Forum on the IOM: Bravewell’s Post-Summit Statement on Key Factors in Any Health Reform Plan

Summary: The alpha and the omega of the IOM Summit is the Bravewell Collaborative. The organization of philanthropists laid down $445,000 to sponsor the gathering. Bravewell now plans significant additional investment to ensure that the outcomes have legs in shifting US healthcare. Just after the Summit concluded, Bravewell issued a statement which included eight “key factors which should be included in health reform.” Here is the Bravewell list. Are you aligned? What did the Bravewell downplay or miss which you felt were key health reform outcomes which the IOM Summit began to shape as consensus?

The first significant sign of what the Bravewell Collaborative might do with the IOM Summit was the coalition formed with the AARP, the US Chamber of Commerce and the Prince’s Foundation.
More recently, Bravewell informed its donors that it would hold a major
event in Washington, DC on November 4, 2009, to release a Summit
document and promote Summit findings.

ImageThere is no doubt the Bravewell is determined to reform US healthcare. The directions it will prioritize were laid out in a statement shortly after the Summit.
Bravewell lists eight key points that will shape its course.
Are these aligned with your views of “integrative practice?” Put in a
more challenging way: Do you believe that your profession and your
practice are aligned with and honors these not just in word but in
deed? If not, should your practice or profession be better aligned?

Notably, in the same statement, Bravewell offers an updated definition
of its view of “integrative medicine.” Those who were present will note
that the organization is still has not adopted the term that seemed
to be preferred by many at the Summit: “integrative health care.”


“Integrative medicine is described as orienting the health care process
to create a seamless engagement by patients and caregivers in the full
range of physical, psychological, social, preventative and therapeutic
factors known to be effective and necessary for the achievement of
optimal health.


_________________________________



Factors to be Considered in Upcoming

Healthcare Reform Efforts

– Bravewell Collaborative


(from this webpage)






  • The progression of many chronic diseases can be reversed and sometimes even completely healed through lifestyle modifications.

    Lifestyle modifications programs have been proven to not only improve
    people’s overall health and wellbeing but to also mitigate cardiac
    disease and prostate cancer, among other chronic conditions.


  • Image

    Christy Mack, Bravewell president

    Genetics is not destiny. 
    Recent research by Dean Ornish, MD, and others has shown that gene
    expression can be turned on or off by nutritional choices, levels of
    social support, stress reduction activities such as meditation, and
    exercise.


  • Our environment influences our health.  Mounting evidence suggests that the environment outside one’s body rapidly becomes the environment inside the body.


  • Improving our primary care and chronic disease care systems is paramount. 
    Participants widely agreed that our primary care system is in danger of
    collapse and that we must retool how both primary and chronic disease
    care are delivered.  The new system must focus on prevention and
    wellness, and put the patient at the center of care.


  • The reimbursement system must be changed. 
    The Summit grappled with the current reimbursement system that rewards
    procedures rather than outcomes and urged changes that would
    incentivize physicians to focus on the health outcomes of their
    patients.


  • Changes in education will fuel changes in practice. 

    Implementation of an integrated approach to health care requires
    changes in provider education.  All health care practitioners should be
    educated in the importance of compassionate care that addresses the
    biopsychosocial dimensions of health.


  • Evidence-based medicine is the only acceptable standard. 
    Researchers and practitioners alike concurred that health care should
    be supported by evidence and urged further research and testing to
    expand the evidence base for integrative models of care.


  • A large demonstration project is needed. 
    Because funding for research on the effectiveness of specific models of
    care is difficult to obtain from standard grant channels, participants
    voiced support for pursuing a demonstration project funded by the
    government that would fully demonstrate the effectiveness of the
    integrative approach to care.


Comment
:  I am imagining
the document which the Bravewell will publish this fall from the dozens of papers, presentations and assessments leading up to and involved in
that rich, 3-day meeting. I am also thinking of my own
journalistic process in which my “reporting” is openly skewed
by my own values an strategic sense of what is most important to get across. Bravewell is choosy about those with whom they align, the language they
select, and the individuals and themes they promote.

That
said, the document which will be produced will be a Bravewell
document, as I understand it, not an IOM document. Put in school-yard terms, Bravewell owns this football. The
Summit’s historic meaning is thus likely to be an elaboration of the
themes enunciated here. I have no gripes, as far as they go, and in fact like these very much. One wonders, however, about the way double standards exist around the application of “evidence-based medicine.”  Present practice favors the one-third to one-half of conventional treatment which is, according to the IOM, wasteful. (IOM, February 2008, From Waste to Value in Healthcare) Note the Summit-related comments of participant Michelle Simon, ND, PhD, about the Technology Assessment Panel on which she serves in Washington State: when applied, many conventional treatments are not covered. The evidence isn’t there. And who will be in
and who out? Will for instance, “improving primary care” include the theme of having additional practitioner types, and not
just nurses but the likes of naturopathic doctors, broad-scope
chiropractors and up-trained acupuncturists in the mix such as are alluded to  by Mary Jo Kreitzer, RN, PhD, FAAN, Elizabeth Goldblatt, PhD, MHA/PA and Simon in their comments? Will the Bravewell allow
themselves to let the paradigm shift to the more inclusive
“health” rather than the exclusive “medicine?” Hope so. We shall see.

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johnweeks@theintegratorblog.com

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