Achieving the Quintuple Aim requires a new model. While modern technology innovation has advanced to unprecedented amounts of data and discovery, and traditional medicine has proved the antidote to many medical mysteries unsolvable by the conventional system, our appetite for collaboration remains of greatest importance in achieving this moonshot aim.
Many health care leaders recognize it is impossible to achieve this vision without the integration of holistic health and well-being through East Asian medicine and a supportive financial model through value-based care. While health system margins are razor thin, administrators need to see a return on investment (ROI) for changes in their current model.
Keys to Integration
Successful integration requires alignment among colleagues and financial sustainability. We’ve been encouraged to see some health care systems improving their return on health (ROH) by implementing integrative medicine programs. There is overwhelming evidence that integrative care is appropriate; however, traditional medical providers need to deepen our understanding of the context and constraints facing our colleagues trained in conventional medicine and simultaneously invest ourselves in improving our documentation strategies to contribute to the evidence.
In this series of articles, we will explore the factors contributing to our current state of “sick care,” the best practices for integrating holistic healing, and three case studies illustrating the evidence that a bridge between the worlds of traditional Eastern medicine and modern Western medicine is not only achievable, but also offers a more sustainable financial model for the future of our nation’s health.
The Latest Vision
The Quintuple Aim is the industry’s latest vision statement.1 It seeks better health and an improved economy, but it’s 2024, and the leading health care delivery and technology solution experts have been talking about telehealth, machine learning, and value-based care implementation for decades.
In 2007, the health care industry collectively sought to improve patient experience, have better outcomes, and lower the cost of care. In 2014, we recognized that clinician well-being is paramount to achieve these aims, and in 2021, we agreed all of this is impossible without a commitment to embed health equity into all that we do.
Until the American health care industry includes integrative medicine as a means through which we achieve these aims, we have a responsibility to develop the body of evidence and clinical relationships that respect, support, and utilize the system of medicine we know it so desperately needs.
The Current Model Is Failing
The current health care model isn’t working for patient experience, outcomes, or cost efficiency. The latest Commonwealth Fund Report issued a scathing report about the health care landscape, and as stewards of this system, we need to work together to investigate why.2
Compared with residents of our peer countries, we not only die younger, but also from avoidable causes. Industry experts agree we are hamstrung by our current payment model, and the intensifying workforce shortages contribute to these frustrations. This pressure has been mounting over time.
In his 2012 book, The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You, Stephen C. Schimpff, MD, described the system as more adept at responding to acute illnesses.3 The National Association of Chronic Disease Directors reported in 2022 that nearly 60% of adult Americans have at least one chronic disease, and we know that more than two-thirds of all deaths are caused by one or more of five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes.4
The current health care service model isn’t working for the care team. The root cause of these patient outcomes stems back to outdated payment models, administrative burdens, and workforce shortages we sought to address in the Quadruple Aim of 2014. Value-based care offers a new model, but it has yet to see widespread adoption.
Many agree that the health care workforce crisis is already here.5 Whole-person care is considered the responsibility of primary care physicians, yet the Association of American Medical Colleges projects demand for health care services to continue to exceed projected supply, leading to a projected shortage of between 17,800 and 48,000 primary care physicians by 2034.6
A Need for Equity
The current health care service model is struggling to embed equity into patient care. Though health care has been reimbursed primarily as a fee-for-service model, the Centers for Medicare and Medicaid Services have been running pilot programs to test the best models to improve health through better communication pathways that coordinate care among the clinical team and center the individual patient’s needs by addressing both medical and non-medical factors contributing to their health.7
In the same year, we aligned to the Quintuple Aim, the AMA Center for Health Equity publicly reckoned with its role in shutting down black medical schools during Jim Crow, and the New York Department of Health released a Health Equity Impact Assessment.8-9
Accountable Care Organizations (ACOs) focus on a value-based framework for marginalized patients in an arrangement of care whereby the organization takes on the risk to care for a community population.
The future of health is an integration of the best of Western medicine’s technological innovations and the best of holistic health-promoting practices of Eastern medicine supported by an appropriate financial model, and it’s on us to make the case, create the strategy, and bring our colleagues into greater team-based care.
An Infusion of Holistic Health & Healing Is Needed
The current health care service model needs an infusion of holistic health and healing. ACOs and integrative medicine have not been defined as best practices to achieve the Quintuple Aim and we need to go back in time to understand the context.
The Flexner Report of 1910 was written when the American Medical Association was seeking greater adherence to scientific literature in medical education, and when monetary support for biomedical research made possible by philanthropic foundations such as the Rockefeller Foundation and the Carnegie Foundation for the Advancement of Teaching in New York City were at new peaks.10 The report had a significant impact on access to complementary and alternative medical and psychiatric teaching in North American medical schools.
While the report greatly encouraged the expansion of biomedicine, it subsequently led to shutting down the majority of the historically black and complementary and alternative (CAM)-oriented colleges and programs (e.g., medical schools, homeopathic colleges, and some psychiatric institutions).11 He wanted to weed practices without biomedical evidence out of the modern canon of North American medicine, labeled them “nonconformist,” and considered them as “charlatanism” and “quackery.”
This refrain was recently repeated by American Medical Association CEO, Dr. James Madera, who drew a direct line between the era of the membership organization’s involvement in The Flexner Report and today’s modern acceleration of digital medicine.12
Editor’s Note: This article continues in the December issue. Complete references accompany the web version.
References
- Itchhaporia D. The evolution of the Quintuple Aim: health equity, health outcomes, and the economy. J Am Coll Cardiol, 2021;78(22):2262-2264.
- U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund, 2023.
- Schimpff S. The Future of Health-Care Delivery: Why It Must Change and How It Will Affect You. Potomac Books, 2012.
- Hoffman D. Commentary on Chronic Disease Prevention in 2022. National Association of Chronic Disease Directors, 2022.
- Owens C. “The Health Care Workforce Crisis is Already Here.” Axios, 2024.
- The Complexities of Physician Supply and Demand: Projections from 2021-2036. Association of American Medical Colleges, 2024.
- Basics of Value-Based Care. Centers for Medicare & Medicaid Services.
- Madara J. “Reckoning With Medicine’s History of Racism.” American Medical Association, 2021.
- Health Equity Impact Assessment. New York Department of Health, 2023.
- Stahnisch FW, Verhoef M. The Flexner Report of 1910 and its impact on complementary and alternative medicine and psychiatry in North America in the 20th century. Evid-based Compl Alt Med: eCAM, 2012:647896.
- Beck AH. The Flexner Report and the standardization of American medical education. JAMA, 2004;291(17):2139-2140.
- Mullin R. “AMA CEO Madara Outlines Digital Challenges, Opportunities Facing Medicine.” Health IT Answers, 2016.
