Integrative Medicine, Complementary and Alternative Health and Medicine Round-up #94: August 2015

The Intersection of Integrative and Community Health: Accountable Communities 2015, September 9-10, 2015
-AANP Pushes Federal Legislation (S. 1406) to "Save Access to Compounded Medications"
-Respond by August 17, 2015: US Veteran's Affairs Seeks Clinical Lead for Integrative Health

Terrific conference Sept.9-10

Employers and Economics
-American Sustainable Business Council Promotes Action on Section 2706, the ACA's Non-Discrimination in Healthcare Provision
-Harvard Pilgrim Begins Covering Acupuncture Treatments in a Step toward "Eastern Harmony"
-Global Wellness Institute Reports 10 Recommendations from Corporate Summit to "Redefine Workplace Wellness"
-Insurance Giant Aetna Is Hiring a "Chief Mindfulness Officer"
-Saying Good-Bye to Traditional Medicare: Useful 3-Page Primer Explains U.S. Medicine's Shifting Economics
Research
-Two Journal Clubs: AIHM's David Riley, MD-led Initiative and Researcher Joshua Goldenberg, ND's DrJournalClub.com
-Oberg and Rioux: Dialogue on the Systematic Review of Whole-system Naturopathic Medicine in select Chronic Disease Conditions
Clinical Care
-Two Steps Backward for Integrative Pain Care: Kaiser Patients Not Sharing Who They See, AMA Still Not Elevating Teams
-Chiropractors Push Conservative Treatment in Campaign to End Prescription Painkiller Abuse
-Portland Tribune Profiles Naturopathic Physician-Owned Patient-Centered Medical Home
- Special to the Integrator: Lori Knutson, Duke Leadership Faculty Member and Integrative Pioneer, on Working with Health System Values and Culture

Taylor Walsh: point for 2706 newsletter

Consortium led research priorities paper

Research Priorities: Integrative Consortium (ACCAHC) Finds Decline to 2.27% in NIH NCCIH Grants to Licensed "CAM" Institutions

The open access article in the Journal of Complementary and Alternative Medicine shares data that grants from the National Center for Integrative Health to institutions associated with the licensed complementary and integrative health professions (DC, LAc, ND, massage therapy) represented just 2.27% of total awards in 2014. This is down from an already low 5.87% in 2010.  The article is entitled "Health Policy Consensus Recommendations to NCCIH from Research Faculty in a Transdisciplinary Academic Consortium for Complementary and Integrative Health and Medicine." The value of the document is that the suggestions come from a consortium of leading research leaders of five "major systems with which the Center is concerned." (See Section a.)

The team proposes these top three areas of investment: 1) "Research CIH the way it is practiced;" 2) "Balance funding between basic science (bench science and efficacy trials to move science forward) and health services research (effectiveness and economics to provide information for health policy)"; and 3) "Focus on the role of CIH therapies and disciplines in prevention and health promotion." The work was led by Martha Menard, PhD, LMT, and her fellow members of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). The team turns its attention to the new NCCIH strategic plan, now in development. They offer multiple recommendations, coupled with this comment: "We believe that affirmative, directive programs from NCCIH in 2016-2020 can significantly advance the quality and quantity of CIH research contributions, particularly to bettering public health."

Does agency reflect constitutent interests?

Comment: I was a co-author with Menard on this piece, together with a sterling interprofessional group that included Belinda Anderson, PhD, LAc, William Meeker, DC, MPH, Carlo Calabrese, ND, MPH, David O'Bryon, JD, CAE, and Greg D. Cramer, DC, PhD. One of the values in the piece is a table, constructed by Menard and with significant input from Calabrese, proposing distinct definitions for: Real World Research, Comparative Effectiveness Research, Whole Systems Research and Disciplines Research. The latter is particularly important as, through the communication from ACCAHC to with NCCIH, the concept of researching the value of a "discipline" is strewn throughout the NCCIH 2011-2015 Strategic Plan. Isn't a core question facing insurers, hospitals and employers what will it mean if we cover providers from these new disciplines of acupuncture, chiropractic, massage therapy and more? Great leadership from Menard, now a co-executive director of ACCAHC. (See People, below.) Here's hoping the 2016-2020 plan will reflect this guidance.

Looking for input

Two Opportunities to Influence: NIH Plan and a National Academy of Medicine Guidance to the New Administration

August 16, 2015: NIH Framework for a Strategic Plan: The NIH has published a Request for Information (RFI): Inviting Comments and Suggestions on a Framework for the NIH-wide Strategic Plan. Deadline is August 16, 2015.

August 14, 2015 - National Academy of Medicine (NAM): Influencing the New Administration: The NAM, formerly the Institute of Medicine (IOM) is undertaking a new initiative, Vital Directions for Health and Health Care. The reason: "With a new administration on the horizon ... to inform the next administration - and the nation - about the most pressing issues in the next phase of health reform."

Comment:  Terrific to know that, under the leadership of Bill Reddy, LAc, Dipl-Ac, the Integrative Health Policy Consortium-Academy of Integrative Health and Medicine partnership is actively developing input to the NAM. The rule is simple for all in a democracy: send no input, lose grounds for complaint about their choices. Here's hope some of you will chose one and take the time to be heard.

