Casey Health Institute: Marrying Integrative Health and Values-Based Medicine

Note: This article was first published in the June 2015 Integrator Round-up. It is highlighted here as part of a recent partnership between the Project for Integrative Health and the Triple Aim (PIHTA) and the Casey Health Institute (CHI) for which the Integrator is providing media support. The goal of the PIHTA-CHI partnership is to stimulate understanding of integrative primary care medical homes (PCMH) via a multi-faceted look at the model CHI is creating. PIHTA is an initiative of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).

Other articles in the series:

• Cory Jecmen, MAc, LAc: An Acupuncturist/Tech Player in Casey Health Institute's Integrative PCMH (October 2015)
  
• Speed-Dating: A Casey Health Institute Method for Building a High Performing Interprofessional, Integrative Team (September 2015)
  
• Casey Health Institute Announces an Integrative Health Care PCMH as an Evolving Model of Practice (May 2012)

Pioneering an integrative PCMH

The co-founder of Casey Health Institute (CHI), David Fogel, MD, recently shared with the Integrator that the Gaithersburg, Maryland-based integrative center has now "met almost all of the criteria for a Level 3 PCMH." By the fall of 2015 the Center will employ four primary care integrative medical doctors, one nurse practitioners, two licensed acupuncturists, one naturopathic doctor, [two psychologists ("we do a lot of mindfulness, and mind-body work"), a full time Reiki master/massage therapist, a full-time Yoga therapist, a full-time nutritionist, and a full time nurse care coordinator. 

In addition, the not-for-profit 501c3 health center has "just signed up to become part of a Medicare ACO" (Accountable Care Organization). In the ACO, CHI will join with 5 other non-integrative primary care practices. Adds Fogel: "We're spending enormous time and effort to get highly-coordinated processes down to operationalize true collaborative, integrative health."

Fogel believes that following this strategy will lead to a quantum leap in evidence to support integrative care: "I think a lot of integrative practitioners are focused on proving that each individual modality is valid. 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." One hold-up in CHI in proving integrative health's value in the context of outcomes-oriented PCMH's and ACOs has been the quality of electronic health records as a collaborative tool. Recalls Fogel: "Our first EHR (Electronic Health Record) was a disaster. It set us back almost a year in many ways."  

The Center is, as Fogel asserts, "one of the few IH settings that accepts all major insurance, Medicare, Medicaid, and charity care." He notes that CHI has "a charity care policy that is based on federal poverty guidelines and includes all modalities." As a result, he says, "the clinic has a bi-model population with some patients very familiar with integrative medicine and others with no knowledge of anything integrative and we are teaching about integrative health from square one."

Co-founders: David Fogel and Illana Bar-Levav

Attracting patients never has been an issue says Fogel: "We have gone from zero to 3000 patients in two years. The challenge has been how to handle the demand: front desk, telephone, electronic health record, and creating high-functioning teams." Fogel, who with his spouse Ilana Bar-Levav, MD, CHI's FIRST COO, spent a great deal of time researching the national landscape for models prior to developing CHI, observes: "The majority of people in integrative medicine appeared to place little emphasis on the power of marrying team-based integrative collaboration and population health strategies." 

Comment:  Fogel and Bar-Levav and their team are clearly in the trenches. They don't have much company, unfortunately. As part of the Project for Integrative Health and the Triple Aim (PIHTA), my colleague Jennifer Olejownik, PhD, has been developing a resource list on integrative PCHMs.  From what Olejownik has discovered, some of Fogel's closest colleagues in this work may be PCMHs directed by naturopathic physicians. One is the Level 3 PCMH Center for Natural Medicine in Portland, Oregon, run by Martin Milner, ND, another the Burlington, Vermont Mountain View Natural Medicine founded by Lorilee Schoenbeck, ND, also a Level 3 PCMH. A third is that overseen by Regina Dehen, ND, LAc the chief medical officer at National College of Natural Medicine who is seeking to turn that center into a PCMH. Both Fogel and Dehen are part of a June 17 PIHTA webinar entitled If I Ran the Zoo: Quality Measures in Accountable Care and the Fit with Integrative Health and Medicine.

Fogel's assumption and assertion is spot on: the best way for integrative care to make a quantum advance in the evidence game is to bypass the proof of individual modalities and go straight to the real world competition between PCMHs on accepted quality measures. There is evidence from a late 2014 PIHTA survey that that the business of medicine's move to values-based care from a production-based medical industry is creating more alignment with the patient-centered, functional outcomes interest in integrative centers. Here's looking forward to CHI's report(s) of the outcomes. Meantime, in the upcoming July 2015 Round-up: how "speed-dating" is serving CHI's effort to create high performing teams. Stay tuned!