(Integrative) “Whole Health” Tops Interests for VA in the President’s Planning Budget … plus more

(Integrative) “Whole Health” Tops Interests for VA in the President’s Planning Budget

Tracy Gaudet, md, publicly shared a remarkable advance for the values, practices, and disciplines associated with integrative health and medicine in a keynote at the October 2013 International Clinical Congress for Clinicians in Complementary and Integrative Medicine. The former director of the program in integrative at the University of Arizona and then at Duke Integrative Medicine is presently the director of the Office of Patient-Centered Care and Cultural Transformation for the Veteran’s Health Administration (VHA). She described an internal process of priority setting inside the agency—the nation’s largest system for delivering medicine and health. Gaudet described a concept of “whole health” that she has been advocating in the VA. She defined it as “A well developed national infrastructure for provision of a proactive integrative health approach for Veterans, which is inclusive of a relationship-based approach, self-care strategies, complementary and alternative approaches, and integrative health coaching.” Then the news: This concept emerged as top dog in a competition for the VHA’s chief focus through 2021.

Gaudet added that the VHA’s initiative will be backed by a system-wide practitioner education program developed by a University of Wisconsin integrative medicine team led by David Rakel, md. She continued: “When implemented, Veterans will have the guidance to address the broad aspects of their life that affect their health, will have education and training to build new self-care skills, will have the opportunity to incorporate more holistic and integrative approaches into their health care, and will have ongoing support to help them make the changes they identify as priorities.”

Comment: Television icon Mehmet Oz, md, may be the medical doctor with the most visibility in drawing the public to integrative health and medicine. Gaudet is certainly the one integrative medical doctor with the most direct power to shift health care practices inside the medical-industrial organizations that are struggling to become “health care systems.” Gaudet’s own comments and subsequent discussion of the VHA model touched repeatedly on the fact that the experiment is taking place inside the single payer system that is the VA. In addition, coupling this whole health direction to the military’s top-down culture will facilitate system-wide exploration. The agency is mandating training on integrative therapies throughout the system. When will a private US health care system so significantly elevate such education for its doctors? Perhaps the answer will be: once this “whole health” education is proven and outcomes are in hand. The VHA’s leadership in developing low-tech options for pain and other forms of care appears to be secure for years ahead. Congratulations to Gaudet and her team. Few who both know Gaudet and who have been following integrative health explorations in the military would disagree that she is the right person in the right job at the right time.

Obamacare’s Impact on Health Savings Accounts

HerbalGram, the publication of the American Botanical Council, recently offered a useful look at some potentially negative impacts on consumers and practitioners of integrative health and medicine. The article by Lindsay Stafford Mader is entitled “Will ‘Obamacare’ Affect Natural Healthcare in the United States?”1 She notes that “various conservative and libertarian-leaning commentators and groups have criticized the individual mandate for infringing on ‘basic’ notions of freedom and liberty.” Mader adds that “some CAM customers and organizations, including Citizens for Health (CFH) and the policy-focused nonprofit Alliance for Natural Health-USA (ANH), also disagree with this tenet of the ACA.” These, she writes, have often promoted coupling catastrophic coverage with Health Savings Accounts. These accounts are used by many who prefer typically noncovered medical alternatives to pay for their care choices. According to the article, under the Affordable Care Act, such individuals would be required to purchase full plans, thus losing their economic benefits. Attorney Michael Cohen and his colleague Ryan Abbott make the case that, while catastrophic coverage is available, “for someone really not wanting conventional coverage, they’re stuck with a premium based on coverage they don’t want.”

Comment: I was quoted for this piece and offered my more upbeat view of the game changer that the Affordable Care Act meant, at the policy level, via historic levels of inclusion of complementary and integrative health views and practitioners in a half-dozen areas in the plan.10 Obamacare has been a game changer for presence and inclusion in diverse, significant initiatives, including the hotly debated Section 2706, which requires “Non-Discrimination in Health Care.” Yet if I were to vote my pocketbook, these adversaries appear to be spot on, particularly given the long battle Section 2706 is likely to have in most states.

ShortTakes.

• ▶ The Integrative Healthcare Policy Consortium2 and the Coalition for Patients Rights2 have also weighed in their opposition to HB 2817 which would amend the Affordable Care Act to remove the nondiscrimination in health care provision.

