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From the Townsend Letter
October 2008

Pathways to Healing
by Elaine Zablocki

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Bravewell Collaborative Reports on Successful Integrative Medical Centers

The Bravewell Collaborative recently released a report that will interest anyone who works with an integrative medicine center. It's an extremely valuable resource for anyone who manages such a center and for someone who's considering starting one. "Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network" outlines best practices at eight US integrative medicine clinics, including business models, strategies for growth, key services provided, and effective marketing programs. A valuable appendix includes model patient intake and assessment forms.

The first thing we learn from this report is that no two integrative medicine clinics operate on the same organizational model. While many of them share target populations and treatment philosophies, these clinics have different approaches and operate within varying economic constraints. They often offer different services aimed at specific markets in their locality.

Bravewell Clinical Network Pioneers Successful Business Models
In 2003, the Bravewell Collaborative formed the Bravewell Clinical Network, designed to help integrative medical centers develop marketing and practice management and financial-planning strategies. As part of the network, representatives of the integrative centers meet face-to-face twice a year to share what they've learned. The current report offers an in-depth look at the eight centers in the network, which include the following:

• Scripps Center for Integrative Medicine, Scripps Health, La Jolla, California
• Osher Center for Integrative Medicine, University of California, San Francisco
• Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
• The Continuum Center for Health and Healing, Beth Israel Hospital, New York City
• Duke Integrative Medicine, Duke University, Durham, North Carolina
• Alliance Institute for Integrative Medicine, Cincinnati, Ohio
• Jefferson – Myrna Brind Center for Integrative Medicine, Thomas Jefferson Medical College, Philadelphia, Pennsylvania
• Advocate Center for Complementary Medicine, Park Ridge, Illinois

The centers in this report range from one-and-a-half full-time employees to more than 25 full-time employees. One has 1,900 square feet of space, two have 4,000 square feet, and the two largest have about 18,000 square feet. The smallest have 4,000 patient visits per year, while the largest have more than 30,000 patient visits per year.

Each center has a different business model, dependent on specific factors such as the local marketplace, the associated medical institution, and the particular expertise and interests of the leaders who founded the center. At present, four of the centers are at break-even or profitable, one is close to break-even, and three are working towards profitability. The most common complementary therapies offered at the centers include acupuncture, massage, mindfulness-based stress reduction, mind-body therapies, nutritional counseling, and yoga. All the centers offer services focused on lifestyle changes, prevention, and wellness, and all of them use a team approach to care. Seven of them have research programs.

These centers work actively to develop philanthropic support. They use advisory boards to help increase awareness about the center and the benefits of integrative medicine, and they all engage in community outreach and education. Payment options vary: some are available on a fee-for-service basis, some take insurance, and some use both.

Fees Charged by Integrative Medicine Centers

Initial Patient Visit with MD
Acupuncture Session
Biofeedback Session
Nutrition Counseling Session
Energy Healing Session
Chiropractic Visit
Massage Session
Psychotherapy Session
Psychiatric Session

Source: "Best Practices in Integrative Medicine," The Bravewell Collaborative

Bonnie Horrigan"The various business models are very different, and all of them are working," says Bonnie Horrigan, Director of Communications and Public Education for the Bravewell Collaborative, who wrote the report. "One key lesson is that you don't have to build a separate building or organization in order to have an integrative medicine center. You can take a look at where you are and what you already have, and then start from that basis. For example, the Scripps Center for Integrative Medicine built an alliance with the Scripps hospital system, which has a strong cardiac program. Now Scripps cardiologists refer heart patients to the integrative center for its lifestyle change program."

Another interesting point is that the various centers specialize in so many different aspects of health care. The Continuum Center in New York generally delivers primary care. The University of Maryland developed an alliance with Kernan Hospital and its trauma center, and part of its integrative medicine program focuses on trauma care. The University of California at San Francisco (UCSF) operates a substantial cancer program, and now the UCSF Osher Center is offering integrative medicine throughout the cancer program. "Integrative medicine isn't just for primary care or OB/GYN or cancer or arthritis," Horrigan comments. "There are applications and programs within integrative medicine that are applicable to many areas of health care."

"Best Practices in Integrative Medicine" discusses the ways each clinic has achieved success within its own unique marketplace and corporate structure, noting several factors that lead to success in integrative medicine. One of them is building a distinctive reputation, as Scripps did when it began to specialize in cardiac care and Osher did in cancer care. "These centers are all expanding, but when they first started out, they all had specialties, and that helped because it gave them a focus on which to build a base," Horrigan says.

Many of the successful integrative medicine centers have built joint programs with conventional departments. "The more the center interacts with the organization of which it is part, the more successful it tends to be," Horrigan notes. "That means offering educational programs, knowing who the other physicians are, getting referrals, being part of the whole organization."

Another key factor for success: paying attention to economic realities and developing a thoughtful mix of higher margin services. For example, massage services don't generate significant revenue, but most of the centers offer it at cost because it's beneficial for their patients. Then they offer other services that do bring in sufficient money, so that on balance, the center can cover all its expenses.

Summit Planned on Integrative Medicine
The Bravewell Collaborative is partnering with the Institute of Medicine (IOM) to convene a summit to explore the science and practice of integrative medicine, with a focus on improving patient-centered care and promoting the nation's health. With sponsorship from the Bravewell Collaborative, IOM will host a National Summit on Integrative Medicine and the Health of the Public, to be held in Washington, DC, on February 25-27, 2009.

Traditionally, health care has focused primarily on healing physical ailments, without much attention to the emotional challenges that often accompany illness and can hinder patients' abilities to take care of themselves. In a recent report, "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs," IOM proposed a new standard of care, stating that all cancer patients should routinely receive support and services for stress, depression, and other mental and social problems.

The summit next February will build on that report and look at many ways integrative medicine addresses the personal and community environments that empower patients to be active participants in their own care. It will also focus on finding ways to spur changes and lead people to maintain wellness and avoid disease.

Consumer Information and Personal Health Planner Are Available
The Bravewell Collaborative website includes a valuable section for consumers on patient empowerment and ways to navigate the health care system. "Take an active role in your own health care," the website urges. "One of the core principles of integrative medicine is that you, working in partnership with your health care provider, should be the ultimate decision-maker regarding any of your own health concerns." The website offers many links to additional resources.

The recent two-hour PBS documentary, "The New Medicine," was funded in part by many of the Bravewell Collaborative philanthropists, and the "New Medicine" website is another valuable tool for consumers. It has a "health planner" tool for tracking your own personal healthy lifestyle changes, plus a timeline showing the history of integrative medicine. There's information on specific conditions, such as allergies, anxiety, chronic pain, depression, migraines, surgery recovery, and many more. In addition, there's a link to order the DVD of the documentary and/or a companion book.


Elaine Zablocki is the former editor of CHRF News Files.


Consumer information on integrative medicine:

The Bravewell Collaborative:

To purchase "Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network":

The National Summit on Integrative Medicine:

For the IOM report, "Cancer Care for the Whole Patient," go to: Brief reports for patients and providers are available at the same web location.


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