Jamie Harvie: conference organizer

The Intersection of Integrative and Community Health: Accountable Communities 2015, September 9-10, 2015

The conference title is "Accountable Communities 2015: Advancing Integrative Approaches to Community, Health and Well-Being." The focus of the September 9-10 meeting in Duluth, Minnesota, is on what award-winning organizer Jamie Harvey and his Commons Health project calls "health creation." More specifically, the meeting engages the intersection between the integrative health and medicine movement and the broader movement to engage determinants of health. The conference is "designed to catalyze place-based health creation." Specifically: "By melding integrative and community expertise and engaging in conversations that matter, this event helps healthcare, human service, business, clinical, wellness and community leadership link and align whole person approaches to health and well-being in the context of community."  Among cross-fertilizing topics: "Your Zip Code and your Epigenetic code; Land Trusts as Health Policy; Pathways out of Poverty; A Community Supported Agriculture (CSA); Health Plan National Model; Community Listening Sessions and a Community Equity Agenda; A Sugar Free, Diet Soda Free Hospital; Mental Health and Food; and Workplace Wellness and Community Health."

The sponsors and speakers for Accountable Communities 2015 reflect the dual movements. Among the dozen sponsors are not only Blue Cross-Blue Shield of Minnesota, but also the Academy of Integrative Health and Medicine (AIHM) and the Center for Spirituality and Healing at the University of Minnesota (led by GAHMJ's co-editor Mary Jo Kreitzer, PhD, RN, FAAN). The speakers range from Kellogg Foundation vice-president Gail Christopher, DN, a licensed naprapath who serves as board chair at the Trust for America's Health (pictured) to AIHM co-founder, integrative psychiatrist and author Scott Shannon, MD Allina Health's Courtney Baechler, MD, MSCE who heads up the most significant inpatient-outpatient integrative care program in the United States.  

Kellogg's Christopher: keynote

Comment: In my recent column in Global Advances in Health and Medicine Journal (The End of Tinkering: International Academic Group Explores Transformational Needs in Health Professional Education) I referenced that just 10%-15% of health influencers are clinical care related. I added that "an integrative health and medicine practitioner might take solace that prioritizing clinical engagement with patients on bettering lifestyle choices affirmatively shifts the balance." The intersection that this meeting puts front and center is long overdue.

In fact, one increasingly hears content at integrative care conferences related to determinants, and particularly environmental health. The late October conference of AIHM, for instance - with which I am involved as a member of the board, and, in this conference, as a speaker - People, Planet, Purpose: Global Practitioners United in Health and Healing is an exemplar. Content there bridges lifestyle, mind-body, lifestyle and environment and deep clinical enrichment. The Commons Health-AIHM connection is strong. The Commons Health site describes AIHM's "Wellness Route Map." Harvey writes:  "Commons Health is working to actualize this vision." Accountable Communities 2015 offers a delicious guide to the steps to health creation. Credit to all parties. Now, how can I get there? (Note: this  piece was originally developed for the Global Integrator Blog of Global Advances in Health and Medicine Journal.)

Prioritizing compounding issue

AANP Pushes Federal Legislation (S. 1406) to "Save Access to Compounded Medications"

The American Association of Naturopathic Physicians (AANP) continues to prioritize protecting compounding pharmacies. In a late July 2015 e-communication from Michael Jawer, the AANP's director of government and public affairs, the organization urged members to Save Access to Compounded Medications - Support S. 1406. The AANP's background: the FDA is "seeking to limit the availability of safely compounded drugs through an onerous limitation on their interstate distribution as well as a ban on office use when the medications are supplied by traditional compounders." The bill, introduced in the US Senate by Senator David Vitter (R-LA) "would remedy this situation." Writes Jawer:  "Whether you're a naturopathic doctor or a patient of a naturopathic doctor, a friend or family member, please act right away!  We need to preserve access to safely compounded medications that meet unique patient needs."

Gaudet: seeking key colleague

Respond by August 17, 2015: US Veteran's Affairs Seeks Clinical Lead for Integrative Health

US Veteran's Administration is seeking a "physician, nurse or psychologist" to serve as the "clinical lead for integrative health."  The person will oversee the organization's "integrative health coordinating center" and will be supported in a move to Washington, D.C.  In a note to colleagues to get out the word, Tracy Gaudet, MD, director of the VA's Office of Patient Centered Care and Cultural Transformation says that "this is a critical position in taking the lead on Integrative Health in the VA, and we obviously want the best people in the nation to be aware of it. In addition: "Despite the VA's challenges right now, the commitment to transforming healthcare stays strong, and the opportunity is great." Here is more info. Act now: the listing closes August 17.

Comment: This is a terrific opportunity. Do you know someone who would be perfect to serve? Let them know!

Promoting 2706 to employers

American Sustainable Business Council Promotes Action on Section 2706, the ACA's Non-Discrimination in Healthcare Provision

The American Sustainable Business Council (ASBC) is supporting members' efforts to inform their employees, and their state insurance commissioners, that under the Affordable Care Act's Section 2706, Non-Discrimination in Health Care, employees should have greater access to covered care from a broader range of licensed practitioners. The ASBC describes the effort here. The intro: "One of the most important developments in American healthcare is the growing use of integrative health options like acupuncture, massage therapy, and naturopathic medicine.  These therapies have been increasingly shown to deliver better outcomes, at lower costs, than standard care."

