integrative medicine: differentiating your services
TRANSCRIPT
Integrative Medicine:Differentiating Your Services
John L. SurprenantSt. Joseph’s Hospital Cancer Institute
Howard J. GershonNew Heights Group
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Key Questions
• What is Integrative Medicine?
• Why is IM important?
• How to leverage IM?
• What are successful examples?
• Where are the land mines?
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What is integrative medicine?• Alternative
– A choice between two or more things• Complementary
– Either of two parts that complete eachother
• Integrative– To make or become whole; to bring
together
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Integrative Medicine Defined
• Modern science + ancient healing
• Healing oriented
• Focus on whole person, includinglifestyle
• Emphasis on the therapeuticrelationship
Source: www.integrativemedicine.arizona.edu
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Principles• Patients and practitioner are partners
• All influences on health, wellness anddisease considered
• Both conventional and alternative
• Facilitate body’s innate healing response.
• Natural and less invasive used wheneverpossible
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Principles (cont’d)
• Does not reject conventional medicine noraccept alternative therapies uncritically
• Good medicine is based on good science• Inquiry driven and open to new paradigms
• Health promotion and prevention areparamount
• Practitioners commit themselves to self-exploration and self-development
Source: www.integrativemedicine.arizona.edu
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Components of IM• Whole Medical Systems
• Mind-body Medicine
• Biologically Based Practices
• Manipulative and Body-BasedPractices
• Energy Medicine
Source: http://nccam.nih.gov/health/whatiscam/
Why is IM Important?
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Sources: Various
Alternative & ComplimentaryHealthcare Expenditures
$10M
$27M$31M
$34M
$47M
0
5
10
15
20
25
30
35
40
45
50
$ (Millions)
1990 1997 2000 2002 2006
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How to Leverage
• Whole Hospital
• IM Service Line
• Integrated Service Line
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Whole Hospital
Integrating high-tech medicine withwhole person healing
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Whole Hospital
Patient-centered care+
Evidence-based medicine
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IM Service Line
"Imagine a world in which medicinewas oriented toward healing rather
than disease…”
~ Andrew Weil, MD
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IM Service Line
“Whole-person” approach to healthand wellness
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Integrated Service Line
Focus on: Quality of Life
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Integrated Service Line
The Whole You
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Selection Criteria• Mission/Vision
• Market Demographics
• Competitive Environment
• Medical Staff Support
• Management Support• Financial Capability
Beginning the Journey…
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Practical Examples from threeexisting and successful programs incancer centers in Michigan
• Van Elslander Cancer Center, GrossePointe, MI
• Assarian Cancer Center, Novi, MI• Webber Cancer Center, Warren, MI
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Issues to consider…• Non-acceptance from some physicians• Lack of well designed Clinical Trials• Small amount of funding for research• Many payers unwilling to pay for modalities• No good licensure process• Quality and Safety issues
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Confusion still aboundssurrounding approach…
• Alternative• Complementary
• Integrative
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Practical ideas to moveconcept forward…• Find a physician champion• Create study group of physicians, include
those committed as well as those skeptical• Develop core group of committed
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Practical ideas…continued
• Research literature to support planned modalities• Conduct a competitor analysis• Start with modalities easier to “sell or promote”
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• Be sure to read Dr. David Eisenberg’slandmark study – Complementary &Alternative Medicine Use in USA,Harvard Medical School – it sets thestage for wide exploration andacceptance.
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• Patients…especially cancer patientsbegan using IM modalities withoutpermission and often not tellingtheir oncologists.
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• Crisis looms over efficacy, safetyand potential harm or danger.
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• Critically important to engageoncologists to discuss the use of IMmodalities with patients.
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Some questions for cancerpatients to pay attention to…• Use of antioxidants…free radicals• Use of garlic…bleeding time• Use of manipulative modalities…bone metastasis• Many more…previous are just examples
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Making the business case…• Develop a realistic pro forma• Carefully consider accepting insurance
payments• Create policies and procedures• Carefully consider amount of overhead
space• Design space for flexible multipurpose
use, if at all possible• Plan for a largely fee- for service model
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• Finding the “right” practitioners can oftenbe difficult. Don’t look just atpractitioner’s ability or training but lookfor a philosophical fit as well.
