"You're either at the table or on the menu." So runs the adage that defines much in the Washington, D.C. Beltway.
Two early 2012 notices sent to me as publisher of the Integrator Blog News & Reports for broader dissemination to the integrative health community by Len Wisneski, M.D. say a great deal about the relationship between the integrative health care community and this power politics metaphor. The first note from Wisneski, the chair of the Integrated Healthcare Policy Consortium (IHPC), arrived Jan. 5, 2012 and described the opportunity of a lifetime for the field. The second arrived just four days later, announcing just such a potential for the right mission-driven individual. With a caveat.
Wisneski's initial email announced publication of IHPC's long-awaited report of a Stakeholder 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, D.C., 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, D.C., Ph.D., vice chancellor at Palmer College. Goertz was since appointed to the Board of Governors of the Patient Centered Outcomes Research Institute. The second was Janet Kahn, Ph.D., 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, N.D., 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), portions of the 2010 Affordable Care Act (ACA) included integrative practitioners and practices. The language was in sections related to payment, delivery, research and workforce.
IHPC, 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 meeting was needed 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, M.D. committed 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, Ph.D., 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 Health Policy and Leadership also stepped in with funding as did Hyland Laboratories, led by policy wonk Jay Borneman, MPH, Ph.D..
The leadership mix ran from integrative M.D.s, 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, an 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 Penny and Bill George, the past Medtronic chair. Another was Wayne Jonas, M.D., CEO of the Samueli Institute, credited with conceiving, with partners like IHPC, 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 bandwidth. The report, titled The Affordable Care Act and Beyond: A Stakeholder Conference on Integrated Healthcare Reform, reflects it. The editors are Daniel Redwood, D.C., Michael Traub, N.D., DHANP, and Kahn. Snider oversaw final publication.
The document's heart is a series of recommendations from each of six 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.
The 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?
The 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 and necessary. Some CPT coding language was changed. Key appointments were recommended, among those the position eventually received by Goertz and Kahn. But funds were drying up. The report was back-burnered. 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.
I've 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 executive director, half-time for starters. Interested?
Help wanted. Wisneski calls it "the opportunity of lifetime, for the right person." That 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 a puer aeternis 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.
Where are the philanthropic agents of change who will forego the charitable deduction because moving this work, in this moment, can be a tremendous legacy -- and a good deal of fun?
It's not clear yet whether the field will step up to the opportunities in this report. If yes, the nation's potential for a health focus will be boosted toward the top of the agenda rather than remain on the menu.