November 2014 John Weeks Integrator Round-Up: Policy
November 10, 2014
top champion for the past 20 years, US Senator Tom Harkin (D-Iowa), was one foregone conclusion of the 2014 Congressional election. Harkin had announced plans to retire. Now the new Republican majority in the United States Senate will remove from their positions of power the next two most significant advocates. First, the person known as the third most powerful elected official in the United States, the chair of the US Senator Appropriations Committee, will no longer by Maryland Senator Barbara Mikulski. She has been Harkin’s close colleague on all things integrative, is a strong advocate for acupuncture, in part through her close relationship with Brian Berman, MD, of the University of Maryland Center for Integrative Medicine and Charlotte Kerr, LAc, MPH and the Maryland University of Integrative Health. She also championed the resolution that gave naturopathic physicians their first formal standing in a Congressional act. An additional significant loss is in the Senate Committee on Veterans’ affairs. The current chair isby John Weeks, Publisher/Editor of The Integrator Blog News & ReportsRepublican Senate Win Sweeps Key Integrative Health Leaders from Powerful RolesThat integrative health and medicine’s would lose its top champion for the past 20 years, US Senator Tom Harkin (D-Iowa), was one foregone conclusion of the 2014 Congressional election. Harkin had announced plans to retire. Now the new Republican majority in the United States Senate will remove from their positions of power the next two most significant advocates. First, the person known as the third most powerful elected official in the United States, the chair of the US Senator Appropriations Committee, will no longer by Maryland Senator Barbara Mikulski. She has been Harkin’s close colleague on all things integrative, is a strong advocate for acupuncture, in part through her close relationship with Brian Berman, MD, of the University of Maryland Center for Integrative Medicine and Charlotte Kerr, LAc, MPH and the Maryland University of Integrative Health. She also championed the resolution that gave naturopathic physicians their first formal standing in a Congressional act. An additional significant loss is in the Senate Committee on Veterans’ affairs. The current chair is Bernie Sanders, the independent from Vermont. Sanders is credited with inserting the licensed complementary and alternative medicine professions into Section 5101 on workforce of the Affordable Care Act. He’s also a strong advocate for vast expansion of access to integrative services across the Veteran’s Health Administration.Comment: Hand-wringing is probably in order. One area of major concern is likely the ongoing funding levels for the NIH National Center for Complementary and Alternative Medicine. Yet at the same time I recall that the Design Principles for Healthcare Renewal, an important early document in the assertion of the emerging integrative medicine movement, was first crafted following a daylong session in the Rayburn House Office Building chamber directed by then Congressman Dan Burton (R-IN) who, to use a line of my father, was “to the right of Attila the Hun.” Complementary and integrative health and medicine has always made for strange bedfellows. Utah’s Republican Senator Orrin Hatch has been a champion for access to botanicals and dietary supplements, for instance. Still, it’s hard to imagine replacement by leaders with the passion for our fields as these three. A lucky era of political stability and strength for integrative health and medicine is over. Who has quality relationships on the other side of the aisle? A longer article on the subject, and looking at likely Republican successors, is here in the Huffington Post. IHPC Opens Much Needed CoverMyCare Campaign for Consumers on Non-Discrimination in Health CareThe Integrative Healthcare Policy Consortium (IHPC) has sent a release to kick off its national campaign called CoverMyCare to engage and support citizens in gaining coverage of services of licensed complementary and integrative health practitioners. The campaign is pegged to Section 2706, Non-Discrimination in Health Care, of the 2010 Affordable Care Act. The site is expertly developed and managed by integrative health and medicine consultant Taylor Walsh, an Integrator adviser. The campaign is supported by grants from Bastyr University and the American Massage Therapy Association (AMTA).Comment: Take a look at this compelling, active web-site for a campaign that optimally would have begun the minute the Affordable Care Act was passed with Section 2706 as part of it. Stirring the grassroots is particularly timely and necessary, particularly with the loss of defenders Harkin and Mikulski (see above, and below). Credit IHPC, Bastyr, AMTA, and Walsh, who proposed and developed the site. The chief problem I have with it is that this is only funded for 6 months. Others need to step up to power this further, and more broadly. IHPC on HHS Missing Deadline for Response to US Senate Demand That It Follow Congressional Intent on Non-Discrimination in Health CareThe November 3, 2014 date has passed by which the US Department of Health and Human Services