Integrative Health Center Integrative Health Center

ProposalProposal

Karen Burt, M.D.Director, CCRMC Integrative Health ProgramCoordinator, CCRMC Group Medical Visits

2009

In an Historic Time of In an Historic Time of National Healthcare Reform:National Healthcare Reform:

Create and Expand:

Integrative Health Patient Services Integrative Health Patient Services Group Medical VisitsGroup Medical Visits

Health Education Health Education

Integrative Health CentersIntegrative Health Centers

Services:Services:Focus on Prevention / Self-ManagementFocus on Prevention / Self-Management

Group Medical Visits

Health Education, Wellness and Fitness Classes

Complementary and Alternative Medical (CAM) Services

Integrative Health Clinic: Individual providers and CHW’s for 1:1 care

Behavioral Health Services: SA/ MH Dr. Ferman

Training Center: Patients Staff Outside providers

Evaluation: Quality improvement

Integrative and CollaborativeIntegrative and Collaborative

Integration: Holistic approach The Whole Person

Integration with CAM

Collaboration with Patients and families: Self- management = decreased unnecessary reliance upon acute care facilities

Collaboration within Health Care System – build upon existing services

DFM PH MH Admin

Collaboration with other County divisions / agencies

Adult Education EHSD Parks and Recreation

Collaboration with members and agencies of the Community

Community Health Workers Community Agencies Community Advisors

Integrative Health CentersIntegrative Health Centers

LocationLocation

Dedicated space: within major Health Centers for groups, classes, CAM

Three centers: PHC, MTZ, and RHC No exclusion of any population

Positive Common Environment: Supporting the mission

Heart:Crisis Intervention/Crisis Intervention/

Disease ManagementDisease Management

Key:Technology

ComplianceEducation

to participate in preventive screening and

disease management

TeamMD, Nurse, OT,

PT, SW, Admin., etc.

Technology

Evidence Based ? Skyrocketing costs

Unequal Distribution - Health Disparities

Current Conventional Medical ParadigmCurrent Conventional Medical Paradigm Not Sustainable

Marginalized: MH / SA / PH / Community

Integrative Health ParadigmIntegrative Health ParadigmSustainableSustainable

Crisis Intervention/

Disease Management Cost effective

Evidence-based

Inclusion of CAM

Collaborative Teamwork

All inclusive

CHW: Link to community

Self HealthcareSelf HealthcareKey: Empowerment/

Support

Preventive Self -CareSelf –Management of

Illness

Nutrition Sleep, Pacing Exercise

Meditation/Deep Relaxation

Empowerment of PatientTrust, engagement, change

Culturally sensitive

Self-Management /collaboration

Emotional / Mental Self-Care

Active Patient Education – Life Skills

Behavioral Health –

Spectrum of CareCrisis / Disease

Counseling: 1:1 & group

Stress Management

Integrative Integrative Health Health CenterCenter

Break IsolationBuild Community

Information/Education

Empowerment

CAM Modalities

Integration /CollaborationEvaluation

Training

Mission of Integrative Health CentersMission of Integrative Health Centers

Self-Efficacy Self-Healthcare

Community Resources

Decrease reliance on pharma

Treatments/Self-Practices:

How to use/How to evaluate

Patient - Provider

DFM - PH - SA - MH

CHW - Community

All services:

Productivity

Efficacy

Cultural Sensitivity

Our staff, public hospitals, community clinics/agencies

Groups & CAM Integration in HC for Underserved

Decrease Stress

Increase Support

Integrative Health Center ServicesIntegrative Health Center Services

Training Center Groups / CAM integration

GroupsMedical Visits / Classes

IH Clinic

1:1 providers

Chronic Illness Peer Support Counselors

Behavioral Health Group and 1:1 Treatment

Innovative / Effective

Therapies

CAM & Other Services Acupuncture

Massage

Chiropractic

Gym Memberships / Pool Use

Integrative Integrative

HealthHealth

CenterCenter

Adult Ed

CHW

Promotoras / HCs

Dr. Ferman

Gyms / Parks and Rec

Promotoras / HCs

CHW / Senior Peer Counselors

CCRMC Providers / Staff / Residents CCRMC Providers

CCRMC Providers Interns Contractors

EvaluationEvaluation

Every Program Evaluated:

1. Measurable parameters of health and illness2. Productivity3. Patient and provider satisfaction4. Patient and provider perception of patient progress

Programs that are not successful will be terminated after quality improvement measures fail.

Collaborate with experts in program / service evaluation e.g.: PH - CHAPE UCB School of Public Health UCSF Osher Center for Integrative Medicine

Example: Peri-natal

Services Centering Prenatal Groups Well Baby Groups WIC Depression Screening 1-800-No Blues Resource Line Doula Program Lactation Consultation Peri-natal Group Peer Support Counseling Behavior Health Counseling

Life Course Training – Community Agency / PH

Collaborators FMC Staff Healthy Start / WIC Behavioral Health Public Health Community Agencies Lactation Consultants Community Health Workers / Promotoras / Health Conductors

Outcomes Preterm birth* / Peri-natal depression Peri-natal screening / care 2007 Yale study: 33% Family Wellbeing / Health

Components Required Components Required

Space:Space: Design and Furnishing Grant

Personnel:Personnel:

Administrative:Administrative: Program Dir 20/40 CCRMC / Grant Medical Dir 20/20 CCRMC Behavioral Health Dir 5/20 Admin Assist to Dir/Eval 0/20 Clinical Services Mgr 0/20 Behavioral Health per Dr. Ferman

Clinical Staff: Clinical Staff: Providers CCRMC ** LVN / CMA CCRMC CHW / Adult Ed Grant / Collaboration ** Group Care Coordinator 40/80 CCRMC / Grant

Consultants: Consultants: Evaluation / Training Grant

IncentivesIncentives GrantGrant

** = already needed at current volume

Family Practice Resource:Family Practice Resource:Patients, Providers and Healthcare System BenefitsPatients, Providers and Healthcare System Benefits

Patients’ fundamental needs addressed: Across age spectrum

Prevention Culturally sensitive / linked to community

Chronic illness / chronic pain / obesity Behavioral Health

New Productive / Successful Venues for Providers to deliver care: Greater patient collaboration and satisfaction

Greater teamwork with other divisions increased resources Increased job satisfaction

Health Care System Balanced / Costs reduced: Increased patient self-management skills & self care

Long term decrease in unnecessary acute care need Cost containment / Cost effective