The early “integrative medicine” period clearly was one of “non-integrated integration.” The hospital or insurer wanted to throw the consumer an integrative bone in the competitive marketplace. They produced stand-alone integrative clinics or a carve-out insurance products. Offerings, in these forms, serve dual purposes. The medical delivery organization or insurer pleases patients by offering a little yoga, or acupuncture, or manipulative therapy or massage. At the same time, the non-integrated nature of what is offered pleases medical leadership: they are not asked to take the integrative methods seriously. They needn’t cross the medical-cultural divide to weigh whether the integrative approaches may be better than usual care. For most of the past decade, the Society for Integrative Oncology (SIO) has been building bridges across the chasm. Twice they’ve developed integrative oncology guidelines with mainstream oncology organizations. Now, through an unrestricted grant from the Samueli Foundation, SIO and the influential American Society for Clinical Oncology (ASCO) are commencing a project to raise three additional girders to bridge treatments.
I have frequently joked with people that I am the very best at what I do in the Integrator – and also the worst. It’s a dual assignation earned by anyone who is essentially an N of 1. Thus I too know that ending regular publication of the Integrator, in some form a fixture in the field since 1997, will leave a hole. I have been contacted by a few who are interested in something like it continuing. At least one dyad imagines a group of parties might be interested in a collaboration. I have made it clear that, while I am not taking responsibility to insure something continues, I am happy to support legitimate efforts toward a sort of Integrator 2.0 (under whatever name). I’d like to have access to an ongoing resource myself! For anyone interested, here is some basic clarity about the current model. I am happy to link interested parties, if they would like.
Tracking the inclusion of integrative strategies inside the Veteran’s Administration (VA) is an exception to the saying that a watched pot never boils. Integrative health research inside the VA funded in 2016 was the basis by which VA leaders chose 3 years later to more than triple the implementation of the “whole health” model to 55 medical centers. It was cause to exult. Now a special issue of the American Public Health Association journal Medical Care documents a further percolating of the inclusion process. With The Implementation of Complementary and Integrative Health Therapies in the Veterans Health Administration, one witnesses the powerful potential for change when a will is linked to a plan and a budget. The success at the VA casts cold light on the relative failure of reduction-oriented and production-minded public and private agencies to guide optimal implementation of integrative practices and practitioners into the delivery institutions on which the vast majority of U.S. citizens rely for their care.
In recent weeks, two influential integrative health organizations each chose to feature presentations on the expansive, multidisciplinary, and remarkably patient-choice integrative pain pilot associated with the University of Vermont Medical Center (UVMC). The presentations for the Academic Consortium for Integrative Medicine and Health and the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM) featured the project’s remarkable, multi-stakeholder partners: the state’s dominant payer, Blue Cross Blue Shield, the Vermont Department of Health, and the academic medical center. Included in the latter was the project’s research leader, longtime integrative health policy activist and prior NIH National Center for Complementary and Integrative Health adviser Janet Kahn, PhD, LMT. The parties shared early outcomes from the unique bundled payment model. Many consider the strategy a potential pilot for the nation. What is being discovered? Can it be implemented elsewhere?