What Else Does ACA Have To Say About
Licensed Healthcare Providers?
John Weeks
Executive Director
Academic Consortium for Complementary and Alternative Health Care
Publisher, Editor
The Integrator Blog News & Reports
National Association of Certified Professional Midwives
Webinar
July 24, 2014
Overview
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A bit about ACCAHC
Action related to specific language
Action on some useful other themes
“Transformational” or “paradigm”
shifts?
• Ideas for CPMs
www.theintegratorblog.com
Licensed Integrative Health & Medicine “CAM” Disciplines
Core 5 with a U.S. Dept. of Education-recognized Accreditation Agency
Profession
Accrediting US Dept. of
Agency
Education
Established Recognition
Recognized
Schools or
Programs
Nat’l
Exam
Created
State
Regulation
Total
Licensed
Practitioners
Acupuncture
and Oriental
medicine
1982
1990
61
1982
44
28,000
Chiropractic
1971
1974
15
1963
50
72,000
Massage
therapy
1982
2002
88*
1994
44
280,000
Direct-entry
(homebirth)
Midwifery
1991
2001
10
1994
26
2000
Naturopathic
medicine
1978
1987
7
1986
18
5500
*Of the roughly 1400 schools, the number accredited via the US Dept. of Education-recognized specialized accrediting agency.
Source: Modified from ACCAHC’s Clinicians’ & Educators’ Desk Reference on the Licensed Complementary & Alternative Healthcare Professions
(2014)
ACCAHC Base: Core Organizational Members
One of the most enduring, formal interprofessional collaborations in the US
Competencies for Optimal Practice
in Integrative Environments
Promote “researching the way we
practice” and increasing capacity
Impact critical dialogues
Key Strategic
Initiatives
Center for Optimal Integration
Creating Health
COMMUNITIES of INTEREST
*Leadership in Integrative Heath
*Interprofessional Education/Care *Primary
Care *Inter-Institutional Relationships *Whole
Systems/Practice Research *Integrative Pain
Care *Triple Aim * Evidence &Education
Advance Interprofessional
respect and inclusion (IPE/C)
Patient Centered Care
ERL
CAM
ACO
PIHTA
OTHERS
Gain recognition of
our workforce contributions
PROJECTS
Capacity:
Staff +
Expertise
Funding
Website +
Business
Market +
Plan
Advisors
Repository
FOUNDATION
Governance: Center Advisory Team and
ACCAHC Board of Directors
Competency 5
Competency 6
Provide Leadership
Integrative Health & “CAM” in the (PP)ACA
Section
Title
Area
Language Used
2706
Non-Discrimination
Payment
“ …license or certification …”
3502
Community Health
Teams/PatientCentered Medical
Homes
Delivery
“doctors of chiropractic, licensed CAM
practitioners …”
4001
National
Prevention, Health
Promotion and
Public Health
Council
Health
promotion
“integrative health care” “integrative health care
strategy” “integrative health” “integrative health
practitioners” “integrative health practices”
5101
National Health
Care Work Force
Commission
Workforce
“doctors of chiropractic”
“licensed CAM providers, integrative health
practitioners”
6301
PCORI-CER
Research
“experts in integrative health and primary
prevention strategies” “State-licensed integrative
health care practitioner”
2301
Coverage for FreeStanding Birth
Centers
Delivery
`birth attendant' means an individual who is
recognized or registered by the State involved to
provide health care at childbirth “
Thanks to US Senate Integrative Health Champions
• Tom Harkin (D-Iowa)
• Barbara Mikulski (D-MD)
• Bernie Sanders (I-VT)
• Kent Conrad (D-ND)
• Maria Cantwell (D-WA)
– Direct-entry midwives
The consumer movement and the US Senate
Appropriations Committee …
Seeded Opportunity in the
Affordable Care Act
Section 6301:
Patient Centered Outcomes Research Institute (PCORI)
Board will include “State-licensed integrative health care
practitioner” ... “experts in integrative health and
primary prevention strategies”
•
•
Viewed as closer to patient-centered and
outcomes focus of optimal IHM research
Specific charge to explore “CAM”
– Special presentation to Board, 12/2011
•
•
•
•
•
Goertz is one of 19 Governors
Oversee $650-million a year of comparative
effectiveness research
Goertz: Chair, PCORI Program Development
Committee (former)
Goertz: Chair, PCORI Science and Oversight
Committee (current)
CEO met with ACCAHC Research Working Group;
asked for an appointment to a committee
Board of Governors Member
Christine Goertz, DC, PhD
Vice Chancellor, Palmer College
National Prevention, Health Promotion and Public
