John Weeks July 2012 Integrator Round-up on Policy with updates on:  National Coordinating Center for Integrative Medicine; Supreme Court upholds Affordable Care Act, maintains key footholds and opportunities for CAM and integrative health.

HRSA offers $3.3-million in grants related to new National Coordinating Center for Integrative Medicine

The U.S. Health Resources and Services Administration (HRSA) has announced two inter-related grant programs that are creating the most significant presence to date for “integrative medicine” at the federal level. The two programs total $3.3 million over the next 3 years. The largest chunk is $2.5 million to dispense to some 16 programs, most likely in grants of up to $150,000 each to conventional medical schools as part of an integrative medicine in residency (IMR). Beneficiaries will offer programs to incorporate “evidence-based integrative medicine” content into existing preventive medicine residencies. The second is more remarkable, by title. With $800,000 to some entity, best bet a medical school, HRSA will establish a National coordinating center for Integrative Medicine (NccIM – their acronym). The core purpose is to provide technical assistance to the IMR programs, and to evaluate them. The Center’s initial duration would be September 2012-September 2014.  

Comment: The creation of NccIM is interesting for those who recall the recommendation of the White House Commission on CAM Policy (2001) to create a federal CAM center. The National Policy Dialogue to Advance Integrated Health Care made a similar recommendation. Nothing faintly echoing this has happened for the ensuing decade until this HRSA program.

The question is: Is NccIM only meant to oversee the IMR? The language in the grant suggests a longer reach. The scope of technical assistance to be provided is explicitly “not limited to” the IMR programs. In fact, the NccIM will be charged with “analyzing the efficiency of integrative medicine.” This would seem to open a barn door into untold opportunities. For instance, the NccIM can assist not only grantees but “other interested residency programs.” No limit to preventive medicine here. In addition, the NccIM will offer “guidance in the implementation of the integrative medicine projects, and demonstrating expertise in the field of evidence-based integrative medicine modalities for health professions disciplines.”

In short, it looks like we’ve got a national center – if located outside the federal government. It’s just clearly focused on medicine and medical schools, rather than CAM and the broader group of disciplines with which the White House Commission was concerned. Here’s hoping that HRSA will give a premium to those IM programs that are partnered with CAM academic institutions. (Thanks to Ryan Bradley, Jud Richland and Taylor Walsh for information on the grants.)


Supreme Court upholds Affordable Care Act, maintains key footholds and opportunities for CAM and integrative health

The June 28, 2012 announcement of the 5-4 decision of the U.S. Supreme Court to uphold the constitutionality of the Affordable Care Act left intact a series of footholds in federal policy for integrative health and complementary and alternative medicine disciplines. These and the law’s initiatives to allow systems to finally get paid for keeping populations healthy are the subject of The Supreme Court and Health Reform: Much is at Stake for Integrative Medicine. One who is close to those changes is Janet Kahn, PhD, CMT, a senior policy adviser to the Integrated Healthcare Policy Consortium. Kahn helped lobby some of the changes and subsequently was appointed to the Advisory Group on Prevention, Health Promotion, Integrative and Public Health of the National Prevention, Health Promotion and Public Health Council. Kahn sent the following comments to the Integrator the morning of the Court’s decision:  

“I have been happy dancing and exchanging emails and texts with colleagues for the last two hours. This is great news for the American people and for the integrated healthcare community. First of all it says that this country and all of its three branches of power are not hopelessly lost in a partisan fever that outshouts all rational thought.  That is good.  Secondly, by upholding the individual mandate the laws financial ‘success’ is much more likely and thus the vision is given a chance at sustainability. It is as near as we have ever been to making a clear statement that people have a right to health care, although those are not the terms on which this was argued or decided.

“Perhaps the best news, however, is that a law that is designed to move us from thinking about medical interventions to thinking about health promotion and maintenance is allowed to move forward.  This law has within it some sections that are distinctly supportive of bringing integrative healthcare professionals into public health and healthcare delivery systems.  More than that, however, it is chock full of language that speaks the values of most CAM professionals – values of primary prevention through helping people establish and maintain good health and balance – a worldview that acknowledges that health and/or disease is established by how we live, including how we are able to live in a country full of economic and geographic disparities.

“This understanding is acknowledged in the creation of the National Prevention, Health Promotion and Public Health Council which charges 17 distinct cabinet level departments and agencies with joint responsibility for wellness and health promotion because distinct as they might be, what they each do contributes to making it easier or harder for Americans to live healthy lives.  It is a victory that this has been acknowledged and acted upon.  Last week the Council released its Action Plan which takes the National Prevention Strategy and moves it into specific actions that each department/agency is taking or is committed to taking in the coming year.  It is not everything we might have dreamt of, but it is a good start.  It is my sincere hope that this ruling by the Supreme Court further protects the Prevention Fund and these efforts as well.”

Comment: It is not everything we have dreamt of, but it is a good start. I share this sentiment, and it is also clear that a significant subset of the integrative practice community finds the Affordable Care Act a dangerous abomination. One long-time reader, the community-based integrative medical doctor Chris Foley, MD wrote of my support: “You have no idea how much this will cost, the potential gain sharing, the total waiver in it of all the Stark and Waxman laws (surprised?), and the massive bureaucracy it will create. Your ardent support without really understanding even fractions of the bill or how an ACA will be run is embarrassing.” Holistic Primary Care editor Erik Goldman offers his wide-lens, ironic perspective here. Another valuable perspective that dissents from support of the reform is that of the Alliance for Natural Health. Their perspective focuses on Health Savings Accounts: What the Supreme Court Decision Means for Integrative Medicine. A view from functional/integrative medicine leader and author Mark Hyman, MD is here: Why Obama Care is Not Enough: It’s the Costs, Stupid!