The ASBC action stems from a long-time partnership with the Integrative Health Policy Consortium. The site features a blog from Taylor Walsh who heads IHPC's CoverMyCare program entitled "Cost Benefits of Integrative Health Practices." A section of the website on "What is Section 2706?" points members to an IHPC clip from Deborah Senn, JD, former insurance commissioner from Washington State who has battled for consumer rights to licensed integrative health and medicine practitioners.  Walsh shared with the Integrator that "the plan is being synchronized with the CoverMyCare state project, so is organized around the four states we're emphasizing there: Minn, Cal, Hawaii, and New Mexico." He adds that ASBC "sees its national potential clearly." 

Comment:  Great to see this long-nurtured IHPC-ASBC relationship bearing this fruit. Does it make sense for integrative health and medicine to increasingly promote itself as "sustainable health care"? Nice work from each party.

Insurance program adds acupuncture visits

Harvard Pilgrim Begins Covering Acupuncture Treatments in a Step toward "Eastern Harmony"

A July 24, 2015 article in the New Hampshire Business Journal states that the insurer-provider Harvard Pilgrim Health Care  began to see growth in membership from people originally from both China and India. In an effort to be culturally appropriate and to draw these individual in as member, the plan chose to initiate an "Eastern initiative." A key component: members can have up to 20 covered acupuncture treatments. The head of the Harvard Pilgrim's Center for Inclusion Initiatives, Karen Brown, explained that "we went directly to the community to share with us what would be of most value." The finding, as explained by Brenda Cole, vice president of marketplace inclusion development: "We realized that they were looking for a more comprehensive approach to health and wellness." As part of the effort, Harvard Pilgrim took time to educate its conventional practitioners to the potential in the new services.

Comment:  All and all this appears to be an exceedingly thoughtful bit of new product development: listen to a new consumer category, seek culturally appropriate solutions, and educate those who needed to know. Note in the workplace wellness article below that the issue of culturally appropriate products and services was also alive in this initiative, with Ayurvedic medicine an example of what firms operating in Southeast Asia must add to their mixes.

Fine work refining workplace wellness

Global Wellness Institute Reports 10 Recommendations from Corporate Summit to "Redefine Workplace Wellness"

"Stop the Mud-Slinging on ROI and Focus on Total Return on Value." This is the top recommendation among ten after the Global Wellness Institute convened experts "from high-profile organizations" to explore the state of the workplace wellness movement.  Among the corporations represented were the Cleveland Clinic, Clinton Global Initiative, Johnson & Johnson, Citi and Goldman Sachs. Michael Roizen, MD from the Cleveland Clinic and longtime integrative health and medicine leader and integrative corporate wellness expert Kenneth Pelletier, PhD, MD (hc) were among participants. The top recommendation notes that 93% of the gains in the first year from workplace wellness initiatives are in "productivity gains not reduced costs." Recommendation #5 is to better adapt programs to local culture. Mentioned is "the reality that if you exclude Ayurveda in many Southeast Asian countries you're alienating the vast majority of the population." The full 17-page report from the July 15, 2015 meeting is here.

Comment: Great to see the cultural sensitivity and push for appropriate integration of traditional practices. It is notable that a study of the cost-effectiveness of an integrative naturopathic intervention for Canada Post employees, led by the Rand Corporation's economist and researcher Patricia Herman, ND, PhD, was in "presenteeism" - a productivity measure. This finding supports the top recommendation. Good to see this more holistic, long-term view emerging. Credit the ambitious Global Wellness Institute for the convening.

Bertolini: Aetna's change agent CEO

Insurance Giant Aetna Is Hiring a "Chief Mindfulness Officer"

The insurance giant Aetna placed a notice on the National Register of Health Service Psychologists that it is seeking applicants for a "Chief Mindfulness Officer." The August 3, 2015 notice (no longer available at the link) states that the new employee will report directly to Hal Paz, MD, CMO. The person will "(serve) as a business leader in mindfulness, helping to positively impact peoples' lives and integrate the insights of mindfulness to foster compassionate communities, this leader will also work closely with the leadership team to assess and direct the impact of the changing industry landscape on Aetna's mindfulness strategy and approach.  Additionally, the Chief Mindfulness Officer will support the business by recommending appropriate actions, strategies and/or alternatives to meet business needs."

Comment:  The note to the Integrator on this new position from colleague Len Wisneski, MD, a former corporate medical director at Marriott, began with "never thought I'd see the day." I think it is fair to say that, as long as Mark Bertolini is leading the firm, more surprises will be ahead. Was a pretty cool job description when it was up!

