John Weeks Integrator Round-up, September 2012 covering news updates on the topic of policy in health care

IOM “horizontal” workshop on interprofessional education and care (IPE/C) urges “holistic perspective” and “widening the circle”

“We need to widen the circle.” “We need a more holistic perspective.” “We need to protect ourselves from a new elitism.” These were among the closing comments from two of the historic leaders in the movement for interprofessional education/care (IPE/C) in the US near the end of the August 29-30, 2012 Institute of Medicine (IOM) workshop called Educating for Practice: Improving Health by Linking Education to Practice Using Interprofessional Education. The participants in the 1.5 day event consisted of a group that Association of American Medical Colleges (AAMC) president emeritus Jordan Cohen MD has called the most diverse mix of disciplines and interests ever convened through the IOM. Jordan and nurse-educator Afaf Meleis, PhD, DrPS (Hon), FAAN, co-chair the convening project, the IOM Global Forum on Innovation in Health Professional Education. The 31 sponsor organizations, listed on the right side of this page, range from the AAMC to similar organizations from such fields as nursing, social work, physical therapy, family medicine, and allied health. Included relative to integrative health is the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).

This is the first of six such Global Forum workshops planned before the end of 2014.  The work advances the vision of IOM president Harvey Fineberg, MD’s “to gather leaders in various fields and encourage discussion.” Under the Affordable Care Act and emerging payment methods meant to better care and contain costs, IPE/C has emerged as a critical reform strategy. A report touching on diverse critical inputs to the meeting is HERE.

Comment: The present IPE/C movement broke first as en effort to get medical doctors and nurses to have better respect for each other and smoother collaboration. To Err is Human has shown that awful doses of morbidity and mortality come from professions being educated in silos and operating antagonistically. Discussion at the workshop, which I attended as ACCAHC’s alternate member, included significant focus on the centrality of the patient, and his or her family and community. This is especially with chronic conditions in the outpatient environment. Discussion returned frequently also to the importance of social justice as a core value across all disciplines. It was a phenomenal experience to have been there. Feels like we might actually be changing something. 


Functional medicine physician and author Mark Hyman, MD offers “manifesto” for health creation

The title of the Huffington Post blog piece by Mark Hyman, MD is Money, Politics and Health Care: A Disease Creation Economy. He offers a whole system perspective that provides a case statement and then a series of prescriptions. The political economic context that is behind the system’s “disease creation” includes the Citizens United decision that allows even more corporate and oligarchic manipulation of politics. Hyman also touches on such issues as food policy, energy policy (“clean coal”) and sustainability. Hyman includes a section on the “perverse incentives” in our payment system. Then, to the prescriptive: Hyman offers a score of suggestions for “Supporting Innovations that Create Health.” And then in “Creating Health: Getting Money Out of Politics,” he ticks off specific “strategies that could have the biggest impact on cost and outcomes.” Many are quite specific. 

Comment: Much of this will not be new to m any Integrator readers. Seeing the ideas aggregated in one place is useful, though potentially overwhelming. Notably, Hyman calls for us to “Empower the National Prevention, Health Promotion and Public Health Council” that was created in the Affordable Care Act. Like Hyman’s work, that council appreciates that health can only be achieved when Health and Human Services is aligned with health-creating policies in departments of Energy, and Education, and Transportation and elsewhere. Missing is a coalition-building and lobbying strategy. Hyman, who has access to the likes of Bill Clinton and Tom Harkin, would serve his core, healthcare message by fronting IHPC (see below) and helping it gain more bandwidth. As I understand that organization, it is the one 501c4 lobbying effort that is probably 98% aligned with this agenda, and has a similar holistic vision. Notably, it’s senior policy adviser and former executive director Janet Kahn, PhD, is on the Council. (Thanks to Bob May, ND for bringing this to my attention.)

