by John Weeks, Publisher Editor of The Integrator Blog News & Reports Shifting paradigms Berwick urges “radical shift” in medical industry toward “creating health” In a plenary session for the annual meeting of the influential Institute for Health Improvement, former Center for

by John Weeks, Publisher/Editor of The Integrator Blog News & Reports

Shifting paradigms: Berwick urges “radical shift” in medical industry toward “creating health”

In a plenary session for the annual meeting of the influential Institute for Health Improvement, former Center for Medicare and Medicaid Services administrator Donald Berwick, MD called for “some part of the health care enterprise to be re-directed to health creation.”  He speaks to us “not having the systems to do this now.” Berwick’s says these may be “vastly further from our current system than what we would like.” He believes that “the re-design may be more radical than we have thought.” To provide guidance, Berwick spoke of his mentors, in particular long-time leaders in the integrative health and medicine community, Jon Kabat-Zinn, PhD, Dean Ornish, MD, and, particularly, Wayne Jonas, MD. He repeatedly refers to these as “thought leaders.” Berwick notes that this shift is greater than that required to take a profit focused medical industry and get it to focus on the Triple Aim values that IHI has led in promoting: increasing patient experience, enhancing population health and lowering per capita costs.  “The improvement movement,” Berwick states, “needs to turn to creating health.” The talk is here.

Comment: This presentation, from perhaps the single most important conventional voice in effort to actually create a health care system out of our medical industry, is historic. Notably, this concept of “health creation” was first put forth and imbedded in the integrative health and medicine dialogue in the 2000 “Design Principles for Health Care Renewal” that grew out of the 2000 Integrative Medicine Industry Leadership Summit. It was later used in 2005 in the vision statements of the National Education Dialogue to Advance Integrated Health Care and the Academic Consortium for Complementary and Alternative Health Care. Listen to this! (Thanks to Integrator columnist Taylor Walsh for bringing this to my attention.)

White House responds to petitions from the acupuncture and naturopathic medicine communities

Last year the Integrator celebrated the success of petition drives in both the licensed acupuncture and naturopathic medical communities to hit the 25,000 threshold which required a White House response. Earlier this month, the responses came in. To the White House response to the naturopathic physicians’ petition to be included as primary care providers, Jud Richland, MPH, CEO of the American Association of Naturopathic Physicians, responded at length in this column to his members. He begins by saying that the White House chose to not take a strong stand on the “political infighting” relative to the effect of the non-discrimination clause. Yet Richland thinks the position is positive enough for his members that the AANP “will use it as one more arrow in our quiver” in meeting with state decision makers on inclusion.

A query to the American Association of Acupuncture and Oriental Medicine did not yield any response to the White House response on their position regarding acupuncturists as covered providers in Medicare. The White House position was essentially a primer on the laws that need changing. An example: “Furthermore, acupuncture is not a covered benefit within the Medicare program. To cover acupuncture would require a change in statute or a change in the CMS National Coverage Determination (NCD).”

: One might wonder whether the petitions were worth the effort. Richland clearly believes there was direct value, even while admitting that “we had hoped the response would have clearly enumerated ‘naturopathic physicians’ as a specific provider type that had to be included.” He concludes with his view that this is “added ammunition” in their work to “connect the dots for officials in licensed states and educate them that naturopathic physicians are providers who are licensed to provide routine health benefits.”  

Events to honor Senator Harkin: Samueli Institute and American Chiropractic Association

The retirement of US Senator Tom Harkin this year is stimulating plans to thank him in this last year of his service. Harkin’s long-time support of chiropractic will be the focus of a “Green Tie Gala” during the American Chiropractic Association’s National Chiropractic Legislative Conference. Harkin has a fondness for green ties. Meantime, the Samueli Institute is stimulating planning by a broad group of organizations They anticipate a celebration of all those who wish to honor the policy-maker who has, far and away, had the most significant influence on advancing the patient’s interest in integrative health and medicine. That event is anticipated to be either May 5 or June 2 and will likely begin with an afternoon program. Hold the dates! More to come. 

Comment: As an invited participant to the team organizing the Samueli-led event, under my hat as a principal in the Academic Consortium for Complementary and Alternative Health Care, I have been reflecting on Harkin’s remarkable contributions. The National Center for Complementary and Alternative Medicine. The White House Commission on CAM Policy. Section 2706, Non-Discrimination in Health Care. Other inclusion of integrative health and complementary and alternative medicine practitioners in the Affordable Care Act. Multiple chiropractic initiatives. Harkin has merely taken what was outside the medical industry, but inside the health care chosen by patients, and used federal policy to move it in. A trip to DC for this event may seem spendy. But imagine the cost of each of these advances had Harkin not been seated in that key, US Senator Appropriations Committee position from which he made these so. What a legacy! Plan to come!  

Mark Guimond offers new resource on acupuncture legislation via National Policy Group

A registered federal lobbyist, Mark Guimond, whose wife is an acupuncture student, offers an overview of developments in acupuncture legislation in this 45 minute webinar via the National Policy Group (NPG). Guimond emerged on the national scene with a report on legislative changes in 2013. He sends out regular updates. A January 2014 version notes new bills introduced in Arizona and Vermont. The NPG site does not provide any information on any other NPG personnel. The webinar is a good review of the current status of the field, state-to-state, relative to legislative priorities. Guimond can be reached, and his newsletter subscribed, via

Not yet “creating health” but “historic” Maryland plan shifts perverse payment incentives in hospitals

The Kaiser Health News article begins this way: “Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform.” The new payment structure, approved by the federal government, will limit Medicare payments to the level of the state’s per capita economic growth. Hospitals, which have grown their revenues at a rates twice as fast as the Maryland economy over the past decade, “agreed that their revenue from all sources – private insurance, government and employers – will rise no faster than growth in the overall state economy.” One administrator was quoted as saying that “we’ve done most of what we can do easily now.”

Comment: The article suggests that the key factor in cutting costs will be moving away from fee-for-service’s perverse incentive for hospitals and practitioners to do more. No one quoted seems yet to have jumped to the Berwickian band-wagon of focusing on “creating health.” (See related article above.) The opportunity for the integrative health and medicine community is to offer methods that will lead to savings. (Thanks to Frank Vitale, president of the Maryland University for Integrative Health, for sending the link.)