Johnson: making the complex simple

Saying Good-Bye to Traditional Medicare: Useful 3-Page Primer Explains U.S. Medicine's Shifting Economics

A medical columnist who does not shy away talking about the perverse incentives in the conventional payment and delivery system that harm appropriate integrative health and medicine integration is David Johnson, MPP, the CEO of 4sight Health. John is a health policy educator at the University of Chicago. His recent column, "Medicare at 50: More Yesterdays than Tomorrows," exemplifies this straight talk and, at the same time, knack for making the complicated simple.  One of his suggestions to medical system leaders: "Don't expect continuation of higher payments for routine procedures performed in high-cost settings.  Respond to payor and consumer demands for more cost-effective and convenient routine care in lower-cost, distributed ambulatory facilities." Another of Johnson's columns that moves into similar ground on the shifting economics is "Reimbursement Roulette: Health Companies ‘Doube-Down' on Revenue."

Comment:  Optimal integration requires solid awareness of the economic platforms and incentives with which one is connecting. This short article is as good of a summary of the effort to shift to "values-based" from "production-based" that I have seen. It's a good introduction for anyone who would like as basic primer. All of us participating in the medical economy have skin in this game! (Thanks to Tom Weeks for putting me in touch with Johnson.)

Riley: runs AIHM journal club

Two Journal Clubs: AIHM's David Riley, MD-led Initiative and Researcher Joshua Goldenberg, ND's DrJournalClub.com

Two possible on-line engagements for individuals who wish to keep their research chops while engaging literature curated by integrative health and medicine leaders have recently become known to the Integrator. The open access AIHM Journal Club from the Academy of Integrative Health and Medicine is edited by long-time integrative medical doctor David Riley, MD the principal mover-and-shaker in the 2011 development of the CARE guidelines, the consensus reporting structure for case reports. Riley's AIHM site hosts roughly 10 articles per month. The index is here. Naturopathic physician researcher Joshua Goldenberg, ND, a member of the research faculty at Bastyr University, has founded the subscription-only DrJournalClub. The site uses video-based article summaries. The site also hosts good resources on evidence-based medicine skills. Some open access sample videos are here.

Comment: I love the concept and potential of journal clubs and hope initiatives such as these will quickly aggregate robust exchanges. So, far, movement is slow. Is this due to some characteristic in the integrative health and medicine community? A brief search found no information on the actual percentage of regular medical doctors and conventionally practicing nurses who participate in such initiatives.

Rioux: comments on ND whole systems paper

Comments from Jennifer Rioux, PHD: "This publication is the result of an ambitious undertaking by the authors, who endeavored to provide an analysis of the overall trends in patient outcomes for whole-practice Naturopathic medicine pragmatic trials to date (2003-2014). The heterogeneity across the 13 clinical trials (plus two cost effectiveness analyses) made the authors' task very challenging. None of the trials were blinded, which is impractical for a multi-modal, synergistic system of care, such as naturopathic medicine. Four of the thirteen trials did not include a control group, including one that was a case series, but most used a usual care comparator. The common factor across studies was that all patients were being treated for chronic conditions, however it was difficult for the authors to draw conclusions about any particular conditions, as the greatest number of studies concerning any one specified condition was three. The authors found data to support their primary claim that ‘the care delivered by naturopathic doctors improves the health outcomes of patients affected by chronic disease, as measured by both clinical and patient-reported outcomes.'  They also showed that naturopathic care resulted in small to moderate improvements in quality of life measures.  Findings associated with traits of the naturopathic care model included: 100% of patients received therapeutic lifestyle change recommendations; 94% were prescribed exercise and 69% were given counseling on stress reduction techniques.

"Meta-analyses of observational studies of whole-practice care are a necessary step in evolving the evidence base for this discipline, as they are characterized by greater external validity.  This task will become easier as the number of studies increases. Though the authors' described the data from individual studies well, their primary conclusions were limited to: 1) suggestion of clinical benefit; 2) no adverse reactions; 3) generally good quality of research, despite considerations of bias due to impracticality of RCT conventions (blinding; incomplete data; selective reporting); and 4) potentially positive public health implications for naturopathic care given the positive outcomes from individual studies on chronic disease precursors such as hypertension; lipids, glycemic control, anxiety and pain. The most important recommendation emanating from the systematic review is mentioned at the end, where the authors encourage future researchers of whole practice NM to include clinically relevant and patient-centered objective measures. I would take this one step further and encourage the naturopathic research community to engage in the standardization of assessment and data collection instruments and procedures via a Delphi process or similar effort.  This would be a major accomplishment for the discipline which would facilitate all future research efforts."

Oberg; lead on ND whole systems review

Erica Oberg, ND, MPH, responds: "One of the most useful applications of this research is that it helps patients, and referring MDs, understand what patients can expect when they work with a naturopathic doctor on a chronic health condition. They can expect a multi-modal intervention that addressed both biometric and patient-centered domains. They can expect improvement, albeit effects may be small at first (most of these studies were about 12 weeks in duration, a few extended out to 1 year). NONE of these studies showed a worse outcome when compared to usual care or when compared to baseline. Patients can expect additive and incremental improvement beyond other healthcare treatments and strategies they may be already trying.

"With attention to the research agenda, it is worth noting that researchers of naturopathic medicine recognized the importance of outcomes that measure both objective biometric data as well as patient-centered quality of life outcomes long before such metrics were favored or recommended by PCORI. Most of the studies included in this systematic review included both.  Of course, this is not surprising given the naturopathic orientation to treat the whole person - body, mind, and spirit, but it may warrant a footnote in history as an acknowledgement of the discipline's contributions to changing the perspective, and the conversation, on health and healthcare to equally prioritize ‘improvement' in both the eyes of the patient and the eyes of the doctor/healthcare system."