• Use contracts to avoid misunderstandings.
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In hospitals or health care settings –make sure you include the role ofPhilanthropy.
Keen interest by some to foster this type ofhealing.
• Naming opportunity• Supporting endowments• Unrestricted gifts
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• Consider including a retail operation.Retail can account for 40% or greaterof net income.
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• A confession: the driving forces forIM for me was the need to provide“mind-body-spirit-healing” for ourpatients and clients.
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Design Model –some elements to consider…
• Nutrition counseling– Customized diets– Supplements– Herbs
• Manipulative modalities– Massage/reflexology/crania/sacred manipulation
• Acupuncture– Traditional Chinese/5 point/Acupressure
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Design Model …continued
• Movement – Tai chi/dance, Chi gong,stretching, dance
• Journaling/creative writing• Art therapy• Music therapy
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Design Model - continued• Hypnosis/guided imagery, bio-feed back• Holistic health assessments
– Conducted by M.D. often billable to insurance• Support groups – various types and approaches• Healing touch – Delores Krieger
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Marketing approaches usedsuccessfully• Website• Newsletter• Community lectures• In-services• Coupons• “word of mouth” (new and repeat clients)
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Be selective in running paid ads –ROI is not great except inspecialized publications.
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Some important considerationsbefore starting…
• Do your homework…it will pay off.• Be sure to conduct a market
analysis…learn about your competitors,aging demographics, education level,income level, etc.
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• Begin to identify practitioners and how toevaluate their skill sets and philosophical fit.
• Think about how you will provide on-goingsupervision and quality assurance.
• Start small…but think big!
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Contact
John L. Surprenant, DirectorSt. Joseph’s Hospital Cancer
Institute3001 W. Dr. MLK, Jr. Blvd.
Tampa, Florida 33607813-870-4991
Howard J. Gershon, PrincipalNew Heights Group, LLC41 Sundance DriveSanta Fe, NM 87506505-690-8433Howard@reach-newheights.comwww.reach-newheights.com
Appendix
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Components of IM• Whole Medical Systems
are built upon complete systems of theory and practice. Often, these systems haveevolved apart from and earlier than the conventional medical approach used in theUnited States. Examples of whole medical systems that have developed in Westerncultures include homeopathic medicine and naturopathic medicine. Examples of systemsthat have developed in non-Western cultures include traditional Chinese medicine andAyurveda.
• Mind-body Medicineuses a variety of techniques designed to enhance the mind's capacity to affect bodilyfunction and symptoms. Some techniques that were considered CAM in the past havebecome mainstream (for example, patient support groups and cognitive-behavioraltherapy). Other mind-body techniques are still considered CAM, including meditation,prayer, mental healing, and therapies that use creative outlets such as art, music, ordance.
• Biologically Based Practicesuse substances found in nature, such as herbs, foods, and vitamins. Some examplesinclude dietary supplements, herbal products, and the use of other so-called natural butas yet scientifically unproven therapies (for example, using shark cartilage to treatcancer).
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Components of IM (cont’d)
• Manipulative and Body-Based Practicesare based on manipulation and/or movement of one or more parts of the body.Some examples include chiropractic or osteopathic manipulation, and massage.
• Energy Medicine: the use of energy fields
– Bio-field therapies are intended to affect energy fields that purportedly surround andpenetrate the human body. The existence of such fields has not yet been scientificallyproven. Some forms of energy therapy manipulate bio-fields by applying pressureand/or manipulating the body by placing the hands in, or through, these fields.Examples include qi gong, Reiki, and Therapeutic Touch.
– Bio-electromagnetic-based therapies involve the unconventional use ofelectromagnetic fields, such as pulsed fields, magnetic fields, or alternating-current ordirect-current fields.