H.R. 3590 & Executive Order 13544–Integrative Medicine Game Changers?

House Resolution 3590, aka the Patient Protection and Affordable Care Act (PPACA), and House Resolution 4872, aka the Health Care and Education Reconciliation Act, combined to create the monumental healthcare reform law of 2010.

Executive Order 13544, a requirement under H.R. 3590, established the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. Over time this executive order may profoundly change our healthcare delivery model. In fact, it has the potential to exponentially increase consumer access of integrative care, compel payers to cover many interventions not currently covered; and importantly, change the economic and clinical models for practitioners of evidence-based integrative medicine. Here’s why:

From Sec. 3., Purposes and Duties

The Council shall:

• provide coordination and leadership at the Federal level, and among all executive departments and agencies, with respect to prevention, wellness, and health promotion practices, the public health system, and integrative health care in the United States;
• develop, after obtaining input from relevant stakeholders, a national prevention, health promotion, public health, and integrative health-care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States, as further described in section 5 of this order;
• provide recommendations to the President and the Congress concerning the most pressing health issues confronting the United States and changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition;
• consider and propose evidence-based models, policies, and innovative approaches for the promotion of transformative models of prevention, integrative health, and public health on individual and community levels across the United States.

Not sure what you’re seeing, but to me that’s a whole lot of mentions of integrative health, prevention, wellness and health promotion.

It gets better.

From Sec. 4., Advisory Group

• There is established within the Department of Health and Human Services an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health (Advisory Group), which shall report to the Chair of the Council.
• The Advisory Group shall be composed of not more than 25 members or representatives from outside the Federal Government appointed by the President and shall include a diverse group of licensed health professionals, including integrative health practitioners who are representative of or have expertise….

After two calls for public comments on the Strategy, the Obama administration has begun to appoint its first Advisory Group.  Among the members are Charlotte Kerr, RSM, MPH, a nursing professor who holds a masters in acupuncture and Sharon Van Horn, MD, MPH, a clinical pediatrician who completed the Integrative Medicine Fellowship program at the University of Arizona. To date, about half of group has been appointed.

From Sec. 5. National Prevention and Health Promotion Strategy

The national strategy shall:

• set specific goals and objectives for improving the health of the United States through federally supported prevention, health promotion, and public health programs, consistent with ongoing goal setting efforts conducted by specific agencies;
• establish specific and measurable actions and timelines to carry out the strategy, and determine accountability for meeting those timelines, within and across Federal departments and agencies; and
• make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health-care practices to ensure that Federal efforts are consistent with available standards and evidence.

Naturally there is a requirement for evidence-based action and priorities. But much work remains to be done in this area. Specifically, substantive research on “whole person”, multi-modality, integrative lifestyle programs has been non-existent. Dr. Dean Ornish’s work in the area of heart disease and prostate cancer was impressive, and his cardiac program is now covered by Centers for Medicare and Medicaid Services (CMS), but it remains incredibly difficult to procure government funding for innovative, synergistic lifestyle programs that do not adhere to basic reductionistic research models

Currently there’s a lot of excitement around Comparative Effectiveness Research (CER), where primary outcomes are squarely focused cost savings. In support of the tenets of the National Prevention and Health Promotion Strategy, the Patient-Centered Outcomes Research Institute (PCORI) created by Congress should be encouraged to recommend an evidence-based integrative medicine arm for each and every appropriate CER study.

There is reason to believe that future CER studies–assuming they include integrative arms–will show cost savings just like these small studies showed in 2010. Once positive economic outcomes are proven under the umbrella of CER, more evidence-based integrative medicine modalities will be covered by payers.  And additional research designs in support of comprehensive, whole person, integrative studies will not only be encouraged by the government, but mandated. Now that would be a true game-changer–for consumer access, payer coverage and the economics of integrative care.

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