INTEGRATIVE/ COMPLEMENTARY HEALTHCARE TAP- NFCPAAlyssa Wostrel, MBA

Executive Director, IHPC

October 9, 2015

Disclaimer • Neither my spouse nor I have any conflict of interest or

financial commitments regarding this presentation and its content.

Integrative Health Policy Consortium• Broad coalition of healthcare organizations, clinicians,

patients and educators • IHPC advocates for public policy that ensures all

Americans access to safe, high quality, integrative, whole person healthcare

• Focus on prevention and wellness (shifting the paradigm from disease focus or sick care to well care)

• Our Partner for Health orgs represent over 400,000 licensed practitioners

Partner for Health Organizations

Integrative and Complementary Care • IHPC represents (via Partners for Health) licensed

naturopathic doctors, chiropractors, acupuncturists, holistic nurses, certified professional midwives, massage therapists, medical doctors and osteopathic doctors (trained in IHC).

• IM/IHC embraces a multi-disciplinary team of licensed health care providers working at the highest level of their scope of practice.

What do we do? IHPC in Action • Most recent congressional briefing – a collaboration

between IHPC, Academic Consortium for Integrative Medicine and Health and Allina “Easing the U.S. Healthcare Crisis: The Role of Integrative Healthcare”

• Conferences, symposia, testimony/comments to federal agencies, advocacy campaigns, legislative calls to action, strategic partnerships with allied orgs, original publications

• www.ihpc.org

Context of the Triple Aim and IHC/IM• US health care system the most costly in the world• Aging populations and increased longevity, coupled with

chronic disease is a major challenge• The Institute for Healthcare Improvement’s Triple Aim

entails ambitious improvement in:• Improving the patient experience of care• Improving the health of populations• Reducing the per capita cost of health care

• Patients who use IHC are healthier, have lower health care costs, and report extremely high levels of patient satisfaction.

Growth of IM/IHC

• Consumer interest and demand for IM/IHC starting to be more acknowledged on institutional levels

• The Cleveland Clinic is the first large institution to offer the functional medicine model to its patients thru the Center for Functional Medicine

• Mark Hyman MD – Director (9x #1 NYT bestselling author – intl leader in the field of Functional Medicine)

Affordable Care Act

• Section 2706: Non-discrimination in healthcare• Section 3502: Inclusion of CAM practitioners in the

Medical Home• Section 4001: National Prevention, Health Promotion,

and Public Health Council• Section 4206: Demonstration projects concerning

individualized wellness plans• Section 5001: National Healthcare Workforce

Commission• Section 6301: Patient-Centered Outcomes Research• Section 2301: Coverage for freestanding birth center

services

42 USC Sec 300gg-5(2706)• A group health plan and a health insurance issuer offering

group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.

2706: Importance to Patients Expand access for patients who wish to receive IHC. Encourages the development of an interdisciplinary team

approach with all providers delivering care within their scope of practice.

Leads to a pluralistic healthcare system based upon prevention and wellness as opposed to disease.

2706 Non Discrimination Context-Turf Battles

• Long History of Inter –Professional Tensions in Health Care-

• Wilk v. American Medical Association

• Struggles Over Professional Control Continue• North Carolina Board of Dental Examiners v. Federal

Trade Commission

Non-Discrimination Drivers• Chronic Illness• Healthcare Workforce Shortages• ACA Demands – Insurance Coverage• Expanding Scopes of Practice• Patient Centric Care – Consumer Choice• Growth of Integrative Medicine

2706 Directed to Insurers• Group, Individual, ERISA• Allows Selective Contracting• Not an “Any Willing Provider” Provision• Insurers Not Bound To Reimburse at the Same Rate• Reimbursement May Vary Based on Performance and

Quality Metrics

2706 Vague• Added on the Senate Side• No Legislative History• No Rule Making• Self Executing• Not Without Some Precedent• Medicare Part C, Medicaid, State Law

Confounding Factors• Clinical Efficacy

• Coverage Policy – Lacks Transparency

• Federalism and the Oddities of Insurance Regulation

Types of Health Plans

• Market-based Healthcare Plans•Plans on the “health insurance exchanges”•Self-insured Plans

Blue Cross and Blue Shield Service Benefit Plan: 2014• Subject to the criteria appearing on page 18, we now

cover any licensed healthcare practitioner for covered services performed within the scope of that license, as required by section 2706(a) of the Public Health Service Act.

2015 – 2016

Work with partners engaged in the states and ready to advocate for IHC

Focusing on selected states to help generate implementation actions

Re-intro, new bills in 2016

state sessions

Integrative Pain Care

Patient-focused professions

Employers

Global integrative health leaders

National clearinghouse

•Webinars &

Social Media•

Local advocate enabling

•Raise

integrative health

awareness

Summary • Sec 2706 is helpful for patients, practitioners and the

paradigm shift to prevention/well care • It is not being correctly enforced• IHPC’s CoverMyCare provides information and resources

to get familiar with the issues and opportunities for action• Don Berwick MD, former head of CMS – “We live in a

civilized and wealthy country … we should make healthcare a right” … (and that includes – the right to access the provider of your choice via Sec 2706)

Thank you! Suggested Resources • www.ihpc.org

• Cost Effectiveness Booklet • Policy Docs

• www.covermycarecare.org• Toolkit for Practitioners• Toolkit for Patients• Stories Album

• Alyssa Wostrel, IHPC Exec Director• awostrel@ihpc.org; cell: 505-331-7358