Top 10 for Integrative Medicine Policy and Action in 2011

A good friend has warned me that my annual exploration of the year's highlights for integrative medicine in the form of a Top 10 is "too much inside baseball." I thought I'd let you decide. The year was a good one for integrative medicine.
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Caveat emptor: A good friend has warned me that my annual exploration of the year's highlights for integrative medicine in the form of a Top 10 is "too much inside baseball" for The Huffington Post readers. I thought I'd let you decide.

The year was a good one for integrative medicine. Many of these developments grew out of the mandated inclusion of integrative and complementary and alternative medicine practices in the Obama-Pelosi Affordable Care Act. Here is the Top 10 for Integrative Medicine Policy and Action for 2011. (Those interested in highlights for the years since 2006 will find links here.)

1. Reports capture growing complementary and alternative medicine use.

The summer months saw a trifecta of reports showing continued uptake of complementary and alternative medicine (CAM) in the United States. A July Consumer Reports article headlined "Alternative Treatments: More than 45,000 readers tell us what helped" was re-published widely. A month later another media wave hit after publication of a study showing health care workers use integrative therapies and practitioners at higher rates than regular consumers. The conclusion that "personal CAM use by healthcare workers may influence the integration of CAM with conventional healthcare delivery" appeared prescient a month later. The American Hospital Association published a report that 42 percent of responding hospitals offer some CAM, up from 26 percent in 2005. The trend-lines are steady. This consumer-led movement is not going away.

2. U.S. health promotion effort linked to integrative practices.

Integrative practitioners see themselves as focused on prevention and health promotion. Now for the first time a National Prevention and Health Promotion Strategy of the U.S., announced in June, includes references to integrative care. In addition, President Obama's appointees to the Advisory Group on Prevention, Health Promotion, Integrative and Public Health include an integrative practice contingent that includes The Huffington Post contributor Dean Ornish, M.D., Janet Kahn, Ph.D., LMT, Sharon Van Horn, M.D. and Charlotte Kerr, RN, MPH, LAc. The public health-integrative care alliance is finally forming.

3. Integrative M.D.s announce plan to establish specialty board.

Is "integrative medicine" a campaign to transform all of medicine toward a more holistic approach? Or is it an effort to establish a new specialty? In September, a coalition of integrative medical doctors led by the Arizona Center for Integrative Medicine announced a plan to establish a formal board specialty in integrative medicine through the American Board of Physician Specialties. The move is controversial. But it appears to be certain, for better and for worse, that integrative medicine will within two years have a formal, recognized guild as a guiding force.

4. Institute of Medicine's pain "blueprint" is an integrative strategy.

A pain initiative buried in Obamacare led to the June 2011 publication of "Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research." The plan was developed by the Institute of Medicine of the National Academies. The document, from a committee that included Rick Marinelli, ND, LAc, the first naturopathic doctor or licensed acupuncturist ever appointed to an IOM committee on a regular medical topic, advocates an integrative, interdisciplinary strategy. The recommendations are laced with references to complementary and alternative approaches such as massage, acupuncture, chiropractic, mind-body and yoga. A broad alliance being organized to keep the blueprint from languishing on a shelf is similarly integrated.

5. "Integrative oncology" becoming the norm.

An NPR spot in Seattle advertises a cancer center where naturopathic doctors and M.D. oncologists work side-by-side. The government of British Columbia announced that it is investing to make the integrative oncology model of InspireHealth the provincial norm. In the U.S., Francis Collins, M.D., director of the National Institutes of Health, headlined the annual conference of the Society for Integrative Oncology (SOI). Even the conservative American Society for Clinical Oncology included at its annual meeting for the first time an integrative medicine track in 2011. Featured were a multidisciplinary group including Memorial Sloan Kettering's Gary Deng, M.D., Ph.D. and Columbia University's Heather Greenlee, ND, Ph.D.

6. New integrative medicine clinical pilot projects explore cost savings.

While integrative center operators argue their services will be cost-saving, data are wanting. New pilots were announced in 2011 that will help us find answers. The Institute for Functional Medicine, led by The Huffington Post contributor Mark Hyman, M.D., engaged a Florida Medicaid-backed program that expects savings via reduced ER visits and hospitalizations. A Grand Rapids ER doctor created a Center for Integrative Medicine that he anticipates will annually save Medicaid $150-$250 million once rolled out to eight hospitals. The Adolph Coors Foundation is giving Maricopa County employees access to integrative medicine services to test a model of payment for "sustainable wellness" through a program led by Andrew Weil, M.D. Key data may finally be forthcoming.

7. New plan from NIH center (finally) focuses on "real world" and "disciplines".

Missing data may also be forthcoming via the National Institutes of Health. Ask integrative practitioners to declare for the optimal research models and they will say look at the whole of what we do. This was the mandate from U.S. Senator Tom Harkin when he created the National Center for Complementary and Alternative Medicine (NCCAM) in 1998. With a new 2011-2015 strategic plan, NCCAM is getting on track. One priority is "real world research." Another is to look at whole disciplines, such as acupuncturists or chiropractors. This priority is linked to the comparative effectiveness research movement that was enshrined in Obamacare's Patient-Centered Outcomes Research Institute (PCORI). Integrative practice researchers see PCORI as a philosophical ally. This movement plays to integrative medicine's strength.

8. Accountable care organizations potentiate integrative models.

Leaders of the accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) prompted by Obamacare believe these new models will potentiate integrative approaches. A CEO of a major health system announced that when the Affordable Care Act "kicks in that supports keeping people healthy ... integrative medicine will be an asset." Integrative medicine adopters of PCMHs are excited with the move away from fee-for-service payment to "unassigned dollars." This fosters development of integrative medicine teams. A physician leader in Minnesota underscores the way ACOs promote a health-focus: "Integrative medicine supports self-efficacy." For the first time, the way we pay for care is aligned with health-focused, integrative principles.

9. Medicine's move toward collaborative teams opens doors.

Integrative health care at its best is team care, using medical doctors, acupuncturists, chiropractors, counselors, coaches and others as appropriate. So a May announcement by Obama's administrator for the Health Resources Services Administration Mary Wakefield, RN, Ph.D. was a great step forward. She celebrated how a historic collaboration of academic organizations for M.D., nurses and four other disciplines published the Core Competencies for Interprofessional Collaborative Practice. They committed to promoting an inter-professional education (IPE) model. Participation in a biennial IPE conference doubled. Meantime, five integrative practice fields (with which I am involved) announced a similar set of collaboratively produced competencies. These twin rivers point toward convergence. Not a moment too soon for our aging population!

10. Your choice -- what's missing?

What have I missed? As is my practice with these top 10 lists since I first published one in 2006, I leave a spot for reader suggestions.

I personally am struck by the influence of Obamacare. ACOs shift payment toward creating health in a population. Academic medicine elevates team-care. Research engages the real world of what patients care about. The IOM's brain trust delivers an integrative-oriented pain blueprint. Integrative leaders are included in the national health promotion strategy. These broad arcs of substantive change are each linked to the Affordable Care Act. Together they made of 2011 a surprising opening to integrative medicine's potential for U.S. health care in 2012 and beyond.

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