“We believe we are pioneering a potent formula by uniting integrative health, value-based care, and population health.”
This is the beginning of concluding comments from David Fogel, MD, in his personal account in Wharton Healthcare Management Alumni Magazine. He was writing of efforts of this team to create an integrative patient-centered medical home, the Maryland-based Casey Health Institute.
Fogel continues: “However, in the end, consciousness, purpose, meaning…even love may prove to be the true secret ingredients for healthcare transformation.”
In the article, Fogel describes the path he and his spouse, Ilana Bar-Levav, MD, took following a life changing moment in 2010, when philanthropist Betty Casey delivered them an opportunity to have “a building the size of a small hospital and $30-million.”
The two physicians toured the country visiting integrative center sites. One conclusion, according to Fogel: “Collaborative, team-focused, value-based population healthcare, which seemed like a natural partner for multimodality integrative health, was strikingly absent from most integrative medicine conversations.”
“In the end, consciousness, purpose, meaning…even love may prove to be the true secret ingredients for healthcare transformation.”
Fogel describes how they ultimately chose to break this pattern and bring together the two emerging fields. On one side, integrative medicine – from outside the dominant school. On the other side, the reform movement from inside regular medicine seeking to transform the $3-trillion industry through “value-based care” as captured in the Triple Aim.
Along the way, Fogel stumbled upon, then sought out what became a third formative force in the Institute’s development, Conscious Capitalism. He particularly wished to link with one of its proponents, Whole Foods founder, John Mackey.
Fogel explains that his interest in conscious business models came from having under-estimated the way that the “insidiously unhealthy culture of healthcare itself” could impact even an integrative care setting. He felt he needed to look outside what he’d found in either integrative or value-based models.
Fogel writes: “How could we ignore the entrenched medical culture I had experienced throughout my career as a physician? Even integrative medicine’s emphasis on balance, healing relationships, and connection couldn’t escape the ingrained hierarchical, fear-driven, competitive, cultural dynamics of healthcare in America.”
He writes that he was attracted to the way that Mackey said things “like purpose, consciousness, caring, and LOVE as pillars that drive corporate success and profits.”
Fogel shared that, while Casey Health Institute is maturing well, his team doesn’t yet have the data to show that it will succeed in the ways he has hoped. But he is increasingly clear that, as he captured in the title of his piece, “turbocharging,” the development of the Institute and the implementation of value-based care is a “secret ingredient – love.”
Comment: I was among those visited by Fogel and Bar-Levav in their tour of the U.S. I had closely reported the challenges faced by the first integrative centers in the 1998-2002 Integrative Clinic Benchmarking Project.
The multiple business failure of these relatively low-cost, human intensive clinical strategies in the production-and profit focused medical delivery organizations with their fee-for-service incentives had proved to be a misfit. This led me to excitement about the potential in value-based medicine that I had begun exploring the integrative care-triple aim cross over.
We sat over a long dinner at a restaurant in West Seattle, exploring possibilities. I’ve since been to the Casey facility and closely reported the Casey experience. (See: At the Huffington Post: Report Shares Successes/Challenges in M.D.-Led and N.D.-Led Integrative Patient-Centered Medical Homes.)
Love, however, was never, directly, part of my counsel. Love, the sensitive stuff that would seem to be quickly singed, scalded, corroded and burned to dust by the medical industry’s “insidiously unhealthy culture,” was never overtly part of a model I recommended.
Fogel’s decision to highlight love in the pages of a Wharton magazine brings to mind a comment at a national symposium on integrative health policy at Georgetown University Medical Center in September of 2014. Politically active individuals tend to see themselves as hard-boiled and tough. Their world can be vicious and back-stabbing. Few would challenge that politics promotes an “insidiously unhealthy culture.”
Toward the closing of the symposium, after work with new colleagues from various organizations in small groups, multiple participants stood to offer the commitments of their organizations to the future of health care. The president of the interprofessional Academy of Integrative Health and Medicine, Danny Friedland, MD, stood to speak.
In an account of the moment, Friedland shared how earlier table talk with colleagues from other organizations among the 120 gathered influenced the commitment he was to offer.
“I [shared] with the group how we had discussed the major challenge to creating a big tent [of all integrative health and medicine organizations and professions]: the natural inclination for each organization to also be concerned about furthering its own needs. We posed a key question: what compelling vision was most needed to inspire organizations to rise up above individual stakeholder orientations and galvanize our entire integrative health community? The answer arising in unison at our table is that the core of this vision – ‘the minimal effective dose’ that was needed – is love.”
I have heard Friedland privately ridiculed by an academic medicine colleague for his naiveté in bringing “love” into that room, at that medical center, among those political leaders, at that moment. Now here is Fogel, in the pages of a Wharton publication, doing the same.
It is indeed interesting how this special ingredient has been deemed elemental by Friedland in the interprofessional organizational setting, and by Fogel in his interprofessional clinical context.