December 2012 John Weeks Integrator Round-up covering the topics of:  Policy; Employers & Costs, Integrative Clinics & Services; Education;
Professions and Organizations and People

MEPS study from Group Health/Kaiser/Dartmouth/OHSU/Missouri/Palmer group finds significant cost savings among CAM users for low back pain
An e-notice of emerging research with which Group Health Research Institute (GHRI) is affiliated begins: “One reason for resistance to complementary and alternative medicine (CAM) is the fear that it will raise health care spending.” A consortium of researchers from GHRI, Dartmouth, University of Missouri, Kaiser Permanente, and Oregon Health and Science University recently dispelled some concern when they reported their study that CAM for back care was cost effective. The team examined a national sample of some 12,000 patients with spine problems. The conclusion: “Those who used some CAM had lower yearly medical costs for spine-related and total health care costs than did those who did not use any CAM.” The team included GHRI’s Karen Sherman, PhD, and Dan Cherkin, PhD as well as Christine Goertz, DC, PhD. Cost differences were found to be mainly due to lower inpatient expenditures among CAM users. A key value of the study was its use of the most respected data pool on costs, the Medical Expenditure Survey of the Agency for Healthcare Research and Quality. The researchers examined data for the years 2002-2008.

Comment: The most important research questions regarding the so-called “CAM” disciplines are to understand the value of what they do. This, typically, this is to work with people and their conditions in the outpatient environment. Diminution of overall costs, as found here, has always been a “hot-tub claim” from these practitioners.  Hopefully findings such as these from the MEPS data will convince the research and delivery community to explore these and other observational claims from these fields, rather than continue on their merry way in research which, as my sometimes salty father used to say, focuses on “separating fly shit from pepper.” Researching Hot-Tub Claims of Whole Person Practitioners May Interest Healthcare Purchasers offers ten areas of potential value where these practitioners speak of the outcomes reported by their patients. The piece below on patient experience of a CAM discipline’s members in successful care of diabetes is further confirmation of the value of listening to the claims of such practitioners as a direction for research.


Engaging a new audience: can the CAM/IM community cross the chasm to employers?

The rash of news in the November 2012 Integrator Round-up related to the potential richness in the employer-integrative health connection led to the publication of this well-received Huffington Post article: CFO Magazine Urges Fortune 500 Firms to Explore Cost Savings Via Alternative and Integrative Medicine. Integrative medical consultant and Integrator adviser Glenn Sabin of FON Therapeutics followed up his piece on the Perfect Marriage between these two stakeholders with this tickler: How to Sell Integrative Medicine to Corporate America. Sabin urges a focus on promoting integrative strategies that will help lower the high cost of chronic conditions.

Comment: A challenge for clinicians of any sort is that they often choose to be clinicians because they see themselves as a service profession. They aren’t interested in business. Maybe, then, the trick is to reframe this employer relationship as a mission to reach employees who are underserved populations. On this context, learning the employer culture and the specialized language of “presenteeism” and “productivity” is a necessary bilingualism to reach and serve this needy population. The opportunity certainly exists in this time as employers increasingly express their rancor with a conventional, disease-based system that can seem like little more than, in IBM’s Paul Grundy, MD, MPH’s words, “a milking machine.”