The following 14 tenets form the foundation of an comprehensive Integrative Health system. The Institute of Medicine believes we can develop and support these tenets by a focused cultivation of research, practice, education, and policy. This foundation ultimately creates a broader definition of health and health care, one that more fully supports the American guarantee of life, liberty, and the pursuit of happiness. The ultimate goal is a personalized, predictive, preventative, and participatory health care system, that moves away from the "find it and fix it" model.
The 14 tenets
1) Inclusive of Mind, Body, and Spirit
2) Care is from cradle to grave
3) Personalized
4) Prevention oriented, using healthcare promotion and comprehensive disease management programs
5) Embraces wellness care, lifestyle management, and self-care
6) Care providers work as a team
7) Patient/Provider Relationship is restored
8) Patients learn about and take responsibility for their own health/wellbeing
9) Uses evidence-based practices
10) Care is focused on what is working for the patient
11) The care process is just as important as the care content
12) Quality of care at the greatest value/lowest cost is the ultimate goal
13) Sensitive to family, societal, and cultural factors
14) Utilizes all health systems and scientific bodies of knowledge, including Genomics/Proteomics, Complementary and Alternative Medicine, and current research
Methods
1) Place the patient at the center
2) Individualize care
3) Welcome family and loved ones
4) Maximize healing influences within care
5) Maximize healing influences outside care
6) Rely on sophisticated, disciplined evidence and information delivery systems
7) Use all relevant capacities- waste nothing
8) Connect helping influences with each other
Realms of Integration
1) Knowledge base
- Evidence of all the healing systems
- Personal initiative and drive from each provider
2) Administration
- Organizational mission, plan, and leadership
- Information Technology
- Quality Management
- Professional & Staff education
- Financial Management
- Human Resources
- Marketing Plans
- Reimbursement system
- Facilities and space planning
- Regulatory factors
- Risk Management
- Qualification and Credentialing of Providers
- Other administrative functions that support clinical functions
3) Provider-System relationship
- Financial incentives
- Marketing support
- Access to facilities and services
- Access to practice management services (support staff, shared revenues/practice/loss, etc)
- Participation in governance & policy making
- Shared mission/vision
- Process for developing organization informed consensus
- Community involvement
- Relationships with other organizations and external providers
- Provider communications
- Conflict resolution and biases
- Positive and negative sanctions
4) Clinical practice
- Clinical protocols
- Clinical outcomes
- Patient satisfaction
- Cost effectiveness
- Quality of service (well trained and experienced practitioners, and services are evaluated using the benchmarks of the discipline and not biomedicine)
- Inpatient admissions and lengths of stay
- Clinical culture
- Educational Programming
- Care management strategies, case management strategies, and clinical pathways
- Practice organization and collaboration
- Coordination of care
Types of Care Needing Innovation & Integration
1) Emergency Care
2) Acute Care
3) Primary Care
4) Chronic Disease Management
5) Rehabilitation
6) Home based Care
7) Long Term Care
8) Self Care/Wellness & Lifestyle Management
9) Medical/Health "Home" model
Success Factors (From Integrating Complementary Medicine into Health Systems by Nancy Faass)
- Establish access to clients (demographic)
- Identify sources of reimbursement
- Devise a flexible & portable payment system that does not compromise the length of visit or the quality of care (because insurance rates are too low)
- Obtain sufficient capital (long-term, min 3-5 years wait before return on investment)
- Develop an effective infrastructure to manage risk
- credentialing to high standards
- ongoing monitoring
- quality assurance initiatives
- minimize risk of litigation
- Form friendly alliances with conventional medicinal facilities and practitioners (formal linkages)
- Recruit a stable of loyal practitioners willing to cross-refer to one another in-house
- Position the organization advantageously in it’s particular market
- Develop a relationship with a research facility
- Provide the therapies most desired in the organizations market, offering a carefully chosen selection
- Empower patients
- Consider healthcare a business, and guide operation with that in mind
- Identify one or more champions in the organization who are highly regarded by all constituents and looked up to by all physicians
- Obtain a strong endorsement from the board and top management
- Develop an extensive education program that serves all stakeholders
- Emphasize effective communication
- Use media to link staff and stakeholders
- Grounded in detailed market and competitor analysis
- Incorporates wellness AND fitness
- Best placed in the for-profit unit, in partnership with a hospital
- expand the scientific paradigm via the scientific method & evidence-based treatments
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