Summary: A remarkable, integrated set of 60 leaders converged in late 2010 as the Stakeholder Conference on Integrated Healthcare Reform. The group, organized by the Integrated Healthcare Policy Consortium (IHPC), explored the opportunities for integrated health care in the Affordable Care Act. Earlier this month, IHPC published the ambitious set of strategic directions. IHPC then advertised for a new executive director – the opportunity of a lifetime for the right individual. The challenge is how to take the puer aeternis that is the integrative practice community when it come to policy – with its non-stop dreams of transforming U.S. health care and its limited commitment to lobbying – into a responsible participant in changing the nuts-and-bolts of U.S. policy. The table is set. The blueprint is in the report. Time to wake up and engage the nuts-and-bolts policy work so well laid out in this report.
either at the table or on the menu.” So runs the adage that defines much
in the Washington, DC Beltway.
Two early 2012 notices from
Len Wisneski, MD,
the chair of the Integrated
Healthcare Policy Consortium (IHPC), say a great deal about the relationship
between the integrative healthcare community and this power politics metaphor.
Wisneski’s first note described the opportunity of a life-time for the field.
The second announced just such a potential for the right mission-driven
individual. With a caveat.
Wisneski’s initial e-mail announced publication of IHPC’s long-awaited report
Conference on Integrated Healthcare Reform. The conference took place after
passage of the Affordable
Care Act (ACA).
If you believe that empowering health-focused, integrative approaches and
practitioners can make a difference in transforming U.S. health care, the
convening of this event was a beautiful thing to behold. After years of
significant but stuttering
accomplishment on a paltry budget, IHPC, the single, multi-disciplinary, collaborative,
torch-bearing lobbyist for integrative care in Washington, DC, appeared finally
to be ready to take a seat at the right tables.
The meeting was the brain-child of a power trio. One was Christine Goertz, DC,
PhD, vice chancellor at Palmer College. Goertz was since appointed to the
Governors of the Patient Centered Outcomes Research Institute. The second
was Janet Kahn, PhD, LMT, then IHPC’s executive director. Kahn was subsequently
appointed by President Obama to the Advisory
Group on Prevention, Health Promotion and Integrative and Public Health of
the National Prevention and Health Promotion Council. The third was Pamela Snider,
ND, IHPC’s vice chair, executive editor of the Foundations of Naturopathic
Medicine Project and past member of the Medicare
Coverage Advisory Committee.
Their plan was a no-brainer, but gutsy. Thanks to a group of U.S. Senators
including Tom Harkin (D-Iowa), Bernie Sanders (I-VT), Barbara Mikulski (D-MD),
Kent Conrad(D-ND) and Maria Cantwell (D-WA),
of the 2010 Affordable Care Act (ACA) included integrative practitioners
and practices. The language was in sections related to payment, delivery,
research and workforce.
with its multiple stakeholder Partners for Health, and
the American Chiropractic Association, which Goertz sometimes advises, helped
place this language. These were firsts. A top-level policy summit was needed for the integrative health community to take
maximum advantage of the new law. The three set a date for late September 2010,
and a place, at Georgetown University.
The gutsy part was finding the cash to convene. Goertz’ brought in her base, Palmer College, and as a financial host. Brian
Berman, MD committed the The Institute for
Integrative Health (TIIH). Berman, who also directs the Center for Integrative Medicine
at the University of Maryland is a former Bravewell
prize winner. He and one of his TIIH co-founders, Aviad (Adi) Haramati,
PhD, were the founding chair and vice-chair, respectively, of the Consortium of Academic Health Centers for
Integrative Medicine (CAHCIM). CAHCIM, with its 51 medical school members,
is the biggest kid on the integrative medicine block. Bastyr University’s
Center for Policy and Leadership also stepped in with funding as did Hyland
Laboratories, led by policy wonk Jay Borneman,
leadership mix ran from integrative MDs, across the CAM disciplines, with a
touch of industry funding to remind us that this is U.S. medicine, after all.
