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    Victoria Maizes, David Rakel, Catherine Niemiec ; commissioned for the IOM Summit on Integrative Medicine and the Health of the Public, February 2009.
    Integrative medicine has emerged as a potential solution to the American health care crisis. It provides care that is patient-centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American health care, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative health care system grounded in team-based care. A primary health partner, who knows the patient well, is able to addresses mind, body and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient centered medical home. The paper culminates with ten recommendations directed to key actors to facilitate the systemic changes needed for a functional health care delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost-effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate health care teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the U.S., new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.
    Digital Access  IOM 2009