Dr. Ralph Snyderman, Chancellor Emeritus of Duke University and James B. Duke Professor of Medicine at the Duke University School of Medicine, offered a diagnosis of what’s wrong with health care today: Health care is a $2.4 trillion industry, that is fragmented, disease-oriented and reactive, with a find-it and fix-it approach. The prescription: bring back the centrality of the individual, and integrative approaches, systems, and resources. He outlined the five dimensions of integrative medicine: 1) it addresses a person’s physical, emotional and spiritual aspects; 2) it extends across the whole spectrum of care, including prevention, treatment and rehabilitation, and end-of-life care; 3) care is coordinated across the range of caregivers and institutions; 4) care is integrated around and within the individual patient, and 5) there is openness to multiple modalities of care.
Above all, we need to think not just about preventing diseases but instead of enhancing health and well-being. Health promotion should be where all health care starts. In the future, there will be a new model for more personalized care, with patients owning the tools of empowerment, and the physician acting as a mentor.
Bill Novelli, CEO of AARP, remarked that 44% of all deaths in the United States can be prevented by behavioral change. What’s needed is a national public policy initiative aimed at health promotion. Right now, we know what to do, but not how to get people to do it. As George Halvorson, Chairman and CEO of Kaiser Foundation Health Plan put it: "Make the right thing easy to do. Let’s start by giving patients a printout of their plan for being healthy. Electronic medical records – which the Marino Center has had since 2002– are a vital tool. In the perfect system, we’ll be able to access all the data about all the people all the time."
A theme of the conference was the misplaced priorities of a reimbursement system that rewards expensive procedures, many of which would be unnecessary if patients engaged in more health-promoting behavior, which would cost insurers, businesses and individuals MUCH less money. A national awareness campaign would be a good place to start.
Dr. Donald Berwick, President and CEO of the Institute for Healthcare Improvement defined health as "the extent to which the body can heal itself; then medicine becomes the servant." He presented Eight Rules for Health Care: 1) Place the patient at the center; 2) Thoroughly customize; 3) Welcome family, loved ones and community; 4) Maximize healing influences within care; 5) Maximize healing influences outside of care; 6) Rely on sophisticated, disciplined evidence; 7) Use all relevant capacities and waste nothing; and 8) Connect helping influences with one another.
An outstanding presentation by Dr. Dean Ornish, Founder and President of the Preventive Medicine Research Institute, offered the astounding fact that we can change our genes by changing our lifestyles, through, for example, meditation. He also noted that the more stress we have, the lower our brain waves, which can lead to depression. Highlighting another often-repeated theme of the conference, he noted that lifestyle changes can be superior to drugs in making us healthier.
Bob DeNoble, the Marino Center’s President and CEO was invited to participate in a Priority Assessment Group focused on DESIGNING AND BUILDING ECONOMIC INCENTIVES FOR INTEGRATIVE MEDICINE. The group was asked to address four questions (1) What are the three most important priorities in addressing the focus issue?, (2) Who are the key actors for implementation and their roles?, (3) What might be achievable 3 -year and 10 - year goals?, (4) What are the next steps? Bob offered the following for the group to discuss:
What are the three most important priorities?:
- Shift focus and resources from therapeutic interventions to wellness and prevention
- Demonstrate how Integrative Medicine is a disruptive innovation in the overall health care system leading to lower costs and improved quality
- Provide evidence that primary care centric integrative medicine produces superior patient outcomes as measured by patient’s health status, less use of high cost/high tech diagnostic and therapeutic interventions, and drugs
Key Actors: - Individual Consumers: Take active role in self care and maintaining wellness
- Research Institutes: Lead evidence based outcomes research on integrative medicine models
- EmployersTake an active role in the health and wellbeing of employees by providing economic incentives to practice prevention and achieve wellness
- Third Party Payers: Alter perverse incentives that encourage high levels of high cost services and shift resources to wellness and prevention
- Federal and State Government: Assume same role as employers for people covered by Medicare and Medicaid
What might be achievable 3 -year and 10 - year goals?
3 year goals:
- Ensure that integrative medicine plays a role in the inevitable health care systems reform
- Garner resources to conduct meaningful outcomes research
- Bring integrative medicine to the workplace
- Expand primary care resources by creating a new level of primary care provider
10 year goals:
- Transform the model of healthcare delivery to focus on primary, secondary, and tertiary prevention, thus improving the health status of the U.S. population and reducing health care expenditures to account for less than 15% of the GDP
What are the next steps?
- Create a collaboration between research entities and front line integrative clinical care providers to evaluate the effectiveness and efficiency of the integrative care model. Both components of this collaboration are required to provide sufficient expertise and data to accomplish this task.
One last bit of learning; the Marino Center model, in which primary care and complementary modalities are housed synergistically together under one roof, is rare if not totally unique. Attendees were very interested in knowing more about how our model works, and how they might replicate us.
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