Two Steps Backward for Integrative Pain Care: Kaiser Patients Not Sharing Who They See, AMA Still Not Elevating Teams

Two recent news stories show what a long way we are yet from optimally integrative pain care.  A widely-covered study from the HMO Kaiser Permanente found that most patients, even when their services are covered by the same insurance plan, are not talking to their conventional practitioners about their decision to see chiropractic doctors or acupuncturists. Many see these for pain conditions. Meantime, a new initiative from the American Medical Association to combat opioid abuse keeps integrative professional organizations out of the picture. The title of the release: Physicians Groups Band Together to Address America's Opioid Crisis.

Comment: Both articles are startling, in their separate ways. One might have hoped in a city such as Portland, Oregon that views itself as one of the most integrative in the country - and with an HMO that has been partnering with so-called "CAM" organizations for years - would have seen more open communication by now. At the same time, one might also hope that following the November 2014 Joint Commission pain guideline, the AMA might extend itself to those who are primarily responsible for the non-pharmacologic services that the Joint Commission is elevating. These two outcomes taken together reinforce a vicious circle, co-conspiring to keep prejudices intact and best practices beyond the horizon of knowing. The AMA initiative reminds me of the Jim Hensen children's story: "I Can Do It. I Can Do It Myself." Time for these folks to reach beyond the toddler mind to appreciate the importance of teams. Try this: "We can do it. We can do it together!" (Thanks to Lou Sportelli, DC for the piece on the AMA initiative. His apt title to his email: "What a crock.")

Chiropractors push conservative pain care

Chiropractors Push Conservative Treatment in Campaign to End Prescription Painkiller Abuse

The media release from the American Chiropractic Association announced a profession-wide campaign: Chiropractic Physicians Call for Conservative Treatments for Pain Management Amid Prescription Painkiller Epidemic. The organization plans to "offer chiropractic physicians resources to help them share information about their conservative approach and why it is especially significant to today's health care consumers amidst the opioid epidemic." They reference the new November 2014 Joint Commission Clarification of Pain Management Standards as having "revised its pain management standard to include chiropractic services and acupuncture."

Comment: Great campaign. This would be a unifying banner for each of the integrative health and medicine fields, perhaps in collaboration, to march under. Wouldn't it be nice if the AMA's campaign, noted above, was entitled "Health Professions Groups Band Together to Address America's Opioid Crisis." That's what we need. Side-note to the ACA: Interesting that the edit made by the writers of the ACA release.  The Joint Commission's "clarification" also includes osteopathic manipulative therapy, massage therapy, relaxation therapy and cognitive behavioral therapy. A bit of guildishness appears to have creeped in here, even as it shows up in spades in the AMA initiative.

Milner: his ND-led PCMH portrayed

Portland Tribune Profiles Naturopathic Physician-Owned Patient-Centered Medical Home

The title of the July 21, 2015 feature reflects a still awkward relationship with the local medicine: "Naturopathics mix traditional, modern medicine." Naturopathics? The article's focus is the Center for Natural Medicine, a 5,000 square foot clinic founded by Martin Milner, ND.  The clinic is "a patient-centered primary care home in Oregon, credentialed by the Oregon Health Authority, to deliver primary care in a coordinated fashion." Then: "The focus at his Portland clinic is to rebuild a patient's health."  The article notes that Oregon naturopathic doctors have prescription drugs in their scope of practice. Adds Milner: "The naturopathic doctor spends a lot more time with their patient (than conventional treatment). We want to focus on diet, exercise, stress management, counsel our patients and get to know them personally."

Comment: The focus Milner describes is strongly aligned with the Triple Aim and values-based health care movement. The article did not share any outcomes from Milner's clinic. This article is an interesting companion piece to the brief on the Casey Health Institute in the July 2015 Integrator Round-up. 

Knutson: great leadership directions

Special to the Integrator: Lori Knutson, Duke Leadership Faculty Member and Integrative Pioneer, on Working with Health System Values and Culture

If one measures a professional's integrative health wisdom based on the total number of integrative visits engaged under one's watch, Lori Knutson, RN, BSN, HNB-BC stands head and shoulders above the rest of the field. The former director of the Penny George Institute guided the development of the nation's most significant inpatient and outpatient initiative in integrative care. The initiative's processes and outcomes have served as the foundation for start-up pitches and plans for scores of programs in other systems around the country. Knutson's present work is as the founder/president of Integrative Healthcare Solutions LLC. She is also a core faculty member of the Duke Leadership Program in Integrative Healthcare. This column from Knutson features some of the measured wisdom from her experience, a sample of what participants in the Duke program will learn. An honor to present it here. 




