Integrative Medizin und Gesundheit. Группа авторов

Well-being, resilience and “health creation”

      3.2.4 Era 4: Acting through Consortia and Collaboratives (2001–Present)

      The experience of the beginning of inclusion – even if not yet an embrace of these practices and practitioners as potential methods to better treatment or lower the cost of care – stimulated activists in the movement, including the present author, to seek ways to produce a stronger and more influential voice for inclusion and transformation. Between 2002 and 2004, four influential collaboratives were created toward these ends.

      

Academic Consortium for Integrative Medicine and Health (“The Consortium”) The accomplishments of the Consortium, noted above, included: publishing “Competencies for Integrative Medicine” in Academic Medicine (Kligler et al. 2004); creating sample curricula; holding biennial NIH-backed conferences; and successfully requesting the leading accreditor of hospitals and medical delivery organizations, The Joint Commission, to reconsider its pain standard and more significantly include non-pharmacologic approaches (Weeks 2014).

      

Bravewell Collaborative Philanthropy plays a major role in all of US medicine and the same was true of the integrative movement. A set of these led by Penny George, the spouse of the former CEO and chair of Medtronic, and Christy Mack, the spouse of the former chair of Morgan Stanley, banded together to jointly invest in strategic projects to accelerated the movement. These projects included: the Consortium, a major public television documentary (The Bravewell Collaborative 2006), a Summit on Integrative Medicine and Health of the Public at the National Academy of Medicine (Institute of Medicine 2009), and multiple reports that highlighted the movement (The Bravewell Collaborative 2020).

      

Integrative Health Policy Consortium (IHPC) Federal elected officials who were friendly to the movement urged the different fields to come to Congress as one voice. As of 2019, IHPC had 27 partner organizations. The range was broad: integrative medical doctors; chiropractors; holistic nurses, naturopathic doctors; midwives; acupuncturists; homeopaths, and others. IHPC’s most significant work was that it had a hand in crafting 5 segments of the 2010 Affordable Care Act (Weeks 2020a). This historic level of inclusion related to delivery, workforce, payment, research and public health. It included the first recognition of the term “integrative health” in federal statute and an expansion of recognition of “complementary and alternative medicine” practitioners. What was once utterly outside federal law was gaining a presence within.

      

Academic Collaborative for Integrative Health (“The Collaborative”) The Collaborative aggregated the councils of colleges and other agencies for the licensed “CAM” fields (s. Table 1). Their accomplishments included: production of the interprofessional resource referenced above, the Clinicians and Educators Desk Reference on the Integrative Health And Medicine Professions; taking the lead in a National Education Dialogue to Advance Integrated Care: Creating Common Ground (Weeks et al. 2005) to engage with members of the Consortium; and participating in the movement for interprofessional education and team-based practice. Their most notable work has been in representing the integrative health field in the Global Forum on Innovation in Health Professional Education at the National Academy of Medicine. There, they provided leadership nationally in bringing forward subjects related to shifting focus toward health and well-being.

      Two other important organizations were formed roughly a decade later. Integrative Medicine for the Underserved focused on the lack of equity and access to the predominantly cash-funded integrative services among populations that did not have such excess capital. The Academy of Integrative Health and Medicine was created by holistic and integrative medical doctors who invited in their colleagues in the licensed integrative health fields to start the first, inclusive interprofessional professional organization. By 2014, leadership of these organizations were on working terms with each other and were coordinating efforts in multiple areas.

      3.2.5 Era 5: Convergence in Health Creation (2010–)

      The Obama-era Affordable Care Act of 2010 marked the formal arrival of the volume-to-value movement in US medicine. Leaders of academic Integrative Medicine organizations agreed in a 2013 survey that value-based care was creating an environment in which they were perceived to have more value to their larger delivery organizations (Weeks et al. 2016). More specialty groups were exploring how the integrative model might assist them in achieving their needs. A subset of those surveyed saw increased investment of their integrative efforts from the parent organization. Over 88% of these leaders of clinical centers among the Consortium perceived that they were operating with stronger values alignment in the era of accountable care. This sense of alignment was affirmed by the CEO of a major health system in a presentation sponsored by the Bravewell Collaborative:

       “When I first heard of integrative medicine in 2006, I thought of it as an expense. But as the Affordable Care Act’s payment structure kicks in that supports keeping people healthy, integrative medicine will be an asset.” (Paulus 2011)

      The integrative movement was more prepared than ever. Evidence of cost savings began to emerge. The Collaborative gathered most of this evidence on their website (https://integrativehealth.org/reducepercapitacost). A first thorough examination of cost-effectiveness in complementary and Integrative Medicine led by Patricia Herman, ND, PhD found evidence of significant cost-effectiveness in 28 separate studies (Herman et al. 2012). A close examination of 4,200 patients at the Benson-Henry Institute at Harvard Medical School who had completed a multi-week mind body program found wildly confirmatory evidence. As compared with matched pairs, the completers averaged 42 percent lower use of conventional services (Stahl et al. 2015). The findings, which held across emergency room visits, prescriptions, physician visits, and hospitalizations, provoked the authors to declare that evidence based mind body programs should potentially be spread to the whole public with the same governmental backing as vaccines and drivers education.

      This commences a truly integrative era in which certain complementary and integrative services were being explored as ways not just to lure patient but to meet declared values. In the United States, convergence in action began first in two areas: oncology and treatment of people with chronic pain. In the former, the Society for Integrative Oncology (SIO) had fostered, in the competitive oncology marketplace, expanding interest in complementary services. Integrative oncology began to be the norm rather than the exception in major oncology centers. Concurrent with the uptake, SIO, under the leadership of past-presidents Heather Greenlee, ND, PhD and Suzie Zick, ND, MPH, engaged an ongoing process of guideline development. It culminated in the influential American Society of Clinical Oncology endorsing a guideline for integrative practices in the treatment of patients with breast cancer (Lyman et al. 2018).

      The second, broader, and potentially much more influential evidence of the arrival of complementary and integrative practices and practitioners was stimulated by the nation’s crisis in the treatment of people with chronic pain. This whole systems issue reached headlines and policy attention reductively as the nation’s “opioid crisis.” The challenges were first felt in the military, where problems of returning soldiers and veterans produced the first robust exploration of non-pharmacologic, integrative interventions (Jonas et al. 2010). Key research was provided over the period of a decade through the Samueli Institute led by the first influential director of the NIH Office of Alternative Medicine, Wayne Jonas, MD. A former US Army Surgeon General Eric Schoomaker, MD, PhD became an outspoken advocate for the integrative model. A survey of CAM use reported in 2017 found that of the 142 military treatment facilities in the military health system, 110 (83%) of the 133 respondent facilities offer