The United States spends much more money on healthcare than any other country. Yet, people die younger and experience more illness than persons in many other countries. As employers, governments, benefits consultants, and other stakeholders around the country struggle to find a solution through accountable care organizations, bundled payment systems, and technology the answer is right in front of us. Value based care, defined as the delivery of superior patient outcomes at a lower cost, is the only solution that will deliver sustainable healthcare cost containment while at the same time contain escalating costs.
In the past I have spoken extensively on this subject and described a roadmap for employers to realize a value based delivery system for their plan members. This roadmap included a value based benefit design, population health management, narrow networks of high performance providers, quality and price transparency, and direct contracting with providers. Now, I would like to introduce another powerful value based tool that can assist employers in achieving superior patient outcomes at a lower cost, namely, Integrative Medicine.
Integrative Medicine (IM) offers a comprehensive prevention-based approach to effectively treat chronic disease and enhance health promotion.
Integrative Medicine embraces a multi-disciplinary team of licensed health care providers who embrace evidenced based therapeutics from both Western and Eastern medicine. This includes health practitioners such as naturopathic doctors, chiropractors, acupuncturists, nurse practitioners, nurses, midwives, nutritionists and massage therapists. IM is a better alternative to the current system, as it offers a combination of conventional medical therapies as well as complementary or alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness.
Participants who are receiving Integrative Medicine services describe 3 main benefits:
How does Integrative Medicine deliver these benefits?
Prevention: Integrative Medicine places a greater emphasis on prevention and wellness.
By doing so they avoid big-ticket costs for many chronic diseases. Seven preventable chronic diseases – cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental illness – cost the U.S. economy $1.3 trillion annually, including the cost of lost productivity. Not only are prevention and health promotion fundamental cornerstones of Integrative Medicine, integrative medicine practitioners counsel patients more frequently and consistently than conventional providers. This leads to greater patient satisfaction scores and higher quality of care.
Integrative medicine delivers better outcomes, especially in those who are chronically ill.
There are currently more than 1,200 randomized controlled trials and 150 Cochrane Collaboration reviews of alternative therapies that support IM can not only reduce costs but also improve outcomes and quality. Medical treatments must also be recognized for their potential There are is a growing body of evidence based on randomized controlled trials published in top medical journals, that demonstrate superior outcomes compared with usual or conventional care. In fact, many European countries, in which general practitioners are co-trained in integrative approaches, have incorporated Integrative Medicine into national health care systems based on studies showing better outcomes and lower costs.
Healthcare cost containment is another benefit of Integrative Medicine.
This is because practitioners are trained to NOT focus on expensive procedures and surgeries to address a medical condition. For example, the field of spinal medicine has been criticized for using technologies that have not been tested adequately. A head-to-head comparison of surgical and non-surgical treatment for lumbar spinal stenosis showed nearly equivalent outcomes. Significantly, of the patients undergoing surgical procedures, 18% experienced complications during surgery and 9% in the post-surgical period. The study authors concluded that while both treatments were shown to be helpful,
“…surgical decompression should be suggested with caution and only after due conservative (i.e. non-surgical) treatment of the patient.”
Overuse of these spinal surgeries and underuse of non-surgical procedures (such as chiropractic) result in higher cost and lower quality of patient care. IM clinicians experts in administering less invasive, low-cost treatments that support the body while it heals itself, and that serve as effective substitutes for riskier modalities such as surgeries and prescription narcotics.
Recent demonstrations of reversals of chronic conditions as well as a concentrated focus on prevention of illness and wellness are promising gateways to bending the cost curve. This has been the cornerstone of the IM disciplines. When a new patient sees a physician who is trained in integrative medicine, it is not uncommon for the visit to last an hour and a half. New patients can expect to be asked about medical history, diet, medications and supplements as well as about their lifestyle – including questions about faith and spirituality (to determine if they have a source of comfort and strength in difficult life phases), family and friends, and other components of support systems including the patient’s community. The objective is to get an idea of the overall lifestyle of the patient and how it may impact the patient’s health status. Tanya Edwards, Medical Director for the Center for Integrative Medicine at the Cleveland Clinic Wellness Institute, says, “We spend a lot of time trying to figure out the underlying causes” (Source). In addition to being comprehensive in their intake exams, the integrative medicine approach is to continue to support and encourage lifestyle changes on an ongoing basis.
In Washington state, where IM health care providers of every discipline have been a mandated part of the health care system for nearly 20 years, data shows that patients who see IM providers have lower prescription drug costs, hospitalization costs, and total costs.
It is essential to partner with an experienced IM organization with a history of managing a network of credentialed IM providers. There are a number of characteristics to look for in a high quality network. Those include but are not limited to:
- Credentialing providers to NCQA standards at a minimum;
- Ongoing provider education and sharing of best practices to advance evidence-based treatment;
- Practice management support to enhance administrative efficiency;
- Utilization management that is transparent to members, respectful of providers, assures medical necessity, and supports quality;
- Clinical quality management that drives continued improvement in health care; and
Complimentary and Alternative Medicine (CAM) are increasingly being used by consumers along with conventional medical care. This combined approach is called Integrative Medicine (IM). Research has demonstrated the clinical effectiveness of many IM interventions and recent studies have shown that IM is cost-effective. IM providers can fill the ever-widening gap in primary care providers. While consumers, conventional providers, and health plans are increasingly recognizing the benefits of IM care, the delivery system has yet to maximize the considerable cost, access, and quality advantages offered by IM. Innovative plan design and collaboration between conventional and IM providers on the health care team can enhance value by improving the quality and outcomes of care and, at the same time, constrain the rapid escalation of cost of employee healthcare.