FOCUS ON: The Affordable Care Act and Functional Medicine
Anyone with even a tangential connection to news media over the last few months knows that the U.S. Supreme Court upheld the entire Affordable Care Act (ACA). (Links to full-text versions of the Supreme Court decision and the ACA itself are provided under Resources, below.) While passionate discussions continue about whether or not the ACA will be repealed this fall, or next year after the 2012 elections (see, for example, McDonough 2012), the ACA continues to be implemented, thereby affecting myriad policies and opportunities throughout the nation’s healthcare system.
Fortunately, despite wildly differing views of the most controversial aspects of ACA—the individual mandate and other payment reforms—there is much in the rest of the act for the functional medicine, integrative medicine, and CAM communities to support. Many worthwhile provisions of ACA have already been activated (e.g., no exclusions for pre-existing conditions, extended eligibility for adult dependents to remain on their parent’s insurance plans, and the removal of limits on lifetime benefits for essential services), and many more will be phased in during 2013, 2014, and 2015. This month (August 2012), for example, triggered the requirement that all new health insurance plans must cover preventive services such as mammograms, colonoscopies, and certain women’s preventive services (e.g., contraception) without cost-sharing elements such as deductibles, co-pays, or coinsurance—surely a win for preventive medicine advocates.
Costs of our
Current Healthcare System
Even with passage of the ACA, the U.S. remains the only western democracy that does not guarantee health care for all its citizens. Partly as a result of the uninsured accessing care only when they are very sick, and partly as a result of our emphasis on acute and end-stage care, the United States has the most expensive healthcare in the world, by a factor of two: “$7000 per capita in overall spending compared with $3500 in other countries in 2006” (Voelker 2008, citing Catlin 2008 and Org Econ Dev 2008). These costs are fueled by the chronic disease epidemic, which costs “the economy more than $1 trillion annually—and that figure threatens to reach $6 trillion by the middle of the century” (Milken Institute 2007).
As many IFM website users will recall, IFM published a white paper in 2010 (updated in 2011) titled 21st Century Medicine: A New Model for Medical Education and Practice
. One of the strongest arguments put forth in that paper was that continuing to focus our resources on the acute-care model will not empower us to effectively address the outcomes and costs (see Sidebar) of the chronic disease epidemic—only a new model for understanding, assessing, and treating chronic disease will achieve that goal.
Those who agree with us on that subject should be delighted to welcome the ACA’s many provisions on preventive, whole-person, integrated care for chronic disease, including the following (quotations all taken directly from the full text version of the ACA; bold face and italics added):
- Establishing a National Prevention, Health Promotion and Public Health Council, charged with providing “coordination and leadership at the Federal level, and among all federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States.”
- Appointment of an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health that includes “a diverse group of licensed health professions, including integrative health practitioners” to “develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.”
- Definition of a healthcare workforce that includes (among the many conventional job titles) preventive medicine physicians, doctors of chiropractic, licensed complementary and alternative medicine providers, and integrative health practitioners.
- Funding for patient-centered outcomes research (including an institute, PCORI, designed to further such research) to measure the comparative clinical effectiveness of a variety of treatments and services, including “integrative health practices,” with emphasis on chronic conditions and attention to “the potential for new evidence to improve patient health, well-being, and the quality and cost of care.” PCORI’s five priorities include:
- Improving healthcare systems
- Communication and dissemination of research
- Addressing disparities
- Accelerating patient-centered outcomes research and methodological research
- Establishing community health teams to support the patient-centered medical homes initiative.1
- Establishing (through HRSA) a National Coordinating Center for Integrative Medicine (NccIM) that will provide technical assistance to and evaluate integrative medicine residency (IMR) programs.
Funding is already being made available to propel that last initiative. HRSA has announced two interrelated grant programs “that are creating the most significant presence to date for integrative medicine at the federal level” (Weeks 2012). One program will offer 16 grants to medical schools for curriculum development in integrative medicine, and the other will establish the NccIM itself (very likely at a medical school). According to Weeks, the two grant programs will award about $3.3 million over the next three years.IFM already has working relationships with a number of medical schools
and can foresee playing a significant role in the development of residency curriculums at medical schools that are already on their way toward (or are interested in) integrating functional medicine into their teaching and clinical practice. Although it’s too early to see how functional medicine and IFM will become involved in other aspects of ACA, it does seem safe to predict that our involvement with advancing the management of chronic disease in clinical care, in education, and in research will continue to develop as the Affordable Care Act provisions are implemented. And, for the first time, those IFM strategic priorities are also reflected in a comprehensive federal law.1From the National Council on Quality Assurance, “A patient-centered medical home is a model of care that strengthens the clinician-patient relationship by replacing episodic care with coordinated care and a long-term healing relationship.” Click here for the brochure.