The most progressive forces in U.S. medicine have signed on and are promoting a new strategy for medicine and health in the United States. In a recent issue of the Journal of the American Medical Association, Institute for Health Improvement co-founder and former Center for Medicare and Medicaid Services administrator Don Berwick, MD published Change from the Inside Out: Healthcare Leaders Taking the Helm.
They declare a set of eight principles including: “Cooperate and collaborate, above all. Eliminate silos and tear down self-protective institutional and professional boundaries that impede flow and responsiveness.” Another: “Move knowledge, not people. Exploit all helpful capacities of the modern digital age, and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally.”
The printed word gathers gravitas with the simultaneous publication of a list of a score of voluntarily participating major delivery organizations. A Wisconsin member posts a blog on the subject of their membership that includes: “Our efforts to improve population health and lower cost are not aligned with how government pays us for services–but we cannot wait for government to fix the health care system or wait for what happens with the Affordable Care Act.” Berwick is saying that this goes well-beyond the Triple Aim–and in multiple ways focuses on de-institutionalization.
Comment: The process of “integration” assumes there is a “here” and a “there.” The principles to shape regular medicine described in this article are the most attractive yet to emerge when viewed through the lens of the values set of integrative health and medicine. My reading is that this is the action step that Berwick developed for the 30-year march he articulated in his December 2013 speech to health system leaders. There he dwelled deeply on the “more radical than we have imagined” concepts of “health creation” and “salutogenesis.” Berwick explained that he had become enamored through mentorship from the likes of integrative health leaders Herbert Benson, MD, John Kabat-Zinn, PhD and above all and Wayne Jonas, MD. The JAMA principles are an opportunity to white board the values alignment and points of optimal intersection, support and alignment between “here” and “there” to create a health care system out of our medical industry. To paraphrase that visionary Buzz Lightyear: To the Triple Aim and Beyond.
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