Integrative Care: A Case Study

The seminar that I am leading is the integrated and managed health care systems. One the lessons I’ve learned from watching the documentary “The Good News on American Medicine” is that as doctors we can make a difference in the way we deliver health. That is an important message with all the uncertainty that lie around. That is easier said than done, however. What separate Grand Junction and Seattle and other town mentioned in the video was that the doctors worked collaboratively to ensure low-cost quality care. To accomplish that it means that we must make sacrifices, time and/or monetary, to achieve the same goal.

In the article, “Our Big Appetite for Healthcare” written by Daniel J. Stone was in the March 31 2013 issue for Los Angeles Times. Doctor Stone intended audience are the reader of the Los Angeles Time. Stone’s purpose in this article is to persuade his readers that he wants to change the healthcare culture from “more is better” to “do what is medically indicated to provide the best outcome”. Stone supports his argument with strategies and evidence.

Other benefits of reverse integrated care ranges from clinical outcomes through patient -centered care and population-based treatment approaches (Auxier, Farley, & Seifert, 2011) to financial incentives with value-based payment and shared revenue stream (Enthoven, 2009). Achieving these benefits requires changes in the cultural dynamics, workflow, and operational processes. For example, implementing new screening tools, the introduction of warm hands-off, huddles and collaboration between physical and behavioral health teams (Buche et al.,

Dr. Tieraona Low Dog, Fellowship Director, Arizona Center For Integrative Medicine explains how we want to expose clinicians to a broader way of seeing the patient a deeper understanding of healing and a larger toolbox from which to choose for therapies. She talks about how if patients were treated with different procedures such as acupuncture or holistic healing, we as consumers would not have to pay out so much on treatment. Procedures such as these would actually benefit us because we would not need to see doctors nearly as much as we do now, because we would not be “treating” the diseases with chemicals (pharmaceutical drugs) which have many side effects. Also, the pharmaceutical companies and insurance companies would never let this happen because then they would be out of money because people would not have to see their doctors nearly as much in hence means that these “cattle runners” would not be making the money they are.

An integration of care study was conducted by a Doctor of Behavioral Health Intern at Michael R. Zent (MRZ)Healthcare Clinic in Phoenix, Arizona. MRZ is a reverse co-located integrated medical and behavioral clinic that provides services to about 4000 children and 4000 adults annually. MRZ provides laboratory, pharmacy, behavioral and physical health services together under one roof. The clinic utilizes an integrated electronic health record to document the treatment of members. The focus of the integration of care study was to understand and assess the barriers and challenges of the integration of care methodology at MRZ.

According to Armitage et al, integrated delivery systems (IDSs) are systems that provide a means to build a more effective and efficient health care system that takes a patient-center focus and better meets the needs of the population served (Armitege, 2008). Although there are myriad types of IDSs within the American health care system, there are a few systems that take precedent within the healthcare policy conversation. Peter Kongstvedt writes that although there are a number of systems to consider, the basic elements of each system remain the same, and the common denominator is the physician (Kongstvedt, 2013).

The current health care sector is too costly and too fragmented with a lot of variation in care even with established evidence based guidelines. Providers lack the tools, support and information they need to offer the coordinated health management that can reduce cost and improve outcomes. Primary Care Physicians are constrained in their abilities to perform any proactive care that involves avoiding Hospital or ER visits, and influencing healthy lifestyles.

From a young age, I wanted to be a conventional physician, but as I grew older, I became more disillusioned with our current medical system. As I became more disillusioned, I was more drawn to the naturopathic field and the opportunities it presented to treat problems naturally. In addition, I felt that the naturopathic field offered more personalized care to the patient as they struggled with their different health problems. The way that conventional medicine practices tries to treat as many patients as possible in the shortest amount of time. The field seems not to respect the patient as a person, and I feel like every person should experience a favorable level of respect when interacting with medical professionals. In addition, I feel that patients should know that their doctor cares for them and their health, and that is difficult to convey in a 15-minute appointment, especially when compared with a 45-minute appointment. As a Naturopathic Physician, I feel that I will be able to provide my patients with the care that they deserve.

Evidence based care- There are mask, tissue and hand sanitizers are provided at all doors and elevators to reduce germs (hand sanitizers kill 99.9% of the germs and are most useful to reduce the microbial load, thus controlling the rate of infection (Vidyashankar, Varma, & Payki, 2011).

While discussions of integrated care are not new in the United States, the research literature has largely been about blending mental and chemical health into physical health systems. Using a critical hermeneutic application of interpretive phenomenology, this study aims to address that gap by interviewing adults with serious mental illness about their experience receiving physical health services within a community mental health center. Nine individuals, five clients and four providers, interviewed for this study were selected using the critical case criterion in partnership with the community mental health center. Interviews were digitally recorded and transcribed. Data analysis was conducted within-case followed by cross-case analysis technique.

These efforts include early intervention, appropriate treatment, use of medications, and suicide prevention. The AAFP being in great support of integrated health care continue to struggle with the rates of reimbursements and continues to advocate for proper payment structures to enable them to support and implement the integrated process into their own private practices. The Affordable Care Act specified that Medicaid payments for primary care services would be at Medicare levels for primary care physicians in 2013 and 2014. Since then this provision has expired and instead of implementing new payment proposals the Center for Medicare and Medicaid services reverted to rates that proved to be lower than those most state Medicaid payors. (Blackwelder,

Throughout the career of a Viterbo University Student Nurse, one sees a variety of clinical settings to enrich one’s own knowledge base and skills practice to ultimately become a well- rounded and exceptional nurse. One of the experiences that we are able to have is to be a part of the Caring Clinic at the Salvation Army. In this setting we care for a population of impoverished and homeless individuals to assess blood pressures, health history, and do a mental health screening. This setting is like no other in the sense of we go to where the individuals that need our help instead of them coming to us. I have learned how it takes a special kind of nurse and group of student nurses to make the Caring Clinic happen to provide care and advocate

Evidenced-based health care management is constrained by multiple factors. The pressure of rapid change and the financial pressures provide much of the incentives for health care managers not to use evidence-based decision practices. Many managers believe the health care rapid cycle change does not allow time for study and analytical review before decision making (McAlearney & Kovner, 2013, p9). Many manages believe it is more efficient to make a decision and change it if it does not work. In addition, many senior leaders and decision-makers are skeptical of the economic value of predictive models (Guszcza & Lucker, 2012). The is also a belief that the stakes are too high and the evidence is to subtle and complex to turn over to relay on an

Integrative medicine acknowledges the necessity for modern practitioners to take into consideration the lives patients assume beyond the clinical setting, where they endure most of their health challenges. The role a patient’s family, community, bills, groceries, and more plays in the prevention and evolution of disease is far greater than is credited and appreciated. Thus, integrative medicine’s focus is centered on the patient when it implements strategies beyond conventional

Written about the structure and culture of biomedical heath care and a society that is attempting to prolong aging, Medicare funding, funding and development of research, and today’s definition of standard care, Sharon Kaufman brings to light the many dilemmas posed to the American health care system. Her ethnographic story, Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line reveals the booming biomedical research and clinical trials industry, the power held by Medicare and private insurance, and a rapidly changing standard of care once a medical treatment is considered reimbursable. This leads to systematic changes in the standard of care result in a massive amount of pressure being placed upon doctors, patients and families to make an ethically and medically sound decision in refusing or accepting therapy. Kaufman exposes the driving forces behind the expansion of biomedicine, society’s response to the growing industry on a personal and bureaucratic level.