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Taylor Walsh: ACCAHC, Integrative Health and the Path to Patient-Directed Transformation PDF Print E-mail
Written by John Weeks   

Taylor Walsh: ACCAHC, Integrative Health and the Path to Patient-Directed Transformation

Summary: Integrator adviser and columnist Taylor Walsh was a guest at a daylong training to help leaders in integrative health disciplines become better ambassadors for integrative health to the mainstream community. The training was developed by the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). Walsh subsequent reflected on ACCAHC's work and published a piece entitled "Multiple Paths to Patient-Directed Health Care Transformation" in the mainstream Altarum Institute Health Policy Forum. Walsh approved my re-posting it here.
Taylor Walsh: translating between the mainstream and integrative health communities
Based in Washington, D.C., Integrator columnist Taylor Walsh combines two passions that have proved of immense benefit to Integrator readers. He sees the importance of transformation of our medical system and the value of integrative practice philosophies and models in that process. In addition, Walsh has an old-fashioned passion for Beltway politics. His coverage of policy developments for the Integrator have proved particularly useful.

I invited Walsh to an afternoon-evening leadership training program sponsored by the
Academic Consortium for Complementary and Alternative Health Care (ACCAHC) in part because while he is in the integrative world, Walsh is not entirely of it. Or perhaps it is that while Walsh is of it, he is not entirely in it. What would his perspective be on ACCAHC's efforts to model leadership that creates space for the integrative health values and disicplines in pat through breaking down guild silos? Walsh regularly translates between the mainstream and integrative health communities through such venues as the Altarum Institute Health Policy Forum, where he writes regularly. This article was originally post on this Altarum site.  Walsh approved my request to re-post.


Multiple Paths to Patient-Directed Health Care Transformation

Taylor Walsh
Consultant, Entrepreneur and Writer on Digital Media & Integrative Health
Washington, D.C.
Integrative Health & Wellness Strategies

Twitter: @taylorw

The path to a Consumer-Directed Health Care (CDHC) has been fairly well laid out. The path to a patient-directed health care transformation is much harder to discern. But the path is there all the same. It is a route that takes one into whole person health, integrative medicine, complementary and alternative medicine (CAM), mind, body and spirit, functional medicine and chiropractic, among other traditions of care and healing practice that continue to draw the public's interest, investment and adoption. Importantly, it also is building new forms of professional links between the practitioners in these fields and those in conventional medicine.

"ACCAHC has steadily aligned the CAM disciplines
on the belief that the only way to truly improve care
will be through better, much deeper professional
relations and collaboration."

Although without an acronym, or t-shirts, an integrative whole person health enterprise has been forming around the maturation of the specific disciplines of practitioners who work in CAM and integrative health fields. In the last couple of years, the most representative organization for those disciplines, the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), has steadily aligned the work of those disciplines with other groups in health and medicine who are starting to act on the belief that the only way to truly improve care will be through better, much deeper professional relations and collaboration.

ACCAHC's disciplines are linked to more than 300,000 of those integrative practitioners, through their professional and educational institutions of naturopathy, chiropractic, homeopathy, traditional Chinese medicine, midwifery and massage therapy. (The current list of member organizations is here). Their licensed members serve the vast majority of those 30 million-plus people every year that the National Institutes of Health (NIH) has estimated who make use of CAM health options.

ACCAHC leaders met in October 2012 in Washington where among other things they re-asserted the organization's mission:
"... to enhance the health of individuals and communities by creating and sustaining a network of global educational organizations and agencies, which will promote mutual understanding, collaborative activities and interdisciplinary health care education."
This mission dates to ACCAHC's formation in 2004, first as a project of the Integrative Healthcare Policy Consortium (IHPC).  IHPC had organized the "National Education Dialogue to Advance Integrated Health Care: Creating Common Ground," in concert with leaders of the now-51-member Consortium of Academic Health Centers of Integrative Medicine, which includes the nation's leading medical schools. By 2005, the Institute of Medicine's (IOM) Board on Health Promotion and Disease Prevention published a report entitled "Complementary and Alternative Medicine in the United States." In part the report reads: "The goal of integrating care should be the provision of comprehensive care that is safe and effective care, that is collaborative and interdisciplinary, and care that respects and joins effective interventions from all sources."

A few recent examples illustrate both the initiatives that the ACCAHC leadership has taken to pursue the agenda that falls out of its mission statement and IOM's emphasis for inclusion of "all sources." They also reflect the receptiveness by conventional care organizations that are also pursuing better cross-professional relationships and collaboration.