The relationships between these professionals, like many of the 60 individuals
they convened, run deep. A significant subset convened the
National Policy Dialogue to Advance
Integrated Health Care: Finding Common Ground in 2001. Berman and
Kahn are presently members of the National
Advisory Council of the National Center for Complementary and Alternative
Medicine (NCCAM). Snider had a significant role in shaping NCCAM’s enabling
language. Goertz formerly worked at NCCAM as a program officer.
Among participants were U.S. Senate staffers, a former state insurance commissioner, policy
leaders from the licensed integrative practice disciplines of chiropractic,
naturopathic medicine, massage therapy, certified professional midwives and
acupuncture and Oriental medicine. I was invited as a representative of the
Academic Consortium for Complementary and Alternative
Health Care. Others included Lori Knutson, RN, BC-HN, then executive
director for the integrative
health program at Allina Hospitals & Clinics, created by philanthropists
and Bill George. Another was Wayne Jonas, MD, CEO of the Samueli Institute, credited with conceiving the whole systems structure
of the National Prevention Council. The participant list is on page 51 of the document.
Integrative health care had never seen such band-width. The report, entitled
Affordable Care Act and Beyond: A Stakeholder Conference on Integrated
Healthcare Reform, reflects it. The editors are Daniel Redwood, DC, Michael
Traub, ND, DHANP, and Kahn. Snider oversaw final publication.
The document’s heart is a series of recommendations from each of 6,
well-integrated work groups: Access and Non-Discrimination; Integration in
Practice; Comparative Effectiveness Research and the Patient-Centered Outcomes
Research Institute; The Healthcare Workforce Prevention and Wellness; and,
Current Procedural Technology (CPT) Codes.
work wasn’t blue sky. All but one of the work groups was linked to a relevant portion
of the Affordable Care Act (ACA). The outlier, CPT, included two members of
the American Medical Association’s advisory panel.
Jonas, who headed the NIH Office of Alternative Medicine in the mid-1990s,
offers this appraisal: “The IHPC policy report is the product of one of
the most collaborative, multi-stakeholder processes in the entire integrative
medicine industry. It should be carefully attended to by practitioners and
policy makers alike.”
All good, so far. But why wasn’t the report published a year ago? Why hasn’t it
been available to guide active participation at a half dozen federal agencies?
question brings us to the second of IHPC chair Wisneski’s notices and the Achilles
heel for integrative health policy work. The field has not yet chosen to step
and fund necessary lobbying. With Kahn’s leadership, IHPC engaged some of the
regulatory relationship-building recommended. Some CPT
language was changed. Key appointments were recommended, among those the positions
presently held by Goertz and Kahn.
But IHPC funds were drying up. The report was
back-burnered for months. Kahn, after a half-dozen years of underpaid, Sisyphean work,
decided to leave IHPC’s directorship and move to an essentially volunteer national
policy adviser role.
observed IHPC for a decade. It typically finds a way, if long on mission and
short on fuel. Wisneski’s note indicated that IHPC had cobbled together the
funds to advertise for a new director, half-time to start. Interested?
Help wanted. Wisneski calls it “the opportunity of lifetime, for the right
person.” The caveat is that this someone must enjoy an ancient method of community organizing:
grow the organization, advance the mission, increase the funding base, grow
your salary and staff; move the stakeholder agenda.
Help is definitely needed. If integrative medicine is to transform itself from
into a responsible participant in shaping U.S. policy, this strategic plan under
the Affordable Care Act needs contributors, more Partners for Health, and
deeper pockets. The blueprint is there. The table is set. More individuals and
organizations must chip in.
are the philanthropic agents of change who will forgo the charitable deduction
because moving this work, in this moment, can be a great deal of fun and a tremendous legacy?
It’s not clear the extent to which the integrative health field will step up to the opportunities in this
IHPC report. If yes, the nation’s potential for a health focused policy will move toward the top
of the agenda rather be on the menu.
for inclusion in a future Your Comments Forum.