and two other federal agencies were to have responded to the demand from the US Senate Appropriations Committee that it rescind the misleading guidance document. The guidance was relative to Congressional intent on Section 2706, Non-Discrimination in Health Care. The HHS had effectively let insurers do nothing. The Integrative Healthcare Policy Consortium (IHPC), which has been dogging the issue for the public, released these remarks to the Integrator:“Michael Traub [ND, co-chair of IHPC’s Non-Discrimination Committee] has been in touch with Senator Harkin’s office. [He reports that] both HHS and the White House were stalling because of Election Day and not wanting to upset insurers. After the result of the elections, that won’t be as much of an issue and it may be possible to get HHS to take more seriously the request to clarify the faulty guidance. The Nov 3rd deadline given by Sen. Mikulski and Harkin was responded to by HHS with a letter that they are reviewing the responses to the RFI but no indication about processor conclusion. Janet Kahn [IHPC senior policy adviser] indicated that Sen Mikulski will be a strong voice in the near future.”Comment: If anyone had any questions about the extent of losses with Harkin and Mikulski no longer empowered after January 2014, noted above, this memo should convince. It also puts a premium on the activity of these two in the next two months of their waning influence. One wonders how much other unfinished business each has that will be competing for their time. Veteran’s Health Administration Initiates Integrative Health Coordinating Council to Set System-wide Plan via Office of Patient Centered Care & Cultural TransformationOn November 4-5, 2014, roughly 40 leaders in integrative health practices across the US Veteran’s Health Administration met in Salt Lake City over a 3 day period to “create a plan to roll out a standardized, sustainable, measurable plan that will make the strongest possible business case for integrative health practices” in the VHA. The work is led by long-time integrative health and medicine leader Tracy Gaudet, MD, the director of the VA’s Office of Patient-Centered Care and Cultural Transformation. The first half of the meeting involved input from a set of six outsiders who were brought in as subject matter experts. It concluded with detailed work on a plan development led by members of an outside agency that is consulting with VA. Kennita Carter, MD, a Bravewell Fellow who is a leader in the effort, clarifies that the plan, while standardized, is envisioned as “a flexible framework – a flexible, tiered, phased-in approach” that can be useful regardless of the state of integrative health practices in a given facility. The over-arching goal is to meet a core VA goal of “advancing a model of health care that is personalized, pro-active and patient-driven and engages and inspires veterans to their highest level of health and well-being.”Comment: VHA has a unique role in US healthcare as our own “single payer” system. The agency’s success in implementing electronic health records positioned it as a model, even as recent reports around access issues seem to echo the broken nature of the civilian system. One can only whole-heartedly hope that the commitment at the top of the VA to an integrative health focus, as evidenced by the hiring of Gaudet and formation of this group, will once again position VHA as a model for transformation into a true healthcare system.For more information on the transformation read the Department of Veterans Affairs “Blueprint for Excellence.” This document outlines four themes and ten essential strategies which frame a set of activities that simultaneously address improving the performance of VHA healthcare now, developing a positive service culture, transitioning from “sick care” to “health care” in the broadest sense, and developing agile business systems and management processes that are efficient, transparent and accountable. Strategy Six focuses specifically on advancing health care that is personalized, proactive, and patient-driven, and engages and inspires Veterans to their highest possible level of health and well-being. Read the entire document at: http://www.va.gov/HEALTH/docs/VHA_Blueprint_for_Excellence.pdf Does the Concept of the Commons Have a Role in the Future of Integrative Health and Medicine?The Omega Institute in Rhinebeck, New York, has long been a center of activity relative to integrative health and medicine. Omega has lately taken up the idea of the “commons” as part of its mission to “through innovative educational experiences that awaken the best in the human spirit, provide hope and healing for individuals and society.” The Commons are Making a Comeback, a November 2 opinion piece via Aljazeera America, described a “historic conference” at Omega called Building a Collaborative Commons. Speakers ranged from environmentalist Bill McKibben to former Obama adviser Van Jones to internet pundit Jeremy Rifkin. The integrative health and medicine movement was not directly represented.Comment: In 1993 in my transition out of a decade of organization-building and politics in the naturopathic medical field, I attempted to write a book under the working title of Our Healthcare Commons. The choice was a response to the under-powered reality of all natural healthcare in our present form of capitalist organization. Each is strapped by the common “non-patentability” of natural agents and practices. Everything from self-care to botanicals to nutrition to mind-body to physical medicine to group programs to mental health to coaching to movement has in common this non-patentable characteristic - and thus this economic disadvantage. So why not turn the negative on its head and seek to promote these as our “commons” – figurative meadows that we own together? What if instead of shrugging our shoulders in resignation regarding the non-patentability, we actively promote our special responsibility and shared “ownership” to elevate and protect? For multiple reasons, the book never got finished. Perhaps its value was simply that twenty years later I’d write this note that we see our close connection to this broader movement. (Thanks to Jamie Harvie, director of the Institute for Sustainable Future, and a member of the Commons Health Network, for the link to the article. See his comments below.)Comments from Jamie Harvie: "As Integrative Health and Medicine has at its core a systems worldview, patient agency and a preventative approach, it should be clear that the commons are implicitly part of Integrative Health and Medicine. To understand, it helps to recognize that a discussion of the commons must necessarily include both common resources - food, climate, water, green space - all connected to a prevention agenda, but as well commons principles, or how we manage these resources. These principles have a strong relationship basis and include shared decision making (or agency), boundaries or a sense of place and more. In fact the commons are already embedded within the Affordable Care Act, through a variety of drivers such as the Community Health Needs Assessment Process. It becomes clear, that the extensive place-based health creation work in communities such as Atlanta, or Akron or national programs such as Place Matters, are beginning to employ components of a commons framework. In Portland, a variety of community and healthcare partners received a health commons grant from CMS. These projects don’t yet include an integrative clinical approach. Our take is that that the integrative health community is at the forefront of this collective health creation work and that to truly catalyze health we need to connect this burgeoning clinical community with communities and visionary healthcare leadership. This is the case and narrative we've been making over the last two years in the work and conferences of the Commons Health Network. The future of health, necessarily includes an emphasis on community, relationships, prevention and engaged and empowered individuals. It is not hard to understand how integrative health and medicine will be central to the future of our shared health.” The Bridge to Health Creation through “Community Development” Workers/OrganizersThe September 2014 editorial co-written by Michele Mittelman, RN, MPH, co-founder and managing partner of Global Advances in Health and Medicine (GAHM), declares the journal’s dedication to being “systems’ focused – our approach will transcend academic or professional disciplines.” This commitment is manifest in an 8-page submission entitled “Fostering Health Creation: Community Development to Address Long-Term Conditions.” The international set of authors led by Brian Fisher, MBBCh, MSc, MBE includes long-time integrative health and medicine leaders from England, Sweden and the United States: George Lewith, MD, PhD, Torkel Falkenberg, MD, and Wayne Jonas, MD, respectively. The focus is on “the role of community development in health, focusing on how it works on the ground, the evidence base for clinical and cost effectiveness, and gaps in that evidence.” Bottom line, as the authors note, is that the Institute of Medicine’s Shorter Lives, Poorer Health (2013) found that “countries that invested more in community development than in advanced medical treatment had better trends in the majority of health indicators.”Comment: Those with integrative health’s health-creating values orientation have much to learn from this emerging orientation. Participants in the September 2014 event to honor US Senator Tom Harkin will have seen evidence of this cross-over work in projects of Jonas’ Samueli institute and the Institute for Integrative Health founded by top NCCAM grant-getter Brian Berman, MD. I was amused on reading to see the profound overlap between the “community organizing” tenets of the likes of Saul Alinsky to empower communities politically with those of the softer-sounding “community development” in empowering communities toward health. Personal note: an expert cited by the authors in a side-bar is Jim Diers who cut his teeth as a community organizer in the late 1970s in the Southeast Seattle Community Organization. There he worked with under-served populations at a time when I was doing similar organizing and writing work in Seattle – including with his organizer spouse, Sarah Driggs - prior to applying what skills I had to the early emergence of integrative health and medicine. Funny how circles can come around.