Draft National Prevention Strategy nearly mum on “integrative care” despite significant inclusion in enabling law Comments close 01 13 11A comment period closes closed January 13, 2011 on the draft National Prevention Strategy. The law behind this strategy represents
A comment period closes/closed January 13, 2011 on the draft National Prevention Strategy. The law behind this strategy represents the most significant inclusion of “integrative care” in federal policy. Three of the top 4 purposes of the National Prevention, Health Promotion and Public Health Council, through which the strategy is being developed, reference “integrative care.” The short-comings of the draft strategy are pointed out in a filing on the strategy’s framework from the Samueli Institute, led by Wayne Jonas, MD. The Samueli Institute, a strong backer and conceptualizing influence for the law that established the Council, points out that the strategy is being determined without the Council first establishing an Advisory Group of community leaders from outside government that the law requires. Notably, this group was to include at least one integrative care practitioner. (See Section 4001 here.) Evidence of the kinds of value in prevention and health promotion that might come from adhering to a progressive inclusion of integrative health care practitioners is present in this position statement filed by the Associated Bodywork and Massage Professionals. Readers can respond here to the draft National Prevention Strategy until January 13, 2011.
Comment: I mailed an “alert” to Integrator readers to stimulate response from the integrative practice community to the draft framework for the strategy (comment period closed December 5, 2010) and then the draft strategy itself (comments closing/closed January 13, 2011). The draft plan teases one with its language. The opening salvo is that the strategy:
” … provides an unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention.”
Nice. Yet it seems to be doing so without embracing the challenges of bridging the chasm between reactive, sickness-focused clinical care and a wellness focus. This is precisely the promise that “integrative practice” represents. Wouldn’t it be nice if clinical care was shifted to integrative, health-oriented principles and practices that create the kinds of prevention and wellness outcomes as side effects that were found in this report:
” … (self reports) found improvement in multiple areas: fatigue, sleep, weight, stress, allergic symptoms, hypertension, coffee consumption and muscoloskeletal problems …”
The so-far meager participation of the integrative practice community in this dialogue suggests that the community is not yet adept at either making its case or gathering the resources to show up. This is sad-making, particularly since the law gives “integrative care” significant standing. Hopefully, the community will increasingly seize opportunities as they arise.
When the Centers for Medicare and Medicaid Services requested comments on preliminary standards for Accountable Care Organizations (ACOs), the chiropractic profession responded with strength. Over 30 DC organizations filed responses. John Falardeau, vice president for government relations with the American Chiropractic Association (ACA) shared the organization’s response, printed here in full. The ACA’s core argument is one that if chiropractic physicians are not included in ACO teams “but treat beneficiaries attributed to ACOs and achieve cost savings, it would be inappropriate to reward only those providers who are delineated within the legal structure of the ACO, rather than those providers responsible for the cost savings.” They note recent studies that have shown savings. The chiropractors began tracking the ACO issue closely when the National Committee for Quality Assurance, requested comments on their Draft Accountable Care Organization Criteria, the end-date for which was November 19, 2010.
Comment: The ACA’s point is well made that those who may be responsible for savings should share in benefits. My guess is that the ACA speaks for more than one profession in calling for a “reconsideration of the practitioners that are needed in an ACO and to expand this list to include … [your non-included profession here].” The ACA also spoke indirectly for other non-included or limited professions in its response to the NCQA:
“The limited nature of the practitioners who will be considered primary and specialty care practitioners in NCQA’s definition of an ACO will seriously limit the ability to reduce per capita costs.”
Note, for instance, the cost-savings in this report on the whole practice of naturopathic physicians. Given public use of chiropractors and other “CAM” practitioners, broad inclusion would also seem to be required if an entity is to meet the NCQA definition of an ACO as an organization in which “providers will need to be clinically integrated and work together to seamlessly coordinate care for assigned patients.”
Read other sections of the John Weeks Round-up: