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 Bravewell Event: Health System & Military Leaders Say Economic Costs and Pain are Motivating Inclusion of Integrative Medicine 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: When it comes to motivation, money may be the queen among carrots and pain the king among sticks. Both financial gain and human pain may soon be promoting more rapid uptake of integrative medicine by mainstream organizations according to representatives from a major health system and the US military. The perspectives were shared during a forum entitled Integrative Medicine in Action sponsored by the Bravewell Collaborative of philanthropists in integrative medicine. If true, the long-standing struggle over misalignment of incentives between the health-oriented approach of integrative medicine and the disease-focus that spawned the $2.6 trillion medical industry may be finding a positive resolution. Obama's health reform and prescription pain-killers may be integrative medicine's best friends.

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Philanthropic group sponsored the event
W
hen it comes to motivation, money may be the queen among carrots and pain the king among sticks.

Both are increasingly on the side of a more rapid uptake of integrative medicine into mainstream delivery according to leaders of health systems and military medicine. Representatives of each spoke on November 10, 2011 at "Integrative Medicine in Action," seminar sponsored by the Bravewell Collaborative of philanthropists in integrative medicine that preceded the Bravewell Physician Leadership Award.

Moderator Jonathan LaPook, MD, the CBS medical correspondent, set the tone at the educational session. He made it clear that this year's program at the New York Palace Hotel would not merely feature opinions on integrative medicine's purportedly transformational philosophy, vision and mission. LaPook, who also moderated a previous iteration of the biennial event, scanned the packed parlor room of individuals who'd paid $250 a person to attend. He declared everyone present a member of the choir. No more preaching, he said. This year the speakers would deliver nuts-and-bolts on the state of integrating healing-oriented, whole person, integrative care within large healthcare systems and into military medicine.

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Jonathan LaPook, MD: CBS correspondent moderated
The field of integrative medicine has moved, as LaPook later put it, "from generalities to the specifics" of implementation. He nodded toward a table where Lt. Colonel Windy Hendrick sat. The F16 fighter pilot was to later present on the positive impact of her integrative health coaching for returning veterans. LaPook joked that if any speaker strayed into philosophizing, he'd pre-arranged with Hendrick to have the back-slider strafed.

LaPook's jest on such a forceful motivational strategy touched the day's pervasive theme. Do powerful incentives exist in the nation's $2.6-trillion payment and delivery system to propel integrative medicine into a leading role in reform?

Close observers know that misaligned incentives are a badgering blues soundtrack for integrative medicine's brief, 15-year history. The field's health-oriented approach runs at counter-purpose to the disease-focus that spawned the $2.6 trillion medical industry. 

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Tracy Gaudet, MD: from IM to the the VA
The challenge was captured recently Duke University Chancellor Emeritus
Ralph Snyderman, MD, a prior winner of Bravewell's $100,000 prize. He wrote a column in the Journal of the American Medical Association about an integrative outpatient program at Duke University. The program saved $2200 per employee but was killed by the system. Snyderman explained: "Ironically, because reimbursement compensates in-hospital patient care at a higher level than outpatient services, the health system realized a financial disadvantage, and the program proved economically unsustainable." 

In short, getting people healthy is not incentive enough. Speaker Tracy Gaudet, MD, formerly a co-worker with Snyderman at the Duke's integrative medicine program and currently the
inaugural director of the Veteran's Health Administration's Office of Patient-Centered Care and Cultural Transformation later put it this way: "The biggest mistake you can make is to believe that everyone wants to make health better."

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A potential for financial alignment?
Notably, the rest of Duke's integrative medicine initiative has been sustained in its first decade only through over $10-million of philanthropy from
John and Christy Mack, the Bravewell evening's Diamond Benefactors and hosts.

