Accountable Care Organization with Integrative Medicine

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change-management-speaker-nick-jacobsBy Nick Jacobs

With the creation of Accountable Care Organizations as prescribed through the Affordable Care Act, Integrative Medicine could become a fully endorsed service-line by all Health Systems to be utilized in income creation and expense reduction for numerous aspects of care.

Integrative Medicine would be a critical component a Health System’s ACO organization by helping to improve overall community health and by managing both acute and chronic health conditions more effectively and efficiently than purely traditional medicine.  Integrative Medicine health coaches  can listen, observe and communicate early, to create healing solutions that enhance efficiency of communication, and anticipate and help to control or ameliorate the healthcare needs of patients in multiple settings; home, inpatient, or outpatient.

In a healing inpatient environment where the patient’s care is actually the center of their personal universe, we have seen significant reductions in patient stays, less infections, and overall healthier patient outcomes, i.e., a healing environment.  Similarly, in the outpatient setting, the use of Integrative Medicine modalities can significantly contribute to the continued health and well-being of the individuals utilizing these techniques by helping them focus on wellness and prevention activities.  Healing touch, spirituality, family support, and various types of integrative therapies ranging from massage to pets have been shown to exponentially improve the patient’s well being and general healthfulness.

Specific populations of high-risk patients are ideally suited to home health coupled with chronic disease management using Integrative Medicine care coordinators.  In the case of the CHF patient, diet, exercise, stress management and group support can not only cut down on these re-admissions, they can literally begin to reverse heart disease.

The push to deliver as much care as possible in the least expensive setting will drive up home health visits and drive down the use of skilled nursing facilities, but, more importantly, once again, it will create a continuously growing market for individuals skilled in Integrative Medicine.

In addition, a greater emphasis on wellness will be necessary to prevent the development of other chronic diseases in the ACO population such as diabetes, obesity, and hypertension in the large segment of the population that is otherwise reasonably healthy.

By improving care coordination, ACOs should help to reduce unnecessary medical care and improve health outcomes.  This combination would lead to a decrease in the overall utilization of acute care services.  According to CMS estimates, a median savings of $470 million from 2012–2015 could result from the ACO’s.

ACO Quality Measures

CMS has established five domains in which to evaluate the quality of an ACO’s performance. The five domains are:

  1. Patient/caregiver experience
  2. care coordination
  3. patient safety
  4. preventative health
  5. at-risk population/frail elderly health

Each of these five domains is addressed by the knowledge base provided through Integrative Medicine Modalities.

In conclusion, less than 10 percent of health systems are seriously engaging in Integrative Medicine practices yet IM represents a multi-billion dollar expenditure in non-healthcare system settings across the United States.  The community, the region and the nation is voting for IM with their feet as these clients and patients seek out massage, acupuncture, music, pet and aromatherapy, dietary counseling, and spiritual direction within Integrative Medicine practices across the country.

The opportunity to reduce costs is immense. The six primary categories of waste in healthcare are:  overtreatment, care coordination breakdowns, lack of success in execution of care processes, administrative intricacy, pricing failures, and fraud and abuse– the lowest available estimates of potential savings exceeds 20% of the total health care expenditures. The savings potentially achievable from efficient, all-inclusive, and cooperative pursuit of even a partial reduction in waste are much higher than from more direct cuts in care and coverage.

Nick Jacobs, FACHE, International Director of SunStone Management Resources and an officer on the American Board of Integrative Holistic Physicians, is currently consulting in Integrative Medicine and Pharmacogenomics and writes the blog, healinghospitals.com.