Coming of the Light! Top 10 for Policy and Action in Integrative Medicine and Health in 2012

Coming of the Light! Happy Solstice

A recent practice of subscribing to Google Alerts for "integrative medicine" and "complementary and alternative medicine (CAM)" astonishes with the raw material of growth and reach of the 15- to 20-year-old integrative health and medicine phenomenon in U.S. health care.

The links listed here and here evidence the seeding of integrative health and medicine, from Shreveport to South Amboy, Asheville to eastern Oregon, Manchester to San Diego. Medicine is changing to reflect popular interest, evidence, and an emergent movement in health systems toward personal empowerment and health creation.

What we call "integrative medicine" was made possible, in part, by work in the 1980s of complementary and alternative health care practitioners like chiropractors, acupuncturists, massage therapists and naturopathic doctors. They laid a groundwork of licensing and certification that enhanced popular interest in, and access to, natural health services. Just so, present action and policy are laying infrastructure that will inform and embolden participants into the future. Here are the Top 10 for policy and action in integrative medicine and health for 2012.

Herman: lead author of key cost-effectiveness publication

1. The Emerging Evidence of Cost-Effectiveness

Evidence of effectiveness is a classically "necessary but not sufficient" tool in fostering integration. "Show me the money" is the rejoinder. The year 2012 put two jewels in this crown. Insurers and employers will be most taken with an analysis in Medical Care grounded in the Medical Expenditure Panels Survey (MEP) 2002-2008 that showed CAM users with spine-related care had $526 lower costs per year for spine-specific costs and $796 lower per year for total health costs. A long-awaited review led by Rand economist and naturopathic doctor Patricia Herman, N.D., Ph.D. and Harvard's David Eisenberg, M.D. reported cost-effectiveness in 28 high-quality studies. The emergence of a positive Swiss government's report on homeopathy added fuel. Time for payers to be more proactive.

Parker Hannifin's Washkewitz

2. CFO Magazine Promotes Employer Exploration of Integrative Medicine

Among payers taking the lead, none is more bodacious in his inclusion of CAM in his benefits plan or confidence in cost savings than global manufacturer Parker Hannifin's CEO Don Washkewicz. In "A Solution to Our Country's Big Health Care Problem?" Washkewicz admits that cause and effect aren't clear. But after introducing his robust CAM benefit, annual per-employee medical costs sunk from $6,500 to $3,200 between 2007 and 2012. His plan is to measure and report the savings then "publicize the hell out of it." As reported in my previous HuffPost blog, Washkewicz' confidence and some related reporting convinced CFO's deputy editor to urge his audience of chief financial officers (CFOs) to "think bigger, much bigger" via exploring new integrative medicine coverage options to control costs and achieve better outcomes.

CAM benefits: will they or won't they?

3. Jeannie Kang, LAc, and the Push to Get Access to Integrative Services in Essential Health Benefits and the Emerging Payment and Delivery System

All we know about what the Affordable Care Act (ACA) will do to access to complementary and alternative health care practitioners and services is that we don't know. Will hard-won "mandates" for coverage over recent decades be lost if services and providers are not in Essential Health Benefits (E.H.B.)? Or might they be expanded to self-insurers via that act's Section 2706's non-discrimination clause, as some believe? A New York Times article featured Jeannie Kang, LAC, past president of the American Association of Acupuncture and Oriental Medicine, on her work to get acupuncture into E.H.B.s in California and five other states. The American Chiropractic Association is activating its state leaders to get to the table. In Oregon, naturopathic doctor Bill Walter, N.D. is finding success in getting his profession into that state's Coordinated Care Organizations. In response to perceived needs at the state level, the multidisciplinary organizing and lobbying collaboration called the Integrative Healthcare Policy Consortium has decided to focus 2013 efforts on supporting state organizations in engaging the changes such as 2706 that are flowing downstream from the ACA's passage.

Hyman: powerful influencer in multiple arenas

4. The Phenomenon Named Mark Hyman, M.D. and the Diabesity Epidemic

Integrative and functional medicine clinician and author Mark Hyman, M.D., seems to have been everywhere in 2012. The new book by the chairman of the Institute for Functional Medicine, The Blood Sugar Solution, is graced by a cover quote testimonial from none other than former President Bill Clinton hoping the book "will inspire you as he has inspired me." The New York Times No. 1 best-seller received heady endorsements from about every other bright light for a new medicine. Meantime, Hyman, a HuffPost blogger, published a welcome manifesto in two parts for what we need in true health reform: Money, Politics and Health Care: A Disease-Creation Economy. Talk not being enough, Hyman partnered with Pastor Rick Warren, Mehmet Oz, M.D., and others to promote The Daniel Plan for weight loss via a church network. Credit Hyman for translating theory into function in both clinical and public health environments.

Adi Haramati, PhD: the lead convenor

5. The International Congress for Educators in Complementary and Integrative Medicine

Integrative medicine and health care are, at their best, team sports. One provider can't do it all. Licensed acupuncture and Oriental medicine practitioners, holistic nurse, massage therapists, mind-body specialists, coaches and others need to be linked with the physician-level services of chiropractors, naturopathic doctors and medical doctors and surgical specialists in optimal teams. That means bringing the disciplines together as they are educated. Pent-up demand was evident when the announcement of the International Congress for Educators in Complementary and Integrative Medicine drew over 250 proposals. The nearly 350 academics who met at Georgetown University, via the leadership of Aviad (Adi) Haramati, PhD, on Oct. 26-28, 2012 experienced a historic phenomenon: a true, lateral collaboration between a 54-member consortium of medical schools and a consortium of 17 national organizations from the licensed complementary and alternative healthcare disciplines. Numerous fruitful, interprofessional collaborations are anticipated to follow.

