On the surface of things, the values of “accountable care” and “patient-centered medical homes (PCMH)” and those of integrative medicine suggest a convergence. A survey found alignment in integrative medicine leaders. Maryland integrative doctors David Fogel, MD, and his spouse Ilana Bar-Levav, MD, presented with a substantial philanthropic gift, jumped into the apparently convergent rivers with both feet, creating the interprofessionally rich environment that is now CHI Health Care. The goal was and remains to prove the value proposition of integrative medicine in the medical industry’s move from volume to value. The center gained recognition as a PCMH and became part of a Medicare Shared Savings accountable care organization (ACO). Now Fogel makes clear that the convergence of the two paradigms have produced rumblings of boulders at the river bottom. While he remains positive about the model, the systemic obstacles are daunting.
At one point over the past three years of robust expansion of dialogue related to chronic pain care I received a somewhat panicky email from an integrative care advocate. He was concerned that by me speaking of the “opportunity” for integrative health produced by the US’ enthrallment with opioids that his field would be tainted as “opportunists.” Fact is, the dialogue over right use of “non-pharmacologic” practices and practitioners in chronic pain treatment has provoked a quantum opening in many quarters. This article shares an invitation to a December 4-5 workshop at from the National Academy Medicine (NAM) – the most robust inclusion of integrative health there since the 2009 Summit. Also included: another positive development at NAM, and first notes of advances at AIPM’s recent Integrative Pain Care Policy Congress. The bad news of the opioid crisis is proving very good for opening needed dialogue.
One can easily count the chickens of non-pharmacological approaches highlighted in multiple organizational guidelines and state strategies related to pain and opioids. But one definitely cannot count on them hatching inside each new, significant policy initiative. Regular medicine tends to regress toward a non-inclusive mean in pain treatment. And “mean” may be the operative word – at least from the perspective of individuals who remain unaware of the integrative therapies and practitioners that may help them.
The movement from the wild-west of “alternative” medical practices into mainstream respect and inclusion is typically a process of standard-setting, self-regulation, and then governmental action. Two principals in the Osher Collaborative for Integrative Medicine recently asked whether – with the chaotic and rapid expansion of the field — its time for integrative medical doctors, in particular, to consider additional, proactive steps.