Project for Integrative Health and the Triple Aim (PIHTA)

The Time is Right

First Era of Business Integration: Meeting Patient Interest, Misaligned Economic Incentives

The first era of health system exploration of integrative health and medicine with mainstream payment and delivery, which began in the late 1990s, was stimulated by meeting patient interest but challenged by misalignment of incentives. 

Patient interest
Initial engagement was stimulated by a growing body of survey outcomes that consistently showed that significant percentages of people with chronic conditions explore some form of "complementary and alternative medicine" (CAM). Offering such services was viewed by some hospitals as a means to enhance patient experience and provide a competitive advantage. 

Typically human-intensive integrative health practices such as massage, acupuncture and whole person, integrative medical office visits do not typically produce revenues that are cost-effective in high-end hospital or medical office space. Reduced to income production per square foot, they compete poorly with high end procedures. 

More significantly, a growing body of research is supporting the belief that such interventions can reduce the need for conventional services, testing and procedures. Might the big money in integrative health and medicine in saving money? Many of these practitioners believe this is so. 

To the extent that these data and this promise of integrative health and medicine is true, such outcomes are antagonistic to the bottom line in an economic model centered on production of procedures. 

In addition, practitioners in silos, focused on their own productivity, are not incented to explore the values other team members, including integrative health practitioners, might bring to their patients. 

The Present Era: Cost, Patient-Centered & Team Care

Soaring costs and medical errors is moving the medical industry away from a centering on production of services toward a system that focuses on the values of the Triple Aim. 

Accountable Care Organizations, Patient Centered Medical/Health Homes, the move toward primary care and outpatient services, interprofessionalism and team care are part of embrace those values. Aspect of the Affordable Care Act seek to shift the "perverse incentives" in the production-oriented model. 

Mayo Clinic innovation leader Douglas Wood, MD and former Center for Medical and Medicaid Services administrator Don Berwick, MD, set a more challenging and visionary goal. The payment and delivery industry must develop a system that focuses on health creation. 

These shifts - and a growing literature - support active exploration of the potential contributions of the whole person, health-focused, and team-based values, practices and disciplines associated with integrative health and medicine