Cherkin: straddling the two institutions

6. The Research That Needs to Be Done: The Group Health Research Institute -- Bastyr University Nexus

So what happens when a population of individuals are treated by integrative medicine physicians? A Seattle area research partnership between an HMO-based research center and naturopathic medicine-based institution of natural health sciences is taking a lead in researching the key questions. The collaborators from Group Health Research Institute (GHRI) and Bastyr University published an influential pilot led by Ryan Bradley, N.D., MPH showing the success in lowering blood sugar and fostering habit change via naturopathic care's personalized, multi-modality approach. A similar team led by Erica Oberg, N.D., MPH followed up with an exploration of what a GHRI newsletter called the "secret sauce" that helped these patients toward greater self-efficacy. That something is right in the care was evident when Bastyr's teaching clinic ranked first among all Northwest primary care clinics in a Puget Sound Health Alliance survey of patient experience. The link between the two institutions was recently fused further when GHRI's Dan Cherkin, Ph.D., a colleague on both the studies, chose to take an additional position as chair of Bastyr's Reseach Institute. Notably, Cherkin was also part of the cost study using MEPS data noted above.

Westreich: modeling a more integrative philanthropy

7. Integrative Medicine Philanthropy and the Leadership of Ruth Westreich

While practitioners and academic health care institutions work toward inter-institutional and interdisciplinary collaboration, the critically important philanthropic sector has typically put its apples in the baskets of M.D.-led initiatives. For most, empowering the institutions connected to the 400,000-plus licensed "CAM" practitioners has been a non-starter. There are signs of awareness that moving integrative health can benefit from investment in these other sectors is growing. Philanthropist and integrative medicine activist Ruth Westreich and the Westreich Foundation epitomizes the new thinking. With roots in Scripps Integrative Medicine, San Diego Hospice and the Bravewell Collaborative, she attended a meeting of roughly 100 members of the Academic Consortium for Complementary and Alternative Health Care (with which I am involved), chose to join their Council of Advisers and then made a $100,000 gift. Westreich subsequently joined the Board of Trustees of the multidisciplinary Bastyr University to assist its opening of a naturopathic college in California. Westreich subsequently joined the board of the Samueli Institute with its historically multidisciplinary agenda. This new philanthropy realizes that moving multiple, inter-related pieces on the chess board can best advance the transformation of U.S. health care.

Base for the new integrative medicine specialty

8. Clarity and Collaboration as the American Board of Integrative Medicine Takes Shape

An awakening juggernaut in the medical doctor sector of the development of integrative health and medicine is the American Board of Integrative Medicine (ABOIM) as an approved specialty of the American Board of Physician Specialties. ABOIM's still-quiet influence will pick up speed with the first certifications in 2013. After announcement, the

gestation period appears to be provoking healing and converging of disparate forces in holistic and integrative medicine. Grandparenting guidelines have reassured those who have been in the field for decades and held prior certification. The quality of accredited education in chiropractic, naturopathic medicine and acupuncture and Oriental medicine was honored through recognizing those with dual training (M.D., D.C. or M.D., N.D. or M.D., LAc). First tests are expect by mid-year. Meantime, the ABPS' list of 21 approved fellowships is testament to the current penetration of integrative medicine as an innovation in the health professional education of medical doctors.

Health Resources Services Administration: NccIM funder

9. Federal Agency Funds National Coordinating Center for Integrative Medicine

That a federal agency, the Health Resource Services Administration (HRSA), saw fit to announce a competitive grant for $770,000 to support development and management of a National Coordinating Center for Integrative Medicine is news enough. While the wing-spread of that title overreaches the goals of the awardee, the American College of Preventive Medicine (ACPM), there is much in the grantee's plans that can help fulfill on that charge. ACPM will support placement of integrative medicine content in 12 preventive medicine residencies established under a parallel grant. Placing this initiative in a specialty focused on prevention and health promotion reconnects the integrative care movement to its roots in health. The ACPM's decisions to drive the initiative via a multidisciplinary steering committee, a diverse set of partner organizations and a broad community of learning each opens new windows. ACPM and its grantees will learn a great deal from their integrative medicine colleagues. Hopefully some of these project characteristics will enhance the broader academic movement.

Mack: powerful president of the sunsetting collaborative

10. Integrative Medicine in America and the Staged Exit of the Generative Bravewell Collaborative

Last listed here, in the spirit of the rain-maker who is often named last on research publications, is the powerful generator of much development of academic integrative medicine in the past decade, the Bravewell Collaborative of philanthropists in integrative medicine. The organization, under the watch of its second president, Duke integrative medicine angel Christy Mack, has announced that it has done much of what it set out to do when founded in 2001. The organization plans to sunset itself in late 2013. Meantime, Bravewell published a significant report entitled "Integrative Medicine in America" that provides exceptional details on the services offered in academic integrative medicine programs, and those believed to be most fruitful for patients. While my blog here on HuffPost notes that the title is an overreach, the gorgeously-delivered report, co-authored by Bonnie Horrigan, Sheldon Lewis, Donald Abrams, M.D. and Constance Pechura, Ph.D., is yet another strategically-delivered gift from that strategically-created organization for integrative medicine.

Quite a year. Under-girding much of the activity is the decision by U.S. President Barack Obama, the U.S. House of Representatives, led by Nancy Pelosi, and U.S. Senate, with influence from Tom Harkin, to pass health care payment reform. Included in that law, upheld in June, are direct footholds for complementary and integrative practices. More importantly, many characteristics and incentives in that act mark a general course correction toward payment and delivery that turns attention to health creation. This is an inviting host for the integrative health community.