Organizations

Terrific AIHM partner for fellowship

Oregon Collaborative for Integrative Medicine (OCIM) Forms Partnership on Academy of Integrative Health and Medicine Fellowship

An August 7, 2015 media release announces the Oregon Collaborative for Integrative Medicine (OCIM) is developing a partnership with the Academy of Integrative Health and Medicine (AIHM). The focus is AIHM's "first truly interprofessional advanced training Fellowship in Integrative Health & Medicine" that AIHM is creating under the direction of Tieraona Low Dog, MD. The Portland, Oregon-based OCIM includes an interprofessional mix of institutional members: National College of Natural Medicine (ND, LAc, nutrition, plus), Oregon College of Oriental Medicine (LAc), Oregon Health & Science University (MD, multiple other conventional), Pacific University (multiple allied health) and University of Western States (DC, nutrition, massage). The chair of OCIM, University of Western States president Joseph Brimhall, DC, states: "Our collaborative is thrilled to partner with the AIHM in training interprofessional healthcare providers to better understand and appreciate each other's disciplines. Patients ultimately benefit when practitioners collaborate to provide inclusive integrated health care." Here is the view from OCIM's site.

Comment: OCIM (pronounced "awesome") is a terrific, one-of-a-kind partnership for AIHM (with which I am involved as a member of the board). AIHM is seeking to find ways through multiple historic, cultural and economic barrier to establish this as a truly interprofessional fellowship. This is Sisyphysian, shoulder-to-the-boulder work. So it is particularly good to have the link to this set of institutions that began formally collaborating two decades ago. Credit the potential in this moment to the vision of Anne Nedrow, MD, MBA, who took the lead in creating OCIM when she was headed the integrative medicine program at Oregon Health Sciences University.

New medical delivery members

Two New Medical System Members at ACIMH: Beaumont and U Hospital/Connor

In an August 7, 2015 memo to their list, the Academic Consortium for Integrative Medicine and Health announced organizational members #62 and #63: Beaumont Health and University Hospitals/Connor Integrative Medicine Network. Beaumont is an 8-hospital system in Southeast Michigan that, in 2014, for integrative services offered "over 22,000 outpatient appointments and over 5,000 inpatient encounters" through a 57 employee department. University Hospitals/Connor Integrative Health Network in Ohio is a major not-for-profit medical complex in Cleveland, Ohio.  University Hospitals' Case Medical Center is the primary affiliate hospital of Case Western Reserve University.

Comment: Remarkable stats from Beaumont, clearly in the top bracket of medical delivery organizations for integrative care services nationally. Good for ACIMH, also: these medical delivery organization memberships count $5000 dues each. That is real money in integrative health and medicine dollars.

Exploring ND PCMHs

NABNE and CHI in Partnership with ACCAHC to Explore Integrative PCMHs

The North American Board of Naturopathic Examiners (NABNE) and the Casey Health Institute (CHI) have developed separate, limited partnerships with the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) to explore and publish information on integrative primary care medical homes (PCMH).  The work, led by Jennifer Olejownik, PhD and involving this writer, will be engaged through ACCAHC's Project for Integrative Health and the Triple Aim. The two projects will methods, issues, practices and outcomes in multiple integrative PCMH environments. The NABNE partnership will focus on formally recognized naturopathic physician-led PCMHs in Oregon and Vermont. (See the related piece on Portland's Center for Natural Medicine, under clinical services, above.) The partnership with Casey Health Institute will examine work of that MD-led non-for-profit center in Maryland. (See "Integrative Services" in the June 2015 Integrator Round-up.)

Modeling integrative MD-led PCMH

Comment: The product of these partnerships will be a good luck at some of the most significant integration in the primary care arena. The goal is two-fold: help people in the integrative practice community see how medical homes can be engaged; and, at the same time, inform those in the non-integrative PCMH world how these more inclusive, person centered approaches can work. As CHI's co-founder David Fogel, MD postulated in the June 2015 Round-up: "The power in integrative medicine is team-based collaboration. I think we will blow values-based metrics out of the water with our outcomes using a team-based staff model of care." Let's see!

2706/Non-Discrimination newsletter

IHPC Debuts Bi-Weekly CoverMyCare Newsletter on 2706/Non-0Discrimination in Health Care 

The executive director of the Integrative Health Policy Consortium (IHPC) Alyssa Wostrel, MBA, DIHom sent a July 28, 2015 notice to colleagues that the organization is publishing a bi-weekly CoverMyCare newsletter on 2706/Non-Discrimination in Health Care. Wrote Wostrel: "The newsletter will provide us with a regular vehicle to stay abreast of CoverMyCare and Sec 2706 happenings."

This first edition included news on the following: the CMC's States Initiative; IHPC's cooperative partnerships and collaborations pertaining to CMC with the Academy for Integrative Health and Medicine, the American Sustainable Business Council (see article below under Employers and Economics); the State Pain Policy Advocacy Network; media partnerships and other relevant/current news about Sec 2706. The newsletter notes, for instance, that Oregon and Rhode Island have become the first two states to pass state legislation that mimics the federal non-discrimination in health care language. Integrator columnist Taylor Walsh, the director of the CoverMyCare campaign, has the lead on the newsletter.

