Making the Case for Integrative Health Care

AS HEALTH CARE SYSTEMS work to transition from fee-for-service to value-based care, some are finding that keeping people healthy may be more cost effective that simply treating symptoms. The key, according to a panel of experts at the U.S. News Healthcare of Tomorrow conference, is integrative health.
In a discussion Friday in Washington, D.C., moderated by Dr. Wayne Jonas, the executive director of Samueli Integrative Health programs for the Samueli Foundation, panelists offered insights from their experiences caring for patients, helping underserved communities, running a health care system and changing the way medicine is taught in the United States.

There is both a business case and a clinical case for adopting a more-holistic approach to health care, said Dr. Mary Jo Kreitzer, the founder and director of the Center for Spirituality and Healing at the University of Minnesota where she also serves as a tenured professor in the School of Nursing.
Nurses are at the bedside 24/7, she pointed out, and integrative therapies can allow for better symptom management. “At hospitals and health care centers across the country, aromatherapy and acupressure, for example, are being used to better nausea. Mind-body interventions are being used to help patients relax,” she said. “And hospitals now are being highly incentivized to use non-pharmaceutical approaches for pain management.”

“While there are times that pharmacological drugs are necessary, we also know that breathing techniques, meditation, distraction therapy can reduce the need for pain medication,” she explained, describing how patient-directed music intervention resulted in patients requiring less pain medication. “There can be improved outcomes at lower cost.”
Simple health care strategies can help patients make different lifestyle choices when it comes to eating, exercising, sleeping and managing stress, she explained, emphasizing the need for patient-centered, evidence-based approaches.
“We know that lack of sleep is associated with diminished concentration as well as ability to manage stress, and an increase in morbidity and mortality,” she pointed out. “There are simple self-care strategies known to be effective, such as sleep-hygiene measures, encouraging people to go to bed when they’re sleepy, developing sleep rituals, avoiding caffeine, nicotine and alcohol. There are mind-body and movement interventions like meditation and yoga and reiki and use of natural products.” Encouraging people to use some of these interventions can reduce the costs of insomnia and accident risks, improving not just the well-being of the patient, but of the overall workforce.
And patients aren’t the only ones who need to consider their health and well-being, she pointed out. Physician burnout leads to adverse outcomes for the patients, of course, but also for the health care provider.
Health care systems also need to promote integrative health at the organizational level, said Dr. George Isham, senior adviser with HealthPartners Inc., the organization’s former medical director and chief health officer and an elected member of the National Academy of Medicine.
The overarching principle: “First, we must do no harm.”
“The impact of education and socio-economic status on health is greater than all healthcare combined,” he said. The massive increases in health care spending is coming at the expense of education and socio-economic opportunity, he said – the “seed corn” of the future of the country.

Health care systems should take a page from the financial world’s rulebook, and look at ways to lower costs and risks.
In pediatric care, pediatricians understand that environmental factors in the home can trigger asthma. What if the industry looked at remediating factors for heart disease or diabetes, and built a business model that addresses the triggers of chronic disease as well as the symptoms?
Dr. Gail Christopher, former senior adviser and vice president of the W. K. Kellogg Foundation, has spent years focused on solving one part of that problem: access to healthy food.
She told the crowd about a partnership developed in New Orleans after Hurricane Katrina, in which a local hospital joined forces with a high-end grocery store to create a “teaching kitchen” as well as an affordable source of fresh fruits and vegetables.
“And so the physicians could actually prescribe healthier foods,” she explained. “And they [patients] could go down to those markets and purchase those foods. And [doctors] were able to track changes in weight, in body mass, in the relationship that the patients had with food.”
“Food is a critical component of the social determinants of health and well-being paradigm,” she said. “Not just food, but access to food. And not just access to food, but motivation to change your relationship with food or your eating habits.”
But access to breast-feeding – our first food – is of primary importance.
[ SPECIAL REPORT: Healthcare of Tomorrow ]”We were able to really… document increases in access to mother’s milk for those populations who for cultural reasons, for economic reasons, for policy reasons weren’t doing the optimum rates and levels of breastfeeding,” she said. “Exclusive breastfeeding for six months you reduce the risk for all manner of chronic diseases, including obesity, not just in the baby, but in the mother.”
“When we think of social determinants of well-being, we have to take a life-course perspective,” she continued.