John Weeks Executive Director Academic Consortium for Complementary and Alternative Health Care Publisher, Editor The Integrator Blog News & Reports National.

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

[email protected]

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!