A leader of a consulting group, Alan Spiro, MD (pictured below left), and the director of the Duke Leadership Program in Integrative Healthcare, Adam Perlman, MD, MPH (pictured below right) recently posted an article titled A Holistic Approach to Health Care Can Lower Costs and Improve Quality. The assertion is a no-brainer for most in the integrative health space. What makes the article notable is the medium: the principal online publication of the American Hospital Association.
The strategy in the Hospitals and Health Networks (H&HN) article first follows familiar contours. Perlman and co-author and consultant Alan Spiro, MD, peg both title and content to the goals of the value-based medicine reform movement in US medical delivery. They locate their thesis in the center of organized medicine’s aspirational yet poorly attained focus on “patient-centered care.” They then give the term an integrative twist, for the disease-focused hospital businesses is paradigm-shifting. “To accommodate true patient-centered care, the focus of our health care system must shift from only treating disease to also creating health and well-being.”
Then the authors add a dimension. They suggest that alongside of two prevailing models of care – “biomedical” and “integrative” – a third model has emerged and deserves consideration. They introduce the idea of an “Assisted Model” for care. In this model ,“consumers get the support they need — via a trusted adviser — to navigate the health care system, coordinate care, address life-context issues, and curate other health- and benefits-related services.”
The assistance model uses care coordinators, coaches, navigators, social workers and others to support patients in getting the right services at the right time. In so doing, they cut down on the “process errors” that may come from patients overlooking, or forgoing optimal, timely treatment. Such care has been shown in biomedical settings to reduce costs by 15 percent.
Optimally, according to the Spiro/Perlman team, “The greatest advances in health — and savings in the cost of care — will come when all three models are employed in concert to help people achieve their health goals.” They underscore that a powerful contribution of the “integrative medicine model” is to “close care gaps and improve treatment effectiveness — particularly for patients with complex, chronic conditions — and it can improve the safety of primary care by improving communication between practitioners.”
Comment: A couple of thoughts here. First, the Cleveland Clinic “functional medicine pod” model of care appears to embrace much of this approach, with a caveat. The Cleveland Clinic team is a trio of a functional medical MD – coupling biomedical and integrative orientations – plus a nutritionist and a health coach. All 3 models are present. The caveat is that this is without as much breadth in provider type and full-on mind-body services as an expansive integrative approach might offer. I wonder what percentage of community-based functional and integrative practices full embrace the “assisted model” concept.
Second, the focus on “process errors” reminds me of a comment during the recent national dialogue on the finding on 250,000 medical deaths per year. A medical doctor commented on the Medscape site that the most significant “error” are not those of doctors but rather the errors individuals make in their lifestyle choices. These shortcomings are included by the Spiro/Perlman team as “process errors.” They note that a PricewaterhouseCoopers report has attributed between $303-billions and $493-billions of treatment costs each year to such “errors.” Integrative medicine with its focus on the whole person rides right into this crisis with its white hat on. “Here,” wrote the authors, “the integrative model thrives.”
Finally, it is good to see this thorough linkage, in this American Hospital Association medium, of the integrative model’s alignment with the movement for value-based medicine. The movement is served to repeat this connection until everyone reflexively thinks “integrative care” when they hear “Triple Aim.”