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 Forum on the IOM: Bravewell's Post-Summit Statement on Key Factors in Any Health Reform Plan 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: The alpha and the omega of the IOM Summit is the Bravewell Collaborative. The organization of philanthropists laid down $445,000 to sponsor the gathering. Bravewell now plans significant additional investment to ensure that the outcomes have legs in shifting US healthcare. Just after the Summit concluded, Bravewell issued a statement which included eight "key factors which should be included in health reform." Here is the Bravewell list. Are you aligned? What did the Bravewell downplay or miss which you felt were key health reform outcomes which the IOM Summit began to shape as consensus?

The first significant sign of what the Bravewell Collaborative might do with the IOM Summit was the coalition formed with the AARP, the US Chamber of Commerce and the Prince's Foundation. More recently, Bravewell informed its donors that it would hold a major event in Washington, DC on November 4, 2009, to release a Summit document and promote Summit findings.

ImageThere is no doubt the Bravewell is determined to reform US healthcare. The directions it will prioritize were laid out in a statement shortly after the Summit. Bravewell lists eight key points that will shape its course. Are these aligned with your views of "integrative practice?" Put in a more challenging way: Do you believe that your profession and your practice are aligned with and honors these not just in word but in deed? If not, should your practice or profession be better aligned?

Notably, in the same statement, Bravewell offers an updated definition of its view of "integrative medicine." Those who were present will note that the organization is still has not adopted the term that seemed to be preferred by many at the Summit: "integrative health care."

"Integrative medicine is described as orienting the health care process to create a seamless engagement by patients and caregivers in the full range of physical, psychological, social, preventative and therapeutic factors known to be effective and necessary for the achievement of optimal health."

Factors to be Considered in Upcoming
Healthcare Reform Efforts

- Bravewell Collaborative

(from this webpage)

  • The progression of many chronic diseases can be reversed and sometimes even completely healed through lifestyle modifications. Lifestyle modifications programs have been proven to not only improve people's overall health and wellbeing but to also mitigate cardiac disease and prostate cancer, among other chronic conditions.

  • Image
    Christy Mack, Bravewell president
    Genetics is not destiny. 
    Recent research by Dean Ornish, MD, and others has shown that gene expression can be turned on or off by nutritional choices, levels of social support, stress reduction activities such as meditation, and exercise.

  • Our environment influences our health.  Mounting evidence suggests that the environment outside one's body rapidly becomes the environment inside the body.

  • Improving our primary care and chronic disease care systems is paramount.  Participants widely agreed that our primary care system is in danger of collapse and that we must retool how both primary and chronic disease care are delivered.  The new system must focus on prevention and wellness, and put the patient at the center of care.

  • The reimbursement system must be changed.  The Summit grappled with the current reimbursement system that rewards procedures rather than outcomes and urged changes that would incentivize physicians to focus on the health outcomes of their patients.

  • Changes in education will fuel changes in practice.  Implementation of an integrated approach to health care requires changes in provider education.  All health care practitioners should be educated in the importance of compassionate care that addresses the biopsychosocial dimensions of health.

  • Evidence-based medicine is the only acceptable standard.  Researchers and practitioners alike concurred that health care should be supported by evidence and urged further research and testing to expand the evidence base for integrative models of care.

  • A large demonstration project is needed.  Because funding for research on the effectiveness of specific models of care is difficult to obtain from standard grant channels, participants voiced support for pursuing a demonstration project funded by the government that would fully demonstrate the effectiveness of the integrative approach to care.

:  I am imagining the document which the Bravewell will publish this fall from the dozens of papers, presentations and assessments leading up to and involved in that rich, 3-day meeting. I am also thinking of my own journalistic process in which my "reporting" is openly skewed by my own values an strategic sense of what is most important to get across. Bravewell is choosy about those with whom they align, the language they select, and the individuals and themes they promote.

That said, the document which will be produced will be a Bravewell document, as I understand it, not an IOM document. Put in school-yard terms, Bravewell owns this football. The Summit's historic meaning is thus likely to be an elaboration of the themes enunciated here. I have no gripes, as far as they go, and in fact like these very much. One wonders, however, about the way double standards exist around the application of "evidence-based medicine."  Present practice favors the one-third to one-half of conventional treatment which is, according to the IOM, wasteful. (IOM, February 2008, From Waste to Value in Healthcare) Note the Summit-related comments of participant Michelle Simon, ND, PhD, about the Technology Assessment Panel on which she serves in Washington State: when applied, many conventional treatments are not covered. The evidence isn't there. And who will be in and who out? Will for instance, "improving primary care" include the theme of having additional practitioner types, and not just nurses but the likes of naturopathic doctors, broad-scope chiropractors and up-trained acupuncturists in the mix such as are alluded to  by Mary Jo Kreitzer, RN, PhD, FAAN, Elizabeth Goldblatt, PhD, MHA/PA and Simon in their comments? Will the Bravewell allow themselves to let the paradigm shift to the more inclusive "health" rather than the exclusive "medicine?" Hope so. We shall see.

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Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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