Health Council
Advisory Group on Prevention,
Health Promotion and Integrative
and Public Health
Charlotte Kerr, RN, MPH, LAc
Janet Kahn, PhD, LMT
Janet Kahn, PhD, LMT
• Report includes multiple
references to “CAM”
• 4 known IHM members, of 22
• Working Group on Integrative
Health
• Sent letter of concern to HHS on
Section 2706 (April 2013)
• Letter also urged adherence to
Section 5101 (Workforce)
• Links IHM to prevention and
health promotion
Dean Ornish, MD
Sharon
Van Horn,
MD, MPH
Graduate, U Az Fellowship in
Integrative Medicine
Section 3502:
Community Health Teams/Patient-Centered Medical Homes
… “may include doctors of chiropractic,
licensed CAM practitioners …”
• New models foster team care
• Major backing from employers,
agencies
• Part of effort to move $ and
investment toward primary care
• Role of IHM is to position themselves
as part of solution - examples
– F4CP and chiropractors
– PIHTA and ACCAHC disciplines
Major report on DC role in
PCMHs
ACCAHC project to elevate
potential value
Section 5101:
National Health Care Workforce Commission
… ““doctors of chiropractic … ”
“licensed CAM providers, integrative health practitioners …”
• Never funded
• Law, nevertheless, is useful and has been cited
• AAMC’s shift from “physician” to “health
workforce” – M Lawlor present May meeting
• ACCAHC, now ACCAHC-IHPC primary
care/”primary maternity care” project
Association of American
Medical Colleges
Meeting the Nation’s Primary Care Needs:
The Current and Prospective Roles of
Doctors of Chiropractic and Naturopathic Medicine,
Practitioners of Acupuncture and Oriental Medicine,
and Direct-Entry Midwives
ACCAHC document, developed
with MEAC as partner
Other A.C.A.-Related
Useful Federal Policy Initiatives
Movement Toward Team Care/Interprofessional Practice and
Education (IPE)
•
Interprofessional Education Collaborative – Core
Competencies for Interprofessional Collaborative
Practice (2011)
•
$13.5-million National Center for Interprofessional
Practice and Education (HRSA, foundations) (2012)
•
American Association of Medical Colleges MedPortal
on IPE (with psych, PT, PA) (2012)
•
IOM Global Forum on Innovation in Health
Professional Education (includes integrative
health/CAM) (2012)
Mary Wakefield, RN, PhD,
Administrator, HRSA
IPE is “patient-centered” and promotes
“egalitarianism” among disciplines
Barbara Brandt, PhD, Center
Director
Inclusion of licensed IHM, health
creation
Focus on self-care health &
well-being
Endorsement of IPEC competences
as part of ACCAHC’s
Focus on inclusive teams,
inclusion of “CAM”
ACCAHC IPE/C
Action in Multiple
Initiatives
Promoting an IPE and inclusive
view of integrative medicine
John Gilbert, PhD: ACCAHC Keynote
(2011) and Council of Advisers member
Create, manage IPE page;
promote IPE/C focus
Stimulated over 40 orgs and
individuals to “join”
Sarita Verma, MD, JD: ACCAHC Keynote
(2013) and Council of Advisers member
Change definition from
“therapies” to IPE language
Promote/support NCIPE’S
Barbara Brandt & JIHC Scott
Reeves as keynoters
A.C.A. and Integrative Pain
• Funds Institute of Medicine (IOM)
Committee on Advancing Pain Research,
Education and Care
– Member: ND, LAc pain expert Marinelli
– Member: UCLA Integrative pediatrician Zelzer
• IOM “Blueprint” (2011) includes “CAM”
in 15 segments
Rick Marinelli, ND, LAc
Plus, Pain focus in NCCAM Strategic Plan
– Highlighted in Strategic Objective #1
– New NCCAM pain-military effort (July 2014)
Lonnie Zelzer, MD
Integrative Health Care and the Military
Motivation
• Performance/functional priority
– Soldiers, like actors, athletes
• “The Imperative for Integrative
Medicine in the Military”
– Schoomaker, May 2014, IRCIMH
• Pressure from chiropractors
Anthony Lisi, DC, Director
VA-chiropractic program
– Success creates openings for others
• Current use (2012)
– 120 facilities offer 275 ‘CAM’ programs
and 213,515 (Dept. of Defense report to
Congress, January 2014)
Former US Army Surgeon General
Eric Schoomaker, MD, PhD
Integrative Care Leader at Veteran’s Affairs
Former IM leader at Weil/U Arizona &
Duke selected to direct
VA Office of Patient
Centered Care and
Cultural Transformation
“ [The Office will be] a living, learning
organization in which we will discover and
demonstrate new models of care, analyze the
results, and then create strategies that allow
for their translation and implementation
across the VA.”
