be Considered in Upcoming
Healthcare Reform Efforts

- Bravewell Collaborative

(from this webpage)

  • The progression of many chronic diseases can be reversed and sometimes even completely healed through lifestyle modifications. Lifestyle modifications programs have been proven to not only improve people's overall health and wellbeing but to also mitigate cardiac disease and prostate cancer, among other chronic conditions.

  • Image
    Christy Mack, Bravewell president
    Genetics is not destiny. 
    Recent research by Dean Ornish, MD, and others has shown that gene expression can be turned on or off by nutritional choices, levels of social support, stress reduction activities such as meditation, and exercise.

  • Our environment influences our health.  Mounting evidence suggests that the environment outside one's body rapidly becomes the environment inside the body.

  • Improving our primary care and chronic disease care systems is paramount.  Participants widely agreed that our primary care system is in danger of collapse and that we must retool how both primary and chronic disease care are delivered.  The new system must focus on prevention and wellness, and put the patient at the center of care.

  • The reimbursement system must be changed.  The Summit grappled with the current reimbursement system that rewards procedures rather than outcomes and urged changes that would incentivize physicians to focus on the health outcomes of their patients.

  • Changes in education will fuel changes in practice.  Implementation of an integrated approach to health care requires changes in provider education.  All health care practitioners should be educated in the importance of compassionate care that addresses the biopsychosocial dimensions of health.

  • Evidence-based medicine is the only acceptable standard.  Researchers and practitioners alike concurred that health care should be supported by evidence and urged further research and testing to expand the evidence base for integrative models of care.

  • A large demonstration project is needed.  Because funding for research on the effectiveness of specific models of care is difficult to obtain from standard grant channels, participants voiced support for pursuing a demonstration project funded by the government that would fully demonstrate the effectiveness of the integrative approach to care.

[NOTE: I have changed this following correspondence from the IOM on April 9, 2009. I was originally under the understanding that the IOM did not plan to publish. The document will in fact come from the IOM.]

I am imagining the document which the IOM will publish this fall based on the dozens of papers, presentations and assessments leading up to and involved in that rich, 3-day meeting. I am also thinking of my own journalistic process in which my "reporting" is skewed by my own values and strategic sense of what is most important to get across.

The Summit's historic meaning is likely to be an elaboration of the themes enunciated here. I have no gripes, as far as they go, and in fact like these very much. One wonders, for instance, how double standards which exist around the application of "evidence-based medicine" will be treated. Present practice favors the one-third to one-half of conventional treatment which is, according to the IOM, wasteful and not evidence-based. (IOM, February 2008, From Waste to Value in Healthcare) Note the Summit-related comments of participant Michelle Simon, ND, PhD, about the Technology Assessment Panel on which she serves in Washington State. When applied, says Simon, many conventional treatments are not covered. The evidence isn't there.

And who will be in and who out of the document? Will for instance, "improving primary care" include the theme of having additional practitioner types, and not just nurses but the likes of naturopathic doctors, broad-scope chiropractors and up-trained acupuncturists in the mix such as are alluded to  by Mary Jo Kreitzer, RN, PhD, FAAN, Elizabeth Goldblatt, PhD, MHA/PA and Simon in their comments? Will the document let the paradigm shift to the more inclusive "health" rather than the exclusive "medicine?" Hope so. We shall see.

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