Integrative Care Promises to Be More Effective, Cost-Efficient
Focusing on integrative care, or caring for all parts of a person, could help people become more active participants in their health, hopefully making them healthier while driving down costs, researchers said.
By Susan E. Matthews
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FRIDAY, November 8, 2013 —For many people, visits to the doctor are about figuring out what is going wrong and then deciding how to treat that problem. This approach, however, focuses too much on the disease and not enough on well-being, according to researchers at the Bravewell Collaborative’s lectures on Health and Wellbeing: Integrative Medicine and the Transformation of Healthcare.
“True health is wellbeing, not just the absence of disease,” said Christy Mack, co-founder and president of the Bravewell Collaborative, as she introduced a series of speakers yesterday who went on to explain how to make integrative care a more prominent part of the country’s health care system, and what the benefits of such an action might be. The Bravewell Collaborative is a philanthropic organization founded in 2002 to establish a new standard of care based on the principles of integrative medicine.
The basis of the idea of integrative medicine is that care would be more complete and effective if all of the patient’s needs were attended to, rather than just using science-based medicine to address the disease. In addition to science-based care, this includes good nutrition, proper rest and relaxation, movement or exercise, stress reduction, awareness and engagement, and complementary approaches such as acupuncture. These numerous methods of care are ideally coordinated in tandem by a healthcare professional, and the individual remains at the center of the process, said Ralph Snyderman, MD, professor of medicine at Duke University School of Medicine.
For example, Dr. Snyderman said, while the current medical practices might attempt to treat a tumor, integrative care would aim to treat the entire patient, not just the tumor.
“In the next five years, it will be the standard of care,” Snyderman said, pointing out that with debate over the Affordable Care Act and rising healthcare costs, “healthcare is more on the agenda today than any other time.”
Finding the Inspiration to be Healthy
One of the problems with only trying to treat the disease or problem is that this approach often fails to inspire people to take responsibility for their health, said Tracy Williams Gaudet, MD, director of the Veterans Health Administration Office of Patient-Centered Care and Cultural Transformation. Dr. Gaudet was also honored with a Bravewell Collaborative Leadership Award on Thursday for her work.
“When you ask people to do something for their health, it’s not very motivating if the goal is to ‘reduce your lipids,’” she said. Gaudet works with veterans, and told the story of one veteran who was overweight.
“He said ‘every doctor I see tells me I need to lose weight…you think I don’t know?’” Gaudet recalled the veteran saying. For him, the advice to lose weight wasn’t helpful — he needed more support to learn how to eat differently.
“If we don’t have the skills we need to eat differently, to take our medications on time, we’re not going to succeed,” Gaudet said. Integrative medicine focuses on providing those skills, often through the help of supplement classes and resources, for example, meetings with nutritionists or access to meditation classes.
Often, these supplement treatments can be coordinated and learned by working with professionals who aren’t doctors, but can provide individuals with the necessary skills to improve their health and even hopefully prevent future health problems, Gaudet said.
Problems with Payment
For these reasons, integrative health care has the potential to be more cost effective than the current health care system, the researchers said. Often, the problem stems back to a payment system that rewards doctors only for treating disease, not for preventing it.
“Medicare will pay for the amputation of a diabetic foot, but it won’t pay the for the podiatrist’s prevention,” Gaudet said.
The other conference participants agreed that a huge barrier to more effectively teaching people how to be healthy and prevent disease is how insurance companies dole out health care.
“We don’t have a health care system in America, we have a disease management program,” said Andrew Weil, MD, director of the Arizona Center for Integrative Medicine at the University of Arizona. Dr. Weil is currently testing a new method of payment at his primary care clinic in Arizona. Participants pay two fees: a reimbursement fee that operates like normal insurance and a membership fee, which covers access to the preventive and wellness services offered at the clinic. Weil hopes to demonstrate that under this method, people end up paying less for health care in the long run, and that it’s a sustainable model.
The Affordable Care Act starts to address some of these gaps, by requiring that annual general visits are covered by insurance, and by starting to bundle services, Snyderman said. The bundling of services means that, for example, if a patient goes into the hospital for a heart attack, rather than add up each individual procedure that is done, there is one fee for the hospital’s handling of the heart attack and 30 days of follow-up care.
It’s also important to consider how well trained doctors are to address all of a patient’s problems, or at least direct patients to appropriate resources, said Myles Spar, MD, director of the Integrative Medicine at Venice Family Clinic’s Simms/Mann Health and Wellness Center in Los Angeles, who also received a Bravewell Leadership Award on Thursday.
“After I left medical school and started seeing patients, I felt I was equipped to take care of about half of them,” he said. This feeling, and his experience participating in Doctors Without Borders and seeing more holistic care elsewhere in the world, inspired Dr. Spar to complete the Bravewell Fellowship in Integrative Medicine at the University of Arizona, and then put his training into practice at the Venice Family Clinic. He also founded Integrative Medicine Access to help connect patients with integrative medicine care, particularly those with low incomes.
“The message is that this isn’t elite medicine — it’s not boutique,” Spar said.
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