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Update: IHPC, Others, Place CAM, Integrative Practices/Care in US Health Reform Legislation PDF Print E-mail
Written by John Weeks   

Update: IHPC, Others, Place CAM, Integrative Practices/Care in US Health Reform Legislation

Summary: US Senator Bernie Sanders (Ind.-VT) and the Integrated Healthcare Policy Consortium (IHPC) have placed "licensed complementary and alternative medicine providers and integrative health practitioners" in the Kennedy-HELP bill's definition of health professionals. This is not the only mention of "complementary and alternative medicine," or "integrative care" or "integrative practitioners" in the bill however. The Samueli Institute's vice president Brian Thiel guides us to other mentions in the Kennedy-HELP draft legislation. These are in sections the establish a "wellness council" and on the medical home. Small steps, maybe; but signs of prospective integration into US healthcare policy. Do you know of other similar advances? Let me know.
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IHPC: Persistence in relationship building lead to results
The steps indicated here may seem small, if what one seeks is a significant transformation of US medicine during the current iteration of US health reform planning. Yet there are undeniable signs showing up of the potential inclusion of integrative medicine, integrative practices and licensed complementary and alternative medicine practitioners in federal health policy in the United States. Credit the persistence in relationship-building of such groups as the Integrated Healthcare Policy Consortium (IHPC) and allies such as US Senator Bernie Sanders (Ind.-VT), Tom Harkin (D-IO) and Barbara Mikulski (D-MD) for making it so. Of course, the legislation has a long way to go.  

1.  Integrated Healthcare Policy Consortium and Sanders team to place licensed CAM in US Senate-HELP bill

US Senator Bernie Sanders - agent of change
US healthcare's table may formally have a few new chairs if the definition of "health care professionals" offered by US Senator Bernie Sanders remains in a US health reform package. The inclusive language change, promoted by the Integrated Healthcare Policy Consortium
inserted ‘‘licensed complementary and alternative medicine providers and integrative health practitioners" in the definition of health professionals included in the healthcare workforce. As of June 24, the language that begins at the bottom of page 445 pf the Kennedy-HELP Committee's Affordable Health Choices Act reads:
"(2) HEALTH PROFESSIONALS.—The term ‘‘health professionals’’ includes— (A) dentists, dental hygienists, primary care providers, specialty physicians, nurses, nurse practitioners, physician assistants, psychologists and other behavioral and mental health professionals, social workers, physical therapists, public health professionals, clinical pharmacists, allied health professionals, chiropractors, community health workers, school nurses, certified nurse midwives, podiatrists, licensed complementary and alternative medicine providers, and integrative health practitioners [bold added]."
IHPC's executive director Janet Kahn, PhD
Janet Kahn, PhD, IHPC's executive director, shares with the Integrator that she was told by Sanders' staff that the amendment passed unanimously on a voice vote. The staffer noted to Kahn that "(IHPC's) message
has gotten to all the members of the HELP committee, Democrats, Republicans and Independent." Among the IHPC's key backers are the National Certification Commission for Therapeutic Massage and Bodywork, American Massage Therapy Association, National Center for Homeopathy, Bastyr University and a group of acupuncture and Oriental medicine colleges.
Comment: Senator Sanders' support of integrative practices goes back many years, including a statewide conference on complementary and alternative medicine he hosted in January 1996 when the public dialogue was just beginning. All of Vermont's leading healthcare authorities basically had to show and rub elbows with the unwashed, given Sanders' clout in the state. IHPC's Kahn happens to be a Vermont resident and associated faculty at the medical college at the University of Vermont, which helped IHPC's effort. The entire integrative practice community owes a note of thanks to the IHPC for hanging in there - and perhaps increased participation! Of note here: the chiropractors, US health care's limbo profession, has secured a place in the list on its own, not surprisingly. A note to members from the American Association of Naturopathic Physicians announced plans to seek to get their profession independently mentioned as well.

2.   Samueli Institute's Thiel: Other CAM and integrative care/integrative practice references in the Kennedy-HELP

After interviewing Samueli Institute's vice president Brian Thiel on the progress of whole systems wellness in health reform language (see Samueli Institute's Thiel on Wellness Provisions in US Senate Health Reform Legislation, July 10, 2009
), I asked Thiel if he knew of other places in the bill where "integrative medicine" or "complementary and alternative medicine" or anything related were mentioned. He wrote back with a short but "not necessarily exhaustive list." 

Inclusion in Medical Homes
In SEC. 212 (page 260). GRANTS TO ESTABLISH COMMUNITY HEALTH TEAMS TO SUPPORT A MEDICAL HOME Under "Eligible Entities" for receiving these grants, the draft legislation states that the "State of State-designated entity" which would receive the grant must:
"ensure that the health team established by the entity includes a multidisciplinary, inter-professional team of providers, as determined by the Secretary; such team may include specialists, nurses, nutritionists, dieticians, social workers, behavioral and mental health providers, licensed complementary and alternative medicine practitioners [bold added]."
Samueli Institute's Brian Thiel
The "requirements for health teams" in the same section also includes the need of the priospective grantee to offer a "whole-person orientation" and "coordinated and integrated care" among these diverse practitioners (page 260, line 25). In the same section on page 262, the prospective grantee is also required to include practitoners across a wide spectrum including "integrative health care practitioners." The language reads:
"(F) provide local access to the continuum of health care services in the most appropriate setting, including access to individuals that implement the care plans of patients and coordinate care, such as integrative health care practitioners [bold added]."

Integration into the responsibilities of the National Prevention,
Health Promotion and Public Health Council

In SEC. 301. NATIONAL PREVENTION, HEALTH PROMOTION AND PUBLIC HEALTH COUNCiL. This section, which the Samueli Institute and Thiel were involved in shaping, proposed the development of a whole-systems, broad-based, multi-agency wellness council. (See Samueli Institute's Thiel on Wellness Provisions in US Senate Health Reform Legislation.) The mention of "integrative health care" is listed in the first paragraph, which describes the Council's "Duties."
"DUTIES.—The Council shall— (1) provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care [bold added] in the United States." (page 348)
Further down in the same section, the bill describes the responsibility of the Council to develop a NATIONAL PREVENTION AND HEALTH PROMOTION STRATEGY. The components of the strategy are many. The report, to be filed by July 1, 2010, would include the requirement to:
"(4) make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health care practices [bold added] to ensure Federal efforts are consistent with available standards and evidence."
Notably, Thiel was not yet aware of the Sanders changes, which suggests that there may yet be other mentions, and certainly are of chiropractic, which is already more thoroughly included in federal policy than most of the licensed disciplines considered CAM.
Comment: Thank you, Brian and the Samueli Institute for being on top of things! I am not sure who may have been speaking to the Senators and their staff to have placed this language, though I was informed by Nancy Gahles, DC, CCH, RSHom, president of the National Center for Homeopathy, that she was aware that the medical home language was under consideration. (If any of you know more, let me know!) Certainly, "integrative care" Or "integrative practices" are phrases that can easily be used to describe care which integrates, but does not necessarily include integrative medicine or complementary and alternative healthcare practitioners or modalities. The phrase creates an opening; and regardless of its inclusiveness, is a positive sign of a direction in the movement the medical home movement is taking. Do let me know if any of you know of additional language in this or other bills.
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