Health Care Reform Bill Contains Opportunities for Integrative Medicine

Article Outline

• Subtitle A: Modernizing Disease Prevention and Public Health Systems
  • Section 4001
  • Section 4002
  • Section 4003
  • Section 4004
  • Section 4103
• Subtitle C: Creating Healthier Communities
  • Section 4201
  • Section 4206
  • Section 4305
• Subtitle D: Patient-Centered Outcomes Research
  • Section 6301
• Other Provisions
• Download the Act
• Biography
• Copyright

The Patient Protection and Affordable Care Act (HR 3590), which was signed into law (No. 111-148) in April 2010, provides many opportunities for the integrative medicine community. Perhaps most important is that the new law specifies the creation of a national prevention strategy and provides $15 billion dollars in funding for a public health and prevention fund. The Act also contains other “calls to action” that address prevention and wellness, patient-centered care, and the management of chronic disease, all areas in which integrative medicine can make a significant contribution.

Most of the opportunities center around helping to shape prevention and wellness strategies through participation in advisory groups or providing input to these groups, and increased funding for demonstration projects and research.

“Prevention and wellness are now firmly embraced within the national health agenda,” said Larry Dossey, MD, executive editor for EXPLORE: The Journal of Science and Healing. “This is a huge step forward.”

Although there are others, the following important items are contained in “Title IV: Prevention of Chronic Disease and Improving Public Health,” and provide opportunities for integrative medicine:

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Subtitle A: Modernizing Disease Prevention and Public Health Systems 

Section 4001 

Perhaps the most important mandate, this section requires the establishment, within the Department of Health and Human Services, of the National Prevention, Health Promotion and Public Health Council and the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. The Council's chairperson, the surgeon general, is tasked to develop a national prevention, health promotion, and public health strategy.

The law states that the Council will be composed of the Secretary of Health and Human Services, Secretary of Agriculture, Secretary of Education, Chairman of the Federal Trade Commission, Secretary of Transportation, Secretary of Labor, Secretary of Homeland Security, Administrator of the Environmental Protection Agency, Director of the Office of National Drug Control Policy, Director of the Domestic Policy Council, Assistant Secretary for Indian Affairs, Chairman of the Corporation for National and Community Service, and the head of any other federal agency that the chairperson determines is appropriate.

This Council is directed to “provide 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, and to develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States.” It will provide “recommendations to the President and Congress concerning the most pressing health issues confronting the United States and suggest changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition.”