Integrative population health management is the use of integrative health modalities (IHM) to adjunctively manage chronic conditions for all patient populations. Under the Affordable Care Act, the phrase “population health management” has become the new buzzword for administering the health of the public. With this new phraseology comes a shift in responsibility – from governmental agencies to private sector healthcare systems and providers. Population health management requires that each healthcare organization step back from its current position and view its geography and the people who give life to that geography from a different perspective. It requires identifying patterns in the population – not just disease patterns – life patterns. Patterns that if managed more effectively will reduce the escalating costs and decreasing quality associated with common chronic conditions such as increased blood glucose, depression, high blood pressure, obesity, tobacco use, obesity, chronic pain, and stress.
Integrative health interventions provide one evidence-based, cost effective option for healthcare systems to pursue effective population health management. Integrative health modalities should match the needs of the patient population, beginning with the type of intervention. There are two basic types of IHM: therapies that must be provided to a patient by a licensed or certified practitioner such as acupuncture, massage therapy, health coaching, or biofeedback; and practices that patients can be trained to do on their own such as meditation, yoga, and relaxation response training. Practices are also the basis of an effective self-care regimen.
I recently participated in a research study that analyzed the claims for all inpatient hospitalizations in the state of Maryland in 2013. The state’s Health Services Cost Review Commission provided the data for this study that included every ICD-9-CM diagnosis and procedure code for each hospital patient provided in a database with any patient identifiers removed. Interestingly, our analysis revealed that of the 589,253 Maryland hospital inpatients, 509,044 (or 86.3%) had diagnoses or symptoms that could be treated adjunctively with IHM. One of the key objectives of the study was to match the IHM intervention to the patients’ diagnoses using the evidence-based literature.
There were 346 diagnostic codes identified in the analysis as being able to be managed successfully with IHM. The most frequent of these diagnoses in the Maryland database were high blood pressure/hypertension, type 2 diabetes, alcohol/drug related diagnoses, coronary heart disease, and gastro-esophageal reflux disease. The top 3 evidence-based practices identified as being the most effective for patients in Maryland were meditation, yoga, and relaxation response training; and the top 3 evidence-based therapies were acupuncture, biofeedback and hypnotherapy/guided imagery.
The findings for me, a teacher and practitioner in the integrative health area, were elating. But more importantly, the information must be transmitted in a way that patients who can benefit from these IHM interventions actually receive them. One way to accomplish this goal is to communicate to leaders in healthcare systems that IHM not only is evidence-based, effective and economic, it increases patient satisfaction with their care. Healthcare providers are now reimbursed in part for the care they provide based upon the level of patient satisfaction with that care. Knowing that the use of IHM by patients has increased significantly over the past decade and that patients who receive IHM in addition to their conventional medical care generally report higher satisfaction than patients not receiving IHM could incentivize healthcare leaders to implement IHM services for all patients.
Population health management requires organizations to reach to deeper levels than traditional approaches to change management. Population health management is the ultimate outreach program and the ultimate accountability process. Integrative population health management is the use of integrative health modalities (IHM) to adjunctively manage chronic conditions for all patient populations whether these individuals need inpatient care, outpatient management or no current medical intervention. An emphasis on patient self-care through IHM, as an adjunct to conventional care, provides healthcare systems with a competitive differentiator for affordable, sustainable population health management. More importantly, IHM offers relief from suffering and invites us to take control of our health – each one of us in the matrix of “population health management”.
For more information on Integrative Health and Medicine, see NIH’s website at https://nccih.nih.gov
For related news from Saybrook on Integrative Health and Wellness see