That there should be a huge transformational drama underway in the US medical industry is a desire and dream that powers the integrative health movement and the work of many others. Those who might enjoy a sort of reality TV examination of not the fantasy but the multi-dimensional actuality of what such change looks like have a treat coming. The scene of action is 18 huge medical centers distributed across the entire United States. The script writers are 25 scientists on an evaluation team. The drama cuts across 4 deeply inter-related story lines: the impact of the transformational change on patients, on employees, on utilization, and on the extent of implementation and cost. We the people literally own this story. The investment and outcomes – from which any delivery organization can learn – are revealed in plain English in the public domain. If the launch of the transformational journey was Episode 1 of the series, then this 39-page report after two years is Episode 2. It’s deep insight into a dream coming true in the Whole Health System of Care at the US Veterans Administration (VA). It’s long awaited. And it is exciting.
Word began to break mid-summer of two developments at the Veteran’s Administration related to the giant agency’s integrative whole health effort. One was that Tracy Gaudet, MD, the charismatic founding director of the VA’s Office of Patient-Centered Care and Cultural Transformation that birthed the initiative was moving on. The immediate response of many is concern. Yet the news came concurrently with word that the VA’s initiative is expanding from the initial 18 to 37 new sites. Even with leadership change at the top of the VA, the initiative is secure and strongly supported. I connected with Ben Kligler, MD, MPH, Gaudet’s colleague who is presently acting director for an update.
The idea that “the first is the last and the last the first” was a value in my liberal Protestant upbringing. It likely had some noblesse oblige in it too. The concept can be challenged as an entrapping promise that good will come of waiting. Regardless, in some the call to work with the least-cared-for becomes a guiding mission. Self-preservation of the integrative field may be another motivator of such a mission. A past head of the NIH agency that researches integrative practices has challenged the main body of clinical research as un-generalizable due to the research being on upper income, well-educated, white, female patients. For a multitude of reasons, Integrative Medicine for the Underserved (IM4US) has emerged as the leading edge of the movement for integrative health.
Cast a net for papers on “innovations in group-delivered services” and what do you get? Guest editor Maria Chao, DrPh, MPA summed up the nearly 40 submissions this way: “Our editorial team was struck by the heterogeneity of integrative group visits for a range of health conditions, serving diverse patients across the life course and implemented in varied healthcare settings. A unifying theme is the potential for integrative group visits to address unmet needs of underserved and vulnerable patients. In many ways, group visits serve as a critical model towards integrative health equity.” The commentaries and research articles in the JACM Special Focus Issue on Innovation in Group Delivered Services make a potent case for an expanded role for groups not just for those who can pay cash but for all populations in a transformed healthcare system. All the articles are in open access until August 25, 2019.