Comment from Integrator adviser Taylor Walsh: 
Mark’s “Disease-Creation Economy” is a near-manifesto. But it reminds me of the 2009 Summit: it has nowhere to go and no one to take it there (unless HuffPo has something surreptitious in mind). The following is instructive. (Hyman wrote) “During the health reform process in Washington, D.C., a group of three doctors (Dean Ornish, Michael Roizen and myself) were asked what organization we represented. We replied simply that we didn’t represent anyone except the patients or anything but the science. They accepted it, but looked perplexed.” Indeed. But this will never do, not in front of a Senate committee where people come to plead for things, and where the Paladin of IM was no doubt waiting for something specific. It is like “representing” the audiences on the Dr. Oz show or on Mark’s PBS “Sugar Solution” presentation.


Integrative Healthcare Policy Consortium (IHPC) posts 2012 Report and future plans

The Integrative Healthcare Policy Consortium (IHPC), which changed its name in August 2012 from Integrated Healthcare Policy Consortium, has filed an early IHPC Annual Progress Report 2012. Among chief accomplishments were three Congressional Briefings at which “attendance has steadily grown.” IHPC says it has presently reached some 200 legislative aides and staffers via the briefings. These are held on the Hill. The organization is led by new executive director Alyssa Wostrel and chaired by integrative medicine clinician and educator Len Wisneski, MD. It presently has 14 Partners for Health. The alphabet soup of IHPC’s Partners is: AAAOM, NMSA, ICPA, AMSA, AAPM, NCBTMB, AANP, NACPM, AIH, NCH, Palmer College, and Bastyr and Life Universities. Dues from these organizations produce the lion’s share of their meager budget, anticipated at $50,000 in 2012. Wostrel is shooting to bring that up to $80,000-$100,000 with project funds for 2013.

Another key accomplishment was publication of a policy document produced in collaboration with Palmer College and The Institute for Integrative Health: Affordable Care and Beyond: A Stakeholder Conference on Integrated Health Care Report. Wostrel is leading an effort to energize working groups from that conference to move the recommendations. In addition, IHPC is in dialogue with former Washington State Insurance Commissioner Deborah Seen about coming on as a lobbyist “in advancing the regulatory implementation of key integrative health care provisions of the ACA.” Other changes are a new IHPC Policy Council plus a “strategic alliance with the American Sustainable Business Council.”

An intriguing new direction is what IHPC is calling a Scope of Practice Summit. The goal would be to “bring representatives (both national and state leaders) of the licensed CAM disciplines together to explore the potential for a stronger state legislative alliance/strategy.” This is positioned as an effort to “offset AMA’s SOPP and Resolution 814 activities, which are in full swing.” The IHPC plan asks: “Can we achieve greater outcomes for all of the disciplines we represent by forging agreements and establishing clarity at the state level-and therefore gain more federal ground by using our human and other resources to accelerate focus and intensity on federal advances?” 

Comment: Ask not what IHPC is doing for you. Ask what you can do for IHPC. It’s a critical force, with no “competition” as a policy and lobbying consortium. IHPC does a lot, obviously, on next to nothing. My how the “integrative health community” limits itself through lack of collaboration. Imagine if you, any organizations with which you are affiliated, a spare visionary philanthropist or two, maybe some far-thinking companies, and others, funded this work? 


Data points in the A.C.A. on the uses of key terms

Integrator adviser Pamela Snider, ND wrote seeking quick information on the the number of times some key phrases were mentioned in the health care law of the land, the recently upheld Affordable Care Act. She shortly thereafter responded with these data points that I thought many Integrator readers might find of passing interest:

  • Complementary and alternative: 4
  • Integrative health care practitioner or practices: 14
  • Health promotion: 42
  • Wellness: 95
  • Prevention:~246

The substantive sections relative to the first two categories are here.

Comment: It would be interesting to see the Prevention” category in particular parsed into those that are related to provider interventions (immunization, testing) and those connected to the lifestyle interventions humans can make to better their own health – which can be supported by integrative health practitioners. The health promotion and wellness uses would similarly fall into distinct categories (employer-related, community-related, etc.).