by John Weeks, Publisher Editor of The Integrator Blog News & Reports President’s Planning Budget for VHA focus on “Whole Health” for 2016 2021The way integrative medicine leader Tracy Gaudet, MD recounted it, “whole health” emerged as top dog in a competition
The World Health Organization (WHO) has published its Traditional Medicine Strategy 2014-2023. The document differs from the 2002-2005 strategic plan in routinely referencing not just TM but rather “Traditional & Complementary Medicine (T&CM)” to better link traditional use to the growing option of traditional medicines in countries where industrial medicine dominates. The goals of the publication are to support WHO member states in: “1) harnessing the potential contribution of T&CM to health, wellness, people-centered health care and (universal health coverage (UHC); and 2) promoting safe and effective use of T&CM through the regulation, research and integration of T&CM products, practices and practitioners into the health system, as appropriate.” The 78-page document includes 12 pages of “Strategic objectives, strategic directions and strategic options.” The document was produced following four working group meetings during 2011-2013 of 15-20 international advisers.
Comment: The new plan differs significantly from the 2002-2005 WHO strategic plan for traditional medicine — the only prior such strategy document – in chiefly two ways. One is the focus on not just products but also “practices and practitioners.” This is related to the WHO’s interest into their integration into the health systems and the role of T&CMs in contributing to the WHO’s broad goal of universal health coverage (UHC). For these reasons, I had the honor of being invited to participate in two of the planning sessions on behalf of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). The organization was included as perhaps the most significant, functional, multidisciplinary organization of T&CM practitioners/academics globally. Those who open the new document will realize that the focus is surely on the rest of the world. I was the only U.S. person present at both meetings. The NIH NCCAM has discontinued the only coordinating center in the U.S. related to the WHO’s T&CM initiative. Canadians had a stronger presence, including the lead author, Andrea Burton. (Thanks to Burton and Integrator adviser Paolo Roberti di Sarsina, MD for sending the report. Side note: Roberti di Sarsina is the only Italian author cited in the report’s references.) Curious about any of your feedback.
IHPC adds voice to chorus of coalitions opposing HR 2817 effort to maintain discrimination in health care
On October 16, 2013, the Integrative Healthcare Policy Consortium sent a letter to the Congressmen Fred Upton (R)and Henry Waxman (D-CA) in opposition to the misleadingly-named Protect Patient Access to Quality Health Professionals Act of 2013 (H.R. 2817). IHPC is a national coalition comprised of 13 organizations and institutions “representing a variety of licensed and state and nationally certified healthcare professionals.” HR 2817 would revoke Section 2706 of the Affordable Care Act, called Non-Discrimination in Health Care. IHPC argues, in part, that Sec 2706 “safeguards patient access to non-MD/DO state licensed or state certified providers, including (but not limited to) chiropractors, naturopathic physicians, acupuncturists, massage therapists, osteopaths, optometrists, nurse practitioners and licensed or direct entry midwives and podiatrists, as long as they are licensed by the state and can treat the condition within that provider’s scope of practice.” The bill is backed by conventional medical specialties who claim a risk to patients from expanding scopes of other disciplines.
Comment: IHPC is the third major practitioner coalition to weigh-in their opposition, following the Coalition for Patients Rights, as reported here in the November 2013 Round-up, and PARCA, as reported here in the September 13, 2013 Integrator Round-up. Nice concerted action from the, in this case, “non-allied healthcare professions.”
Taylor Walsh on Health Affairs-AAMC Briefing: Continued non-inclusion of licensed integrative health and medicine in the workforce
In a report in The Integrator, journalist-integrative health consultant Taylor Walsh writes: “The reconfiguration of the American healthcare workforce is a topic of intense examination, but if a national conference in Washington last week is any indication, the role for integrative health disciplines will remain ‘a hidden dimension,’ as described by the Academic Consortium for Complementary and Alternative Health Care in its 2013 white paper, ‘Meeting the Nation’s Primary Care Needs.’ The briefing was sponsored by the Health Affairs and Academic Medicine (the Journal of the American Association of Medical Colleges), both of whose November 2013 issues were devoted to the workforce challenges addressed at the briefing. Walsh continues: “While the topic of non-physician leadership in primary care and in other points of delivery was thoroughly discussed, any role for integrative disciplines as contributors to such a solution was oblique, at best. But it is also clear that sharing any physician-assigned responsibility even with nurse practitioners or physician assistants will be a tremendous culture pull that will not quickly come to pass.” Walsh adds that two presenters offered the most potent visions for adjusting the prevailing medical education culture: Edward Salsberg, director of the National Center for Health Workforce Analysis at HRSA, and George Thibault, president of the Josiah Macy Jr. Foundation, which has take a leading role in funding interprofessional care and workforce development innovations.