Co-CEO Sudak lays out AIHM plans

AIHM Co-Executive Director Nan Sudak, MD Interviewed in Acupuncture Today

The title of the article by Bill Reddy, LAc, DiplAc is "The Integrative Medicine Puzzle: Putting the Pieces Together."  The title is fitting for an interview with Nan Sudak, MD, the co-executive director of the Academy of Integrative Health and Medicine.  The organization is attempting to "put the pieces together" under one big tent. Among her comments: "The Academy hopes to support the implementation of integrative medicine in the U.S. and globally by providing community and empowering unification of multiple disciplines within a single organization. The AIHM will provide a home to a broad international community of healthcare practitioners and health seekers connected by a shared holistic philosophy of person-centered care, and recognizing the link between our health and the health of the planet."(Alignment of interest note: I serve on the interprofessional AIHM Board.)

Comment:  Interviews can be good divining rods into organizations. For those vaguely aware of AIHM's presence, this is a good review of plans, and works in progress.   

AANP Partners with Foundation for Care Management to Provide Naturopathic CME to Multiple Other Professions

In a media release entitled "American Association of Naturopathic Physicians to Provide Naturopathic Education for Physicians, Nurses, Pharmacists, Physician Assistants, Dietitians, and Other HCPs," the AANP announced a CME partnership with the Foundation for Care Management. In the release, the AANP positions the profession as care collaborators: "AANP intends to enhance these collaboration opportunities via education programs on integrative approaches to common patient conditions. The association will seek to develop education programs that focus on cancer, diabetes, obesity, digestive disorders, fertility problems, and other conditions." The Foundation for Care Management (FCM) is a recognized leader in local, national, and international continuing medical education for physicians, nurses, pharmacists, and other healthcare professionals.

Comment: This is a good, interprofessional gesture from a position of power for a profession that too often is licking its wounds out of concern that other fields might lift what they view as their family jewels. Truth is, it will be something short of an eon before any other field approximates the depth of integrative education in naturopathic medicine's four-year, residential program. Good to see this education commencing.

First VHA chiropractic residents speak

First Chiropractic Residents in the Veteran's Health Administration Share Their Experiences

History was made two years ago when the Veteran's Health Administration began a program to accept chiropractic doctors as residents in VA facilities. A recent article in Dynamic Chiropractic is a joint interview with the inaugural class of 5 residents with 4 separate academic institutional affiliations: Logan University, Southern California University (SCU), University of Bridgeport, each with one resident, and New York College of Chiropractic, with two. The three male and two female chiropractic physician residents respond to questions on research, payment, reception in the VA, types of VA departments involved, and more. One, answering a question regarding the level of collaboration with other practitioners, concluded: "This system allows all providers the ability to view the patient through a whole-body approach, provide integrative treatment plans, and improve quality of care."

Comment: One of the early champions of the chiropractic-VA relationships was Reed Phillips, DC, PhD, presently the president emeritus of SCU. Phillips chaired many of the early chiropractic-VA collaborative committees. I recall him reflecting on those first meetings. To paraphrase: they started with people imagining each other with horns but in time, as humans met humans, horns retracted and the new partners began to think about how to best collaborate to better care. This process of prejudice being eroded by human contact seems to happen roughly 100% of the time. The happy conclusion from this non-scientific assertion might be that, for all the vitriol and bluster about the "quacks" on one side and the "medics" on the other, for most people the prejudice is shallow and quickly recedes.

Source for global IHM activity

John Weeks' GAHMJ Global Integrator Round-Up for July 2015

The Global Integrator Blog posts for June 2015 include:

• Indian Prime Minister Urged to a More "Integrative" Model for AYUSH Strategy
  
• Terrific SciDevNet Review of Issues as Traditional Medicine Meets the Modern World
• Italian Author Team Stakes Ground for Traditional Medicine in "Person-Centered Medicine"
• US CDC Head Frieden on Global Health Nightmares: Contributions From Indigenous Systems?
• South Africa's San People Find a Respectful Partner for Marketing a Sacred Herb
• Whole System Research: Survey on Naturopathic Practice Studies Published; and 
• Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for June 2015.

Is Your City One of the Most Zen in the United States?

The markers chosen were the number of yoga studios and alternative medicine businesses per 10 thousand souls in each city. Using data from Dunn & Bradstreet, FindTheHome and FindTheCompany created a "Zen-dex" through which they determined that the top 5, in order, were Boulder, Santa Monica, Santa Cruz, Encinitas and Santa Fe. Of the top 25, 8 more were from California (thus 11/44%).  The Easter Seaboard makes it first as number 11 (Bethesda), and includes a trio of Florida cities as well as Cambridge, MA and Ashville, NC. The West is the best, with 3 Washington state communities (Seattle, plus two of its suburbs, Kirkland, Bellevue) and two Oregon (Portland, Bend) on the top 25.

Comment: A more thorough accounting would probably add in some minuses. For instance, if the number of elective plastic surgeries were factored in as un-zen sorts of activities, Santa Monica would likely tumble. And if the length of the average workday, capitals overworked software engineers such as Palo Alto and San Francisco (Silicon Valley, etc.) and Seattle, Bellevue and Kirkland (Microsoft, Amazon, etc.) would likely fall from their perches.  "Zen and the Art of the 14 Hour Work Day" remains an unwritten book. That said, the list is a fun little exercise.