  • Early this year, ACCAHC became a co-sponsor of the IOM's three-year Global Forum on Innovation in Health Professional Education, which involves 30 councils of colleges and professional associations from medicine, nursing, public health, pharmacy and other disciplines, including the American Medical Association and the American Association of Medical Colleges. ACCAHC's goal here is to: "Explore innovations associated with graduating students who are expert in assisting individuals and communities toward wellness, self-care, personal empowerment, prevention and health promotion."
  • The Pain Action Alliance to Implement a National Strategy (PAINS) is a national collaboration of groups devoted to addressing the persistent problem of chronic pain that was most recently addressed in the June 2011 IOM report, Relieving Pain in America.  ACCAHC is among more than 40 participating institutions, including the American Cancer Society, the American Academy of Pain Management and American Academy of Family Physicians. PAINS was organized by the Center for Practical Bioethics. Click for more details
  • A new National Coordinating Center for Integrative Medicine (NccIM) was created this fall by the Health Resources Services Administration (HRSA) when it awarded a cooperative agreement to the American College of Preventive Medicine (ACPM). ACCAHC was a partner on ACPM's grant proposal and is represented on an NccIM advisory group (as are two other integrative health leaders). NccIM will oversee 12 concurrently awarded integrative medicine grants for preventive medicine residencies. ACPM wrote that its goal for the NccIM "is to create, convene, administer and sustain a Community of Learning for integrative medicine  and preventive medicine that includes partners in preventive medicine training, primary care, other health professions such as nursing, dentistry, and pharmacy, and complementary and alternative medicine practitioners from a wide variety of practice modalities."
  • When the NIH body charged with research into CAM therapies, the National Center for Complementary and Alternative Medicine (NCCAM), produced its five -year strategic plan in the fall of 2011, it acknowledged a reality of the street that had long been omitted from its research agenda: "CAM practitioners," it reported, "are the key holders of knowledge related to the potential application of CAM interventions and disciplines." ACCAHC educated NCCAM on the importance of the essential clinical experience attained by practitioners and how it should be embodied in NCCAM research.

ACCAHC's involvement in these initiatives continue to formalize recognition of the value of the patient experience in all of health care, and in particular the care that has sustained the practitioners in integrative and CAM fields, many for more than a generation. This is evident in particular in the growth of the well-established undergraduate and graduate educational institutions in the field that are recognized by the U S. Department of Education, their professional organizations that set licensure and professional standards, and the increasing collaborations such as those listed above.

ACCAHC's emphasis on and initiatives around collaborations in health education are mirrored elsewhere in medicine, as in the inter-professional education movement among the major medical disciplines, including physicians and nurses. In 2010, the American Interprofessional Health Collaborative was formed to respond to health conditions for reasons similar to those that informed the ACCAHC mission:
"Health profession education remains isolated from practice realities, and profession-specific learning does not prepare future and current health professionals for working together. We must transcend boundaries to connect ‘traditional' health professions, educators, new and emerging health and care providers, care coordinators, administrators of health care delivery and payment systems, and policymakers in partnership with patients, communities and populations."
ACCAHC's Executive Director John Weeks has been a tireless advocate for encouraging the CAM disciplines themselves to look beyond the confines of their own silos, or guilds as he refers to them, to sustain the broadest health choices available to patients and consumers.

"A practitioner or organization that embraces patient-centered care,'" he told me, "must include all the provider types that patients are choosing in developing the health care teams for today and tomorrow.  Patient-centered is not guild-favored. Nor is it evidence-centered. It is patient-centered and that means inclusion. Happily, more people in the inter-professional education movement are getting this and wrestling with the challenges."

Weeks also observes the influences of financial realities that resulted in the provisions of the Affordable Care Act to imbue cost-saving incentives in Accountable Care Organizations and Patient Centered Medical Homes. "It took the economic incentive really to finally move the system toward collaboration," he said in an interview in Health Insights Today earlier this year.

Weeks also noted: "There is now an ethical basis around patient-centered care which the inter-professional education movement says is at its core ... if somewhere between 40 and 60 percent of people with chronic conditions are exploring alternatives, then having the providers at the table who are most expert in those alternatives is the most patient-centered choice."

  "As traditionally distanced professionals
start to sit down together, the complementary
efficacies of their combined experience will
continue a patient-centered health transformation
that until now has been hard to see from
one silo or guild to the next."

The patients among that "40 to 60 percent" have been gravitating to integrative and CAM alternatives for two decades. Large and serious care institutions, notably U.S. military and Veterans health systems, are increasingly sold on their viability. For example: the military's primary research partner in integrative medicine, the Samueli Institute of Alexandria, VA, has conducted many projects since 2001 using acupuncture, therapeutic yoga, massage and other modalities to address combat-related and chronic pain, PTSD, and traumatic brain injury among other conditions. Earlier this year, the VA established a new Office of Patient-Centered Care and Cultural Transformation and appointed Tracy Gaudet, MD its first director.  She had been director of Duke Integrative Medicine, one of the nation's leading medical-school-affiliated clinical integrative centers.

In this sense, health improvement is coming not only from the admin efficiencies of access to Health and Human Services data or networking M.D. offices, but from responding to positive patient experiences with whole person health approaches that are shared among the integrative and CAM disciplines, no matter their silos.

Weeks, who participated in the IOM's Global Forum on Innovation in Health Professional Education with ACCAHC Chair Liza Goldblatt, Ph.D., M.P.A./H.A. recalled the exhortation of forum participant George Thibault, M.D., the C.E.O. of the Josiah Macy Foundation, who said that he "... and other IPE leaders must ‘widen the circle' and beware to not to ‘create a new elitism' among a few professions."

As traditionally distanced professionals start to sit down together, the complementary efficacies of their combined experience will continue a patient-centered health transformation that until now has been hard to see from one silo or guild to the next.

 Comment: Nice the way Walsh pegged his reflections to the general movement in medicine toward "patient-directed health care transformation." For most in the integrative health fields, this linkage is
a no-brainer for any "patient-centered" endeavor whether this shows up in the aspiration of a hospital, a medical home, an interprofessional education initiative or a research organization. After all, these disciplines grew up out in the wilds of patient choice, rather than inside of the academic and mainstream delivery organizations that are presently trying to find their way back to the patient. Perhaps one day the inclusion will not be merely begrudged as consistent with the "patient-centered" language but actually affirmatively embraced as an opportunity to see and explore what the patient, unguided by mainstream medicine, has chosen, and co-created.

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