"If we can show that we have better outcomes and it's cheaper to take a functional approach, in the end, the doctors who adopt this model -- and their patients -- they will be the ones who win."
This is Institute for Functional Medicine (IFM) president Mark Hyman, M.D., interviewed in a June 2014 article in the widely read political blog The Daily Beast. Hyman mentions that he was working with the Cleveland Clinic to create a program there in functional medicine.
On September 15, 2014, an article in Crain's Cleveland Business propelled news of this pioneering program nationally. The move by the highly-regarded Cleveland Clinic is not merely a dabbling in functional practices. Rather, it's a full partnership with IFM. According to the release from the Cleveland Clinic, IFM's chief medical officer Patrick Hanaway, M.D. will be on the ground in Cleveland with best-selling author Hyman also serving in leadership.
The Crain's article notes that plans for the center include a strong research focus. The partners will engage four clinical trials focusing on the treatment of asthma, inflammatory bowel disease, Type 2 diabetes and migraines.
Cleveland Clinic CEO Toby Cosgrove, M.D. positions the move as "not a departure for Cleveland Clinic, but a continuation of the innovative, holistic approach that we have embraced." He noted that that Clinic already has a Wellness Institute, Center for Integrative Medicine, the Center for Personalized Healthcare and a Chinese herbal therapy clinic.
I asked integrative center consultant Glenn Sabin for his perspectives. He called the IFM partnership "potent." He particularly noted the roles of Hanaway and Hyman. He wondered at the clinical and business model: "I can only surmise that a whole system, non-reductive approach is the direction they are headed."
Sabin then raised some questions about the intersection of typical functional medicine business practices with the Cleveland Clinic culture. He noted that in Hyman's private clinic an office visit with the doctor to the Clintons can run pretty steep. It's $1,500 for 80 minutes with Hyman. Fifty minutes with a nutritionist will set you back $240. Hyman's clinic does not accept insurance. Hyman's business model also includes profiting from supplement sales, from which he donates a portion for functional medicine research.
Sabin adds a further question: "How deep will Cleveland Clinic go in terms of embracing a model of comprehensive functional labs looking at biochemical milieu to inform recommendations of well-placed nutraceuticals." Such lab work-ups can also be quite expensive for patients even as are the bags of natural medicines that are typically part of functional medicine therapeutic regimes.
Notably, at the Cleveland Clinic, all providers are salaried like at Mayo Clinic, and the staff model health maintenance organizations like Seattle-based Group Health Cooperative. These organizations with employed physicians routinely generate some of the best outcomes in primary care in U.S. medicine. In this model, says Sabin, "the focus is where it needs to be: squarely on health creation and patient outcomes."
Despite the questions, Sabin thinks that for the integrative health and medicine community the Cleveland Clinic partnership with IFM means that "we have reached the tipping point."
It's interesting to juxtapose Sabin's "tipping point" with Cosgrove ho-hum placement of the IFM partnership as merely making a full house of four prior initiatives. The clinic, like functional medicine itself, co-habits an evolving organized medical environment that is increasingly populated by initiatives in wellness, personalized medicine and integrative medicine. (The widely reported engagement with Crane on that firm's compounding of Chinese herbals remains a clear stand-out.)
That Cleveland Clinic's leadership in embracing functional medicine may be influenced by its employed physician model is astutely noted by Sabin. Such a model creates separation from the self-serving focus on producing services that presently dominates the $2.8 trillion U.S. medical industry. A focus on health, wellness and functionality comes more readily into focus if one hasn't the perverse incentives to produce sick care procedures.
Tests, supplement sales and sky-high office visit prices can be a functional medicine practitioner's answer to how he or she can make a good living when their main procedure is the whole person evaluation and management of the patient.
Yet unless Cleveland Clinic merely sells functional medicine to corporate executives and the wealthy -- and there are no signs that this is the focus -- the migration of the IFM model into the Cleveland Clinic will require a new business model.
The talk in the announcement of the partnership is all about healthy lifestyle. The rub in this relationship will be the products and tests.
Here's hoping that this partnership will model a functional health and medicine that does two things. First, the team must find affordable price points for services. More importantly, the partnership must do all it can to not reduce a patient's road to functionality to the popping of new brands of pills and the administration of tests that support such a course.
The Cleveland Clinic experience with IFM provides an opportunity to deeply engage, with proactive use of groups and team care, a core focus on the human-to-human technologies for moving people to the lifestyle choices that deliver functionality, wellness, and, well, happiness.
Now that can be a tipping point.