Misbrener: access to elders

"Crone & Sage School" Seeks to Create Sacred, Interprofessional Space for Integrative Practitioners

The Academy of Integrative Health and Medicine (AIHM) has an emerging structure through which to impart some of the wisdom of the field's elders. In this special article for the Integrator, AIHM writer and staffer Kelsey Misbrener writes on her experience with AIHM's "Crone and Sage School." AIHM is "an interprofessional membership and education organization committed to the transformation of health care on a global level." The Crone and Sage School are ceremonies that are part of the Academy's annual conference. "During these events," writes Misbrener, the wisdom of the elders is honored as they lead a group of healers to share in reflection and come together to celebrate our shared humanity and holistic heritage." The conference will be held this year on October 25-29 in San Diego, California. The theme is People, Planet, Purpose. The leading "crone" is the godmother of holistic medicine, Gladys McGarey, MD.



People

Westreich: well-deserved honor

Integrative & Hospice Strategist and Philanthropist Ruth Westreich Honored

"It's her passion for integrative therapies, for palliative care and really for hospice. She is an undying advocate for those kinds of programs." These were among the words used by Jill Mendlen, chair of the LightBridge Hospice Community Foundation, regarding Ruth Westreich who was honored at this San Diego function. Mendlin adds: "Ruth can be feisty and she doesn't mind being out there ‘fighting the fight' for people and that is part of what I love about her. She is real and genuine." Westreich, who runs the Westreich Foundation, is a long-time advocate and strategist for whole person hospice care, and integrative health and medicine.

Comment: Westreich has been at the leading edge of multiple developments in the field of integrative health and medicine. She's has past membership on the board of the Samueli Institute and with the Bravewell Collaborative, influence on Bastyr University's Southern California campus, and empowerment of such organizations as the Academy of Integrative Health and Medicine and the Academic Consortium for Complementary and Alternative Health Care. A professional artist herself, she's helped bridge the creative arts therapies and integrative communities. She recognizes that transformational influence will be most likely through expanded collaboration. Mendlin's quote is apt. Westreich will comfortably take what for others may be uncomfortable stances. Terrific to see her honored.

Goldblatt:ACCAHC co-CEO

Liza Goldblatt-Martha Menard Team Named to Co-Direct ACCAHC

Two long-time professionals in the integrative health and medicine space have been selected to co-direct the Academic Consortium for Complementary and Alternative Health Care (ACCAHC): Elizabeth A. (Liza) Goldblatt, PhD, MPA/HA and Martha Menard, PhD, LMT. Goldblatt is a leading educator in the acupuncture and Oriental medicine profession. She has been involved in interprofessional education and collaborative practice educational projects and activities since 1990 when she became president of Oregon College of Oriental Medicine. Author and researcher Menard, is also the director of the Crocker Institute, where she uses program evaluation as a means for helping nonprofit organizations, businesses, and institutions assess their outcomes and impact.

Menard: ACCAHC co-CEO

According to this ACCAHC media release, together they have over two decade of experience as volunteer leaders of ACCAHC. Goldblatt is an ACCAHC co-founder and served as board chair from 2008 until she was selected for her new position. Menard has held key roles as co-chair of the organization's Research Working Group and as chair of the organization's task force on integrative pain treatment through which she had the lead role in the Never Only Opioids policy brief. Goldblatt has twice served on Institute of Medicine committees on behalf of the organization. They replace the present writer, John Weeks, who held the position starting from January 2007-June 2015.

Comment: ACCAHC's 17 North American organizational members across 8 professions, and 40 college/university members. These descriptors make it a one-of-a-kind organization to manage and grow. Add to it that some 80% of its revenues are soft money and that challenge can feel Herculean. My shoulders have lightened substantially since the June 30, 2015 transition. I was very happy when I learned that these two had come forward to apply for the position and were willing to shoulder the heavy lifting. I wish the best to them, the ACCAHC staff, and the rest of the ACCAHC teams and its network of over top-flight 100 volunteers. I am pleased to continue involved in a minor way as a retained consultant on a couple of projects including partnering with Goldblatt at the IOM Global Forum on Innovation in Health Professional Education.

Snider: Vis Award

AANP's Annual Naturopathic Physician Awards to Snider,

Murray: Lifetime Achievement

The AANP's "Champion" award, given to a non-ND who has meaningfully assisted the profession, went to David Schleich, PhD, the visionary president of National College of Natural Medicine. Schleich previously played a major role in lifting the Canadian College of Natural Medicine toward its present health while serving as president there. The "President's Award" that is selected each year by the AANP president - in this case former Washington States Association of Naturopathic Physicians' president Kasra Pournadeali, ND, went to one of Pournadeali's predecessors at WANP, Daniel Labriola, ND. Labriola had the central role in creating the first modern naturopathic licensing statute in the mid-1980s and subsequently became known nationally for work in integrative oncology. He is director of integrative ser4vices for Swedish Medical Center and Seattle Children's Hospital. 

Parker: Physician of the Year

Comment: Great crop this year. Time will show Snider to be as the Queen of the Vis once the long-awaited life-work of the Foundation's textbook comes out.  The sky's the limit for Parker who has already been recognized by Utne Reader as a visionary.  Schleich has done nothing less than take the risks to guide both CCNM and NCNM through periods of tremendous expansion. His commitment to the field is profound. Labriola provided critical foundational mark and has since, through a conservative approach to his field, built bridges with many institutions that likely could not have otherwise been built.