But presenter
Ken Paulus says this problematic financial climate for integrative medicine is about to be turned on end. Paulus is president and CEO for Minnesota's dominant delivery system, Allina Hospitals & Clinics.  He argued that the economic obstacle to expansion of integrative medicine inside healthcare delivery will change under the Affordable Care Act. Paulus recounted that Allina has "been in this business of treating diseases for 100 years and we do it very well." The system serves roughly a third of Minnesota's population. Then Paulus referenced the soaring cost of care in the United States: "Being increasingly broke completely changes the equation."

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Ken Paulus, Allina CEO
Paulus took a side-journey to underscore his point. He recounted a story he'd heard that intrigued him about an ancient Chinese form of healthcare payment. Barefoot doctors, he said, were only paid by communities if the people in their charge were kept healthy. Fast forward to the new payment forms in Obama's Accountable Care Organizations and Patient Centered Medical Homes. "For the first time ever," said Paulus, "the payment will change toward keeping people healthy." He repeated, for emphasis: "For the first time in 100 years it will be our job at Allina to keep the village healthy." 

This, Paulus concluded, is where Allina "is headed." And this shift is "the point of inflection" for integrative medicine.

"When I first heard of integrative medicine," he told his audience," I saw you as an expense."  He credited philanthropic support via the Penny George Institute for Health and Healing with keeping the integrative flame alive at Allina.  "We've had benefactors for integrative medicine. The George's [Family Foundation] and the Ted and Roberta Mann Foundation have bridged us to where we are going." But now Paulus anticipates that when the Affordable Care Act's payment structure "kicks in that supports keeping people healthy, you will be an asset. Integrative medicine will be an asset."

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Pain drives Army's interest in integrative medicine
Presenter Colonel Kevin Galloway turned attention to another well-known motivator. Pain, he said, has brought the US military to adopt holistic and integrative approaches. Galloway is chief of staff of the US Army's Pain Management Task Force and action officer for the
Comprehensive Pain Management Campaign Plan. "In the past," shared Galloway, "we used to say when you have more pain, give mor-phine."

This changed in a big way under the
guidance and personal experience of Lt. General David Fridovich. Said Galloway: "He made holistic okay. He redefined pain as a functional issue. He told the specialties you need to stop fighting among the tribes and focus on what is the best medicine." Galloway added: "We are rebuilding our system with a multidisciplinary approach. We have acupuncturists and massage therapists around our interventionists. We're forcing them to sit together."

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Colonel Kevin Galloway: Army initiative has team model
Integrative medicine's emergence was captured in the words, and presence, of Gaudet. The former Duke leader in integrative medicine now heads up the Veteran's Health Administration's Office of Patient-Centered Care and Cultural Transformation. The integrative medicine experience that informs Gaudet's work also includes an earlier stint as director of the Arizona Center for Integrative Medicine, founded by Andrew Weil, MD. Recalling that pioneering work, Gaudet stated: "In 1996, we had to argue to just have a conversation" about integrative medicine's potential value. 

Gaudet took up LaPook's practical charge: "We need to define what we mean by a transformed system. What is it that we want? We need to define a personalized health plan. What is it?" She moved into the nuts and bolts of the forms we use for gather patient outcomes related to pain. Gaudet suggested that a pain scale in a health-oriented system would not merely reach from a 10 for intolerable pain to zero for pain free. She suggested that intolerable pain should be a -10 in a scale that stretches not merely to 0 but to a true positive of 10 for happiness. Her suggestion was evidence-based: "We know that if patients have to fill in different boxes (in forms), behavior changes." She added: "We have to hard-wire this change" toward a health-orientation.

To 1960s-era Baby Boomers who fostered the growth of the alternative, complementary and now integrative medicine fields, the idea of military medicine leading the uptake of soft-belly, integrative practices can seem oxymoronic. Similarly, conventional medical professionals don't much like thinking that in the US system, making money and focusing on the health of our villages has too often proven an even more awkward fit. 

To listen to the speakers brought together by the Bravewell philanthropists, these cobbled motivators may yet launch integrative medicine as the transformational agent the Bravewell's founders have advocated for a decade. 


Send your comments to johnweeks@theintegratorblog.com
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 About The Author
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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