Tracy Gaudet, MD
Former Director of IM at U
Arizona and at Duke
“Transformational?”
Shifting Incentives
“When I first heard of
integrative medicine in
2006, I thought of it as an
expense …
Ken Paulus, CEO
Allina Health System
Ken Paulus, CEO, Allina Health System
Weeks J. Health System & Military Leaders Say Cost and Pain are Motivating Inclusion of
Integrative Medicine
http://theintegratorblog.com/index.php?option=com_content&task=view&id=795&Item
id=189
Shifting Incentives
“… but as the Affordable Care
Act's payment structure kicks in
that supports keeping people
healthy, integrative medicine will
be an asset.“
Ken Paulus, CEO, Allina Health System (2011)
Weeks J. Health System & Military Leaders Say Cost and Pain are Motivating Inclusion of Integrative Medicine
http://theintegratorblog.com/index.php?option=com_content&task=view&id=795&Itemid=189
Ken Paulus, CEO
Allina Health System
Is this values framework conducive to
midwifery and integrative health outcomes?
Typical “Hot-Tub Claims”
of Integrative Healthcare Practitioners #1
So, what is your value
to your patients?
After my care, my patients:
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•
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Can do more things
Aren’t in as much pain
Suffer fewer adverse effects
Have more energy
Enjoy things more
Feel better
Integrator Blog News & Reports
www.theintegratorblog.com
24
Typical Hot-Tub Claims
of Integrative Healthcare Practitioners #2
So, what is your value
to the system?
My services:
• Diminish use of pharmaceuticals
• Lower adverse effects of
pharmaceuticals
• Limit needs for more expensive
conventional tests and services
• Lower costs
Integrator Blog News & Reports
www.theintegratorblog.com
25
Collaborate &
Engage
-Data
-Best practices
-Webinars
-News pushes
-Face-to-face
www.optimalintegration.org
The Emerging
Opportunity:
Creating Health
Perlin/AHA: “We Don’t Fully Understand the Recipe”
"From Sick Care to Health Care"
“We have been honed to focus on sick care
… It is a tough transition, but we have to
learn how to move from sick care to health
Jonathan Perlin, MD, PhD
care.
Chair-Elect, AHA
CMO, HCA
"I'm not sure that any of us … fully
understands or knows the recipe."
Mayo: From “Producing Health Care” to “Creating Health”
"We are realizing fairly quickly that
we need to change the focus of the
health care industry to
creating health, not just producing
health care."
American Hospital Association's Hospitals and Health Networks, April 2013
http://www.hhnmag.com/display/HHN-newsarticle.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2013/A
pr/0413HHN_FEA_PatientexperienceGate
Douglas Wood, MD
Director, Strategy and Policy
Mayo Clinic Center for
Innovation
Berwick: “Radical Shift” Toward “Creating Health”
“It is fortunately commonplace now to say
that we would be better off to re-direct
some of our health care enterprise from
fighting illness … to health creation."
"The pursuit of health, the creation of
health, may require … a redesign that may
be even more radical than we have
imagined."
Plenary Panel, Institute for Health Improvement, December 2013
http://www.youtube.com/watch?v=r5Tbikk44jY
Also: “Hooking Up: Don Berwick, Integrative Medicine and His Call for a Radical Shift to 'Health Creation‘”
http://www.huffingtonpost.com/john-weeks/don-berwick-integrative-m_b_4781105.html
Don Berwick, MD
Former CMS Administrator
Past CEO, Institute for Health
Improvement
Recommendations for Midwives
• Get out of your silos (and related attitudes)
• Educate for team practices (even if virtual)
• Gain competencies for practice in integrated
environments
• Form inter-professional networks in your
communities
• Gather and publish Triple Aim outcomes
• Collaborate in policy with those with like values
Campaign with others to research and promote
the concept of “conservative treatment”
throughout medicine
Thank You!
jweeks@accahc.org
www.accahc.org
www.optimalintegration.org
Facebook: Center for Optimal Integration
LinkedIn: Project to Enhance Research Literacy
LinkedIn: Project for Integrative Health and the Triple Aim
Twitter: #CentOptInt