Editor’s Note: Part 1 of this article appeared in the November issue.
A Whole-System Upgrade
Returning to a health-promoting framework requires a whole-system upgrade. Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Future articles in this series will explore case studies that illuminate the implementation, operations, and scalability of value-based care models that help integrate whole-person care into the modern Western health care system through complementary and alternative medicine.
At a recent New York HITLab Innovation Summit, a speaker described how East Asian medicine offers a holistic approach in which our philosophy asks us to trust that there is more at work than we can measure with modern approaches.13 Developing new ideas for the future of medicine may be more like remembering a value-based approach than it requires developing new technology and procedure codes.
Creating the conditions to achieve the Quintuple Aim may feel more like holding a space of healing and creating the financial scenarios for that to be appropriately reimbursed. Evaluating these new care models may be iterative, but it begins by looking at what health systems are doing to integrate holistic health care treatments supported by a sustainable financial model of value-based care.
A Systematic Approach
Widespread acceptance and adoption of value-based care require a systematic approach. In today’s environment, the question is no longer if, but how acupuncture can effectively and equitably be integrated into the existing and evolving health care landscape. How do we create a space for acupuncturists in current health care systems? Health systems nationwide are embracing acupuncture integration models tailored to meet specific goals and organizational needs. There is a common thread of best practices applicable in private clinics and hospital systems that highlights the flexible integration of acupuncture into incumbent systems.
The Value of Documentation
Acceptance starts with consistent, structured, and accurate documentation.14 Clinical documentation supports patient care, impacts reimbursement rates, outcomes, data collection, and how acupuncture is viewed in an integrated setting.15-16
Clearly structured notes on patient history pre-visit and examination post-visit provide the information necessary to use the appropriate evaluation and management (E&M) codes to assess patient progress, adjust treatment plans, and demonstrate the value and effectiveness of acupuncture in patient care.
Without proper documentation, acupuncture services may be undervalued, leading to incorrect reimbursement and hindering the progress of integration into the broader health care environment.
Documentation improves visibility and interoperability. Clinical care team members and health care administrators see acupuncture notes in the electronic health record and their department analysts look at key metrics from these data records to assess utilization, quality and performance. Documentation is as relevant in private practice as it is in a health care system.
Due to greater interoperability and patient initiative, it is more than likely that your documentation will be read by a member of your patient’s care team in another facility. The updated ICD-11 classification will feature traditional medicine pattern diagnoses in addition to the conventional diagnosis codes. This will significantly increase the visibility of acupuncture in the current health care system.17
Inviting acupuncture care into existing coding systems is an incredible opportunity to bridge the gap in clinical terminology between traditional and conventional medicine, providing for the first time a common diagnostic language with which to demonstrate the scope and functionality of integrative medicine for our colleagues in the broader health care service community.
A Need for Unified Advocacy
Adoption depends on strong advocacy for all stakeholders. Clinical champions of whole-person, value-based care need to seek, establish, and nurture relationships that build a coalition of diverse providers and administrators who will sponsor initiatives to incorporate integrative practices.
Collaborative efforts between departments facilitate and accelerate the incorporation of acupuncture and integrative medicine into existing care models. Community members are strategic and impactful advocates in building awareness and understanding of integrative medicine.
Effective advocacy depends on appropriate documentation and data collection to measure the improved patient outcomes achieved after the integration of care models. Health system administrators need to see not only a return on investment (ROI), but also a return on health (ROH) evidenced by well-documented improvement of patient outcomes over time.
Questions & Opportunities
The Quintuple Aim calls us into an integrated, value-based system promoting ROI and ROH. How we go about doing this is a significant question for our larger community of Eastern medicine providers.
We know traditional medicine is effective in providing whole-person care. Still, we need to work together to develop the evidence supporting a shift to more fully integrative medicine enabled by value-based care payment models. Such a presentation would include improved patient outcomes, lower healthcare costs, fewer emergency-room visits, decreased hospital readmissions, and shorter rehabilitation times.
For our biomedical readers, we’re curious about what outcomes data you want to see and the opportunities to present this more cohesively for your health care administrators and decision-makers taking risks for their patient populations.
For our traditional medicine practitioners envisioning deeper integration and broader adoption of traditional medicine into innovative and integrative health care systems, we’re curious what it would take for you to feel more empowered to deepen integration points between your care model and your financial models.
Let’s move past the impacts of The Flexner Report, learn about the value-based care models that support more whole-person care in the conventional medical frameworks, and measure our patient outcomes to demonstrate the strength of acupuncture and integrative medicine so we can build a more sustainable model for the future of our nation’s acute, chronic, and longitudinal health.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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