  

• ▶ Chiropractors are pushing for broad inclusion in a health report in Oregon that features lobbyist Vern Saboe, dc, who asserts, “Chiropractic is a profession, not a single modality.” The only chiropractic program in the Northwest, at the University of Western States, promotes a functional medicine approach to the field.4

  

• ▶ On the heels of the defeat of an initiative to require GMO labeling in Washington State, the American Herbal Products Association is advocating, via an November 8, 2013 release, that the herb industry organization both called for “a federal standard for voluntary disclosure of GMOs” and “federal legislation that instructs either the FDA or USDA to establish a standard for non-GMO labeling that would ensure the absence of GMO ingredients.”5

  

• ▶ As a fitting coda to the swansong of the powerfully influential Bravewell Collaborative of philanthropists in integrative medicine, Hillary Clinton made a cameo appearance at the organization’s 5th and final gala. Bravewell, founded in 2001, has chosen to sunset its operations.6

  

• ▶ Alliance Instutite for Integrative Medicine cofounder Sandy Amoils, md, will shortly take over as president of the American Academy of Medical Acupuncture. The Alliance is a pioneering integrative center and part of BraveNet. Amoils and her husband, Steve Amoils, md, are the recent authors of Get Well & Stay Well: Optimal Health through Transformational Medicine.

  

• ▶ The Program in Placebo Studies led by Ted Kaptchuk, lac, at Harvard University has received a $250 000 grant from the Robert Wood Johnson Foundation.7

  

• ▶ Michael Traub, nd, dhanp, reports that the dominant player in the Hawaiian health insurance market, the Hawaiian Medical Service Association (HMSA), is taking nondiscrimination seriously and has announced coverage plans for licensed providers in his state.8

  

• ▶ Integrative pain care has a nice friend in a high place, Aetna CEO Mark Bertolini, according to a response to a query from Arianna Huffington in an interview. Bertolini’s conversion came through his care following a skiing accident.9

  

• ▶ Heather Greenlee, nd, phd, has been elected to be the first naturopathic physician to head up the Society for Integrative Oncology.

  

Analysis of Naturopathic Doctors as Primary Care Published by the Nelson A. Rockefeller Center at Dartmouth

In order to serve decision processes inside the Vermont Senate Governmental Operations Committee, the Nelson A. Rockefeller Center for Public Policy at Dartmouth University has published a report entitled “Naturopathy in Vermont: Evaluating Education Differences and the Role of Naturopathic Doctors (NDs) as Primary Care Providers.”11 In Vermont, naturopathic doctors have significant roles under the state’s Blueprint for Health, including the option of serving as leaders of primary care medical homes. The 25-page report addressed what they described as 6 key areas of concern: “(1) the undergraduate prerequisites to entering ND programs, (2) the teaching of homeopathy, (3) medical coursework, (4) the lack of ND residencies, (5) the licensing examination, and (6) the continuing education policies.”

The authors conclude that options for Vermont include “stricter regulations on the practice of homeopathy, providing quality ND internships and residencies, formulating an additional examination for new ND practitioners, requiring more continuing education hours, and improving the integration of NDs into existing hospital systems.” They note that such steps “may yield improved quality of care provided by NDs, broader patient access to naturopathic practices, increased alignment of ND and MD care through Blueprint for Health teams, and the drawing in of more primary care practitioners to Vermont.” They state that “properly trained naturopaths as primary care providers can contribute to reduced healthcare costs in Vermont and personalized care for patients.” And finally, “MDs can learn from NDs about holistic evaluations of disease while NDs can learn about modern technologies for improving the efficacy of care.”

Comment: All in all, the Rockefeller study is quite a positive report from the perspective of those naturopathic doctors who are seeking to up their status as primary care providers. This is not a moment too soon for that profession which, like the rest of the licensed integrative health field, was overlooked in this recent issue of Health Affairs devoted to “reinventing” primary care.12 I personally was pleased to see the concluding observation: “MDs can learn from NDs about holistic evaluations of disease while NDs can learn about modern technologies for improving the efficacy of care.” What a simple world it could be if we just cut through the prejudice and focused on value.