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Casey Health Institute Announces an Integrative Health Care PCMH as an Evolving Model of Practice PDF Print E-mail
Written by John Weeks   

Casey Health Institute Announces an Integrative Health Care PCMH as an Evolving Model of Practice

Summary:  The elements are these: a philanthropist in the nation's Beltway with an interest in integrative medicine, her faith in an integrative-minded physician, and an opportunity to occupy a large building site near a medical corridor. Such was the opportunity offered by Betty Casey to David Fogel, MD in 2010. In this article by long-time integrative health leader Alan Dumoff, JD, MSW, a consultant to the project, readers have a chance to see the decisions 2010-2012 via an array of consultations in a cross-country exploration of best practices. Their decision was to develop the new Casey Health Institute as a model patient centered medical home (PCMH) that could influence developments across the country as the PCMH model expands. There is a position open, by the way, for a top-notch medical director. See the job description at the bottom of Dumoff's article.

Between the ages of 11-13,
I had a thing for architecture. I developed elaborate plans for two homes, one with a basketball court, reflecting my actual ruling passion of the time. The pleasure of dreaming big onto a blank slate, incorporating one's favored elements, is among life's best offerings.

Fogel and Bar-Levay: opportunity and responsibility
Such an opportunity, and responsibility, was handed to integrative physician David Fogel, MD and his spouse,
Ilana Bar-Levav, MD, two years ago by philanthropist Betty Casey and the Eugene B. Casey Foundation. Casey proposed to them that they develop a major integrative center. She promised substantial backing. They were to fill in the piece, with this caveat: the integrative clinic would need to be housed in a 65,000 square foot office building that she owned in Gaithersberg, Maryland.

Here is the story of the journey from Alan Dumoff, JD, MSW, a long-time consultant and leader on integrative medicine legal issues and clinical care strategies. Dumoff consulted with Fogel on Bar-Levav on the project. (Disclosure note: Through Dumoff, I was also involved in early discussions in 2010.) Here is a portrait of the model they developed.
What do you think? At the bottom is a job description for a medical director. Interested? Know anyone who might be a fit? This initiative has the potential to be a significant beacon for integrative medicine. 

The Casey Health Institute Integrative Health Care Announces
Patient-Centered Medical Home as an Evolving Model of Practice

Integrative Medicine Director Sought

Coming to Suburban Washington, D.C. in the Spring of 2013

- Alan Dumoff, JD, MSW ( )

Alan Dumoff, JD, MSW
"Integrative care" has carried many meanings; functional medicine delivered by MD's, the varied work of complementary and alternative medical (CAM) practitioners, or to the elusive ideal of team-based, collaborative care central to many of these visions. Truly collaborative care has been quite elusive in practice, however, because business models have difficulty sustaining it. Meanwhile, mainstream medical practices, in partnerships with insurance companies, have been developing Patient Centered Medical Homes (PCMH) as a model for delivery with better payment that emphasizes coordination of services and preventive care.

Integrative care and PCMH models share a common core value of patient-centered care, and while they arise from different worlds, may be a natural fit. Will delivering integrative, team-based care in a PCMH model bring a workable business model to collaborative care? The Casey Health Institute (CHI), scheduled to begin offering services in the Spring of 2013, intends to demonstrate that this is the case.

The Development of CHI

In 2010, Mrs. Betty Casey, a philanthropist and long time supporter of Integrative Medicine, approached Maryland physician, David Fogel, MD, to help realize her vision of creating an Integrative Health Center in Gaithersburg, Maryland. Prerequisite to leading the project, Dr. Fogel, together with his wife, Ilana Bar-Levav, MD, organized a team of health care professionals to travel the country researching a broad range of sustainable Integrative Health Care models. I was privileged to participate, and we were able to visit a number of successful integrative centers as well as leading lights in the field, including John Weeks.

This effort led to a plan that, through the generosity of Mrs. Casey and the
Eugene B. Casey Foundation, led to establishing The Casey Health Institute (CHI), a public 501(c)(3) not-for-profit. In addition to funding for the project, the Foundation gifted a 65,000 sq. ft. office building that will be a home for other integrative practices, and related services and products, cooking classes and an healthy foods eatery.

The Patient Centered Medical Home

Developed over four decades by the American Academy of Pediatrics and the American Academy of Family Practitioners (AAFP), the PCMH is an approach to comprehensive primary care that emphasizes partnerships between individual patients, families as appropriate, and their personal physicians. The team collectively takes responsibility for each patient and coordinates care among the often complex system of subspecialists, hospitals, home health agencies, nursing homes and the array of community-based services. Health coaches and navigators are integral to the team. Cutting edge technology facilitates information exchange and communication between patient and practitioner and simplifies and assures better follow-up on immediate needs, health goals, and preventive care.

Philanthropist Betty Casey
A New Kind of Doctor/New Kind of Team

This model lends itself to a whole systems approach to care; the next step is to populate it with practitioners that can offer the best available therapies.

Integrative medical physicians have become identified with either taking on CAM methods themselves or developing esoteric therapies that may have gotten ahead of the evidence. CAM practitioners most often practice in isolation. CHI believes that the professions should bring evidence-based expertise to the same table and that best care emerges from the competency and involvement of the team.

CHI will bring well-trained physicians cross-trained in a range of evidence-based CAM side-by-side with skilled CAM practitioners, including acupuncture, chiropractic, nutritional medicine, massage therapy, yoga therapy, as well as allied professionals such as nurse practitioners and physical therapists.

The Integrative Medicine Team Room

Multidisciplinary weekly case conferences will provide the formal venue for collaboration, but for CHI, this is not enough. The Integrative Medicine Team Room is a carefully designed setting where all practitioners "live" and work together. The unique interactive space design will foster cross-disciplinary discussion and consultation.

The Shared Medical Appointment

The Shared Medical Appointment (SMA) is an exciting model of prompt, easy access to one's personal physician and health team for both chronic and acute illness. In a safe and confidential group setting, the SMA gives the patient prolonged face time with their doctor, less waiting, and access to the support and validation from others with health issues.

Among patients who try these voluntary meetings, there is enthusiasm and a documented high return visit rate. SMA's reduce the isolation of chronic disease and the stigma of illness through emotional support and positive modeling between patients. The model is endorsed by the AAFP and is increasingly being used at major centers like Harvard Vanguard and Kaiser.

Community Services and Research

CHI will also be community focused and offer health services for many segments of the community, and have an active research department that will explore medical and economic outcomes associated with a wide range of integrative approaches.

An Opportunity for a Unique Physician:
CHI is looking for a Medical Director

CHI is actively seeking a medical director versed in IM who has PCMH experience:

CHI is seeking an innovative Medical Director and practicing primary care physician to join us on the ground floor of newly established Integrative Health Care Institute combining traditional allopathic medicine with Complementary and Alternative Medicine (CAM) in the setting of a primary care-Patient Centered Medical Home (PCMH).

Opportunity for a physician with vision to become a key leader on our core clinical team.  Experience implementing and practicing within a PCMH is important.  Position requires creativity and leadership by an adept manager who is well versed in EHR, enjoys patient interaction, and thrives in a team approach to the practice of medicine.

The first 6 to 9 months will be 100% implementation of a well structured business and medical model.  We are projected to begin seeing patients March 2013, at which time the position will become 80% clinical and 20% administrative.

Health Center Description

The Casey Health Institute (CHI) is a fully funded 501 (c) 3, public, not- for-profit, clinical Health Institute. Interested candidates should send a cover letter, curriculum vitae, and list of references to:

Barbara Gallagher

Casey Health Institute
7920 Old Georgetown Road
Bethesda, Maryland 20814
301 664-6464

Comment: When I first heard of the opportunity presented to Fogel, I was something akin to envious. What an opportunity to have such significant funds be made available to advance integrative medicine. I immediately began in my mind to dispense fractions to the causes and initiatives that I knew could most flourish with a nice bit of fuel injection. Then I learned that the offer to Fogel was attached to the building. Waves of memories of large integrative "build-it-and-they-will-come" failures washed over me. Jealousy turned to fear. Gawd, what a challenge! What a responsibility! How much easier to comment from the side-line ...

I like the elements Dumoff lays out. Fogel's base in the psychological and mind-body parts of integrative are great at the mission level. Ultimately we need people to be engaged in their own healing practice. I'd rather the use of groups pioneered beyond the "Shared Medical Appointment" as modeled by Group Health Cooperative and others. Someone needs to maximize exploration of the value of the clinical use of groups in behavior change and health creation. I hope the Casey initiative will move in that direction. That Dumoff is there is good. Under his MSW, Dumoff has been a steady advocate for thorough exploration of optimal use of teams.

I remain nervous for them. Most who run integrative centers will likely share my sentiment. I know that Fogel has been in touch with the Bravewell Collaborative and hope he has an advisory council from the Bravenet group regularly informing him, and Bar-Levav, of best, and worst, practices.

The elements and approach that make the Casey Health Institute an exceptional candidate for modeling the best of integrative care in a patient-centered medical home environment. This is where CHI has the opportunity to be have the most impact on the future of health care in the United States. Exciting business. Now who is it will drop everything to step into the medical director role? 

Side note: Integrative medicine makes for strange bedfellows. Fifteen years ago, I learned with surprise that the money for a pioneering, still standing, large integrative center
in Boston was funded by the man behind Boston's famous public works boondoggle, the Big Dig. Then there was the discovery that chief forces behind the Bravewell Collaborative were none other than the spouses of the chairman of Morgan Stanley and past chair of Medtronic. Meantime, the former House co-chairs of a former Congressional Caucus on CAM were Indiana's Dan Burton and Ohio's Dennis Kucinich. The former, in my father's favored phrase, is "to the right of Atilla the Hun," while the latter is to the left of everyone else then in Congress. My internet research for this story suggests that Casey should be added to this odd, composite Mount Rushmore of integrative medicine backers. She appears to be a huge Rush Limbaugh champion. Health issues cross all party lines. Thanks Mrs. Casey, for creating the opportunity that is CHI.

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