John WeeksExecutive Director
Academic Consortium for Complementary and Alternative Health CarePublisher, Editor
The Integrator Blog News & Reports
National Association of Certified Professional MidwivesWebinar
July 24, 2014
What Else Does ACA Have To Say AboutLicensed Healthcare Providers?
• A bit about ACCAHC• Action related to specific language• Action on some useful other themes• “Transformational” or “paradigm”
shifts?• Ideas for CPMs
Overview
www.theintegratorblog.com
Licensed Integrative Health & Medicine “CAM” Disciplines Core 5 with a U.S. Dept. of Education-recognized Accreditation Agency
*Of the roughly 1400 schools, the number accredited via the US Dept. of Education-recognized specialized accrediting agency.
Source: Modified from ACCAHC’s Clinicians’ & Educators’ Desk Reference on the Licensed Complementary & Alternative Healthcare Professions (2014)
Profession Accrediting Agency
Established
US Dept. of Education
Recognition
RecognizedSchools or Programs
Nat’lExam
Created
StateRegulation
TotalLicensed
Practitioners
Acupuncture and Oriental medicine
1982 1990 61 1982 44 28,000
Chiropractic 1971 1974 15 1963 50 72,000
Massage therapy
1982 2002 88* 1994 44 280,000
Direct-entry (homebirth) Midwifery
1991 2001 10 1994 26 2000
Naturopathic medicine
1978 1987 7 1986 18 5500
ACCAHC Base: Core Organizational MembersOne of the most enduring, formal interprofessional collaborations in the US
Key Strategic Initiatives
Center for Optimal Integration Creating Health
Capacity: Funding Website + Business Market +
Staff + Repository Plan Advisors
Expertise
ERL PIHTA OTHERS
*Leadership in Integrative Heath *Interprofessional Education/Care *Primary
Care *Inter-Institutional Relationships *Whole Systems/Practice Research *Integrative Pain
Care *Triple Aim * Evidence &Education
Patient Centered Care CAM ACO
FOUNDATION
PROJECTS
COMMUNITIES of INTEREST
Governance: Center Advisory Team and ACCAHC Board of Directors
Competencies for Optimal Practice in Integrative Environments
Advance Interprofessional respect and inclusion (IPE/C) Gain recognition of
our workforce contributions
Impact critical dialoguesPromote “researching the way we practice” and increasing capacity
Competency 6Competency 5Provide Leadership
Integrative Health & “CAM” in the (PP)ACASection Title Area Language Used
2706 Non-Discrimination Payment “ …license or certification …”
3502 Community Health Teams/Patient-
Centered Medical Homes
Delivery “doctors of chiropractic, licensed CAM practitioners …”
4001 National Prevention, Health
Promotion and Public Health
Council
Health promotion
“integrative health care” “integrative health care strategy” “integrative health” “integrative health
practitioners” “integrative health practices”
5101 National Health Care Work Force
Commission
Workforce “doctors of chiropractic”“licensed CAM providers, integrative health
practitioners”
6301 PCORI-CER Research “experts in integrative health and primary prevention strategies” “State-licensed integrative
health care practitioner”
2301 Coverage for Free-Standing Birth
Centers
Delivery `birth attendant' means an individual who is recognized or registered by the State involved to
provide health care at childbirth “
Thanks to US Senate Integrative Health Champions
• Tom Harkin (D-Iowa)
• Barbara Mikulski (D-MD)
• Bernie Sanders (I-VT)
• Kent Conrad (D-ND)
• Maria Cantwell (D-WA)– Direct-entry midwives
The consumer movement and the US Senate Appropriations Committee …
Seeded Opportunity in the Affordable Care Act
Section 6301: Patient Centered Outcomes Research Institute (PCORI)
Board of Governors MemberChristine Goertz, DC, PhD
Vice Chancellor, Palmer College
Board will include “State-licensed integrative health care practitioner” ... “experts in integrative health and primary
prevention strategies”• Viewed as closer to patient-centered and outcomes
focus of optimal IHM research• Specific charge to explore “CAM”
– Special presentation to Board, 12/2011
• Goertz is one of 19 Governors• Oversee $650-million a year of comparative
effectiveness research• Goertz: Chair, PCORI Program Development Committee
(former)• Goertz: Chair, PCORI Science and Oversight Committee
(current)• CEO met with ACCAHC Research Working Group; asked
for an appointment to a committee
National Prevention, Health Promotion and Public Health Council
Sharon Van Horn, MD, MPH
Advisory Group on Prevention, Health Promotion and Integrative and Public
Health
• Report includes multiple references to “CAM”
• 4 known IHM members, of 22• Working Group on Integrative Health• Sent letter of concern to HHS on
Section 2706 (April 2013)• Letter also urged adherence to
Section 5101 (Workforce)• Links IHM to prevention and health
promotion
Dean Ornish, MD
Janet Kahn, PhD, LMT
Charlotte Kerr, RN, MPH, LAc
Graduate, U Az Fellowship in Integrative MedicineJanet Kahn, PhD, LMT
Section 3502: Community Health Teams/Patient-Centered Medical Homes
ACCAHC project to elevate potential value
… “may include doctors of chiropractic, licensed CAM practitioners …”
• New models foster team care• Major backing from employers,
agencies• Part of effort to move $ and
investment toward primary care• Role of IHM is to position themselves
as part of solution - examples– F4CP and chiropractors– PIHTA and ACCAHC disciplines
Major report on DC role in PCMHs
Section 5101: National Health Care Workforce Commission
ACCAHC document, developed with MEAC as partner
… ““doctors of chiropractic … ”“licensed CAM providers, integrative health practitioners …”
• Never funded• Law, nevertheless, is useful and has been cited • AAMC’s shift from “physician” to “health
workforce” – M Lawlor present May meeting• ACCAHC, now ACCAHC-IHPC primary
care/”primary maternity care” project
Meeting the Nation’s Primary Care Needs: The Current and Prospective Roles of
Doctors of Chiropractic and Naturopathic Medicine,Practitioners of Acupuncture and Oriental Medicine,
and Direct-Entry Midwives
Association of American Medical Colleges
Other A.C.A.-RelatedUseful Federal Policy Initiatives
Movement Toward Team Care/Interprofessional Practice and Education (IPE)
• Interprofessional Education Collaborative – Core Competencies for Interprofessional Collaborative Practice (2011)
• $13.5-million National Center for Interprofessional Practice and Education (HRSA, foundations) (2012)
• American Association of Medical Colleges MedPortal on IPE (with psych, PT, PA) (2012)
• IOM Global Forum on Innovation in Health Professional Education (includes integrative health/CAM) (2012)
IPE is “patient-centered” and promotes “egalitarianism” among disciplines
Mary Wakefield, RN, PhD, Administrator, HRSA
Barbara Brandt, PhD, Center Director
ACCAHC IPE/C Action in Multiple
InitiativesCreate, manage IPE page;
promote IPE/C focus
John Gilbert, PhD: ACCAHC Keynote (2011) and Council of Advisers member
Focus on inclusive teams, inclusion of “CAM”
Promote/support NCIPE’S Barbara Brandt & JIHC Scott
Reeves as keynoters
Stimulated over 40 orgs and individuals to “join”
Change definition from “therapies” to IPE language
Endorsement of IPEC competences as part of ACCAHC’s
Sarita Verma, MD, JD: ACCAHC Keynote (2013) and Council of Advisers member
Inclusion of licensed IHM, health creation
Focus on self-care health & well-being
Promoting an IPE and inclusiveview of integrative medicine
A.C.A. and Integrative Pain
Rick Marinelli, ND, LAc
• Funds Institute of Medicine (IOM) Committee on Advancing Pain Research, Education and Care – Member: ND, LAc pain expert Marinelli– Member: UCLA Integrative pediatrician Zelzer
• IOM “Blueprint” (2011) includes “CAM” in 15 segments
Plus, Pain focus in NCCAM Strategic Plan– Highlighted in Strategic Objective #1– New NCCAM pain-military effort (July 2014)
Lonnie Zelzer, MD
Integrative Health Care and the Military
Anthony Lisi, DC, DirectorVA-chiropractic program
Motivation
• Performance/functional priority– Soldiers, like actors, athletes
• “The Imperative for Integrative Medicine in the Military”– Schoomaker, May 2014, IRCIMH
• Pressure from chiropractors– Success creates openings for others
• Current use (2012)– 120 facilities offer 275 ‘CAM’ programs
and 213,515 (Dept. of Defense report to Congress, January 2014)
Former US Army Surgeon General Eric Schoomaker, MD, PhD
Integrative Care Leader at Veteran’s Affairs
Former IM leader at Weil/U Arizona & Duke selected to direct
VA Office of Patient Centered Care and Cultural
Transformation
“ [The Office will be] a living, learning organization in which we will discover and demonstrate new
models of care, analyze the results, and then create strategies that allow for their translation and
implementation across the VA.”
Tracy Gaudet, MDFormer Director of IM at U
Arizona and at Duke
“Transformational?”
Shifting Incentives
“When I first heard of integrative medicine in
2006, I thought of it as an expense …
Ken Paulus, CEO, Allina Health SystemWeeks J. Health System & Military Leaders Say Cost and Pain are Motivating Inclusion of
Integrative Medicine http://theintegratorblog.com/index.php?option=com_content&task=view&id=795&Itemid=189
Ken Paulus, CEOAllina Health System
Shifting Incentives
“… but as the Affordable Care Act's payment structure kicks in
that supports keeping people healthy, integrative medicine will
be an asset.“Ken Paulus, CEO, Allina Health System (2011)
Weeks J. Health System & Military Leaders Say Cost and Pain are Motivating Inclusion of Integrative Medicine http://theintegratorblog.com/index.php?option=com_content&task=view&id=795&Itemid=189
Ken Paulus, CEOAllina Health System
Is this values framework conducive to midwifery and integrative health outcomes?
Typical “Hot-Tub Claims” of Integrative Healthcare Practitioners #1
So, what is your value to your patients?
After my care, my patients:
• Can do more things• Aren’t in as much pain• Suffer fewer adverse effects• Have more energy• Enjoy things more• Feel better
Integrator Blog News & Reports www.theintegratorblog.com
24
Typical Hot-Tub Claims of Integrative Healthcare Practitioners #2
So, what is your value to the system?
My services:
• Diminish use of pharmaceuticals• Lower adverse effects of
pharmaceuticals• Limit needs for more expensive
conventional tests and services• Lower costs
Integrator Blog News & Reports www.theintegratorblog.com
25
Collaborate &Engage
-Data-Best practices-Webinars-News pushes-Face-to-face
www.optimalintegration.org
The Emerging Opportunity:
Creating Health
Perlin/AHA: “We Don’t Fully Understand the Recipe”
"From Sick Care to Health Care"
“We have been honed to focus on sick care … It is a tough transition, but we have to
learn how to move from sick care to health care.
"I'm not sure that any of us … fully understands or knows the recipe."
Jonathan Perlin, MD, PhDChair-Elect, AHA
CMO, HCA
Mayo: From “Producing Health Care” to “Creating Health”
"We are realizing fairly quickly that we need to change the focus of the
health care industry to creating health, not just producing
health care."
American Hospital Association's Hospitals and Health Networks, April 2013 http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/
templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2013/Apr/0413HHN_FEA_PatientexperienceGate
Douglas Wood, MDDirector, Strategy and Policy
Mayo Clinic Center for Innovation
Berwick: “Radical Shift” Toward “Creating Health”
“It is fortunately commonplace now to say that we would be better off to re-direct some of our health care enterprise from fighting illness … to health creation."
"The pursuit of health, the creation of health, may require … a redesign that may
be even more radical than we have imagined."
Plenary Panel, Institute for Health Improvement, December 2013http://www.youtube.com/watch?v=r5Tbikk44jY
Also: “Hooking Up: Don Berwick, Integrative Medicine and His Call for a Radical Shift to 'Health Creation‘”http://www.huffingtonpost.com/john-weeks/don-berwick-integrative-m_b_4781105.html
Don Berwick, MDFormer CMS Administrator
Past CEO, Institute for Health Improvement
Recommendations for Midwives
• Get out of your silos (and related attitudes)• Educate for team practices (even if virtual)• Gain competencies for practice in integrated
environments• Form inter-professional networks in your
communities• Gather and publish Triple Aim outcomes• Collaborate in policy with those with like values
Campaign with others to research and promote the concept of “conservative treatment” throughout
medicine
www.optimalintegration.org
Facebook: Center for Optimal IntegrationLinkedIn: Project to Enhance Research Literacy
LinkedIn: Project for Integrative Health and the Triple AimTwitter: #CentOptInt
Thank You!