background resources in PDF |
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some CAM/IM publication links |
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Casey Health Institute: Marrying Integrative Health and Values-Based Medicine |
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Written by John Weeks
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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:
.jpg) 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."
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"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."
David Fogel, MD
Casey Health Institute
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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!
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