Comment: I am a co-author with Michael Goldstein, PhD of the UCLA Center for Health Policy Research on the ACCAHC report referenced by Walsh. The project made clear that, whatever the exclusionary views of the current policy professionals in charge of workforce planning, they are missing a significant chunk of what, in this patient-centered care era, Goldstein and I chose to call “primary providers of care.” These are the licensed so-called CAM practitioners who millions of people turn to instead of their formal, system-centered “PCPs,” whether MDs or PAs or nurses. We don’t have a clear estimate, but there is no doubt that these licensed practitioners are relieving a significant burden from the mainstream primary care system. They should, in an open and unprejudiced society, and more certainly in a nominally patient-centered system, be in the workforce calculations and dialogue. Walsh’s account of the meeting is thoughtful and worth a read.
Oregon chiropractors take non-discrimination fight (Section 2706) to Governor Kitzauber
The November 22, 2013 edition of the Lund Report on Oregon health policy shares that the state’s chiropractors are pushing hard for a broad inclusion of chiropractors under the Section 2706 provision of the Affordable Care Act. Chiropractors Take Discrimination Fight to the Governor notes that Governor John Kitzauber, MD supports a broad interpretation. It was Kitzauber, according to the article, who argued for their necessary inclusion in the state’s coordinated care organizations. The Oregon Chiropractic Association’s Vern Saboe, DC, whose lobbying work is featured, argues that “chiropractors are equipped to do much more than just spinal manipulation and can treat the 60 most common conditions dealt with by primary care physicians such as hypertension, mild diabetes, hypothyroidism and food allergies.” Adds Saboe: “We intend to keep the pressure on so that the federal law is enacted as it was intended from the top down, and the governor is absolutely supportive that we should be fully included in the healthcare system. Chiropractic is a profession, not a single modality.”
Comment: Fighting words! Notably, Oregon is a state with a broad scope of practice for chiropractors and a chiropractic academic program at the University of Western States that promotes a functional medicine approach to chiropractic and a role for doctors of chiropractic in primary care. A challenge for the profession is to help payers distinguish between those who are “primary care for back pain” or more broadly primary care. Saboe’s last comment should be taken up, ceaselessly, as a banner by each of the so-called “CAM” disciplines: “We are professions, not single modalities.” Each member must start by reprogramming their colonized minds from ever using the “modality” or “therapy” word to describe what happens in their offices. Side note: a more recent issue of The Lund Report shares that the Blue Shield firm Regence has moved to limit access to licensed integrative health practitioners.
Washington States naturopathic doctors begin optional role as Medicaid providers
An article entitled Medicaid – A New Environment for NDs in the Fall 2013 issue of the newsletter of the Washington Association of Naturopathic Physicians lays out a brave new world that will open for these practitioners in January 2014. The writer notes that the opening into “Apple Health,” the state’s re-named Medicaid program, “is a significant achievement for our profession in terms of recognition and inclusion of naturopathic medicine in the health care system” and also “brings the promise of expanding the value of our medicine to a population that has not had much access to it in the past.” The writer is honest about the impact on practices: “At this point we don’t really know.” Then: “Below is the information we have thus far, but be forewarned – these are uncharted waters and before you rush to ‘sign up for more patients’, we really encourage you to do your research.” Those NDs who wish to take a look at the assembled piloting log for these waters are urged to read on here. The author suggests that those who participate share their stories so that WANP can build an archive of Medicaid experience.
Comment: Key features of health professionals of the future, as recommended through the Lancet Report of Health Professionals for a New Century is that they be 1) leaders, that their leadership be focused on 2) “change agency,” and that they be 3) comfortable with ambiguity. Engaging Medicaid, choosing to be under-paid and bureaucratically Lilliputianized in order to meet one’s mission to serve the underserved or advance one’s profession, looks an awful lot like falling down a rabbit hole; or, if more awake to the challenges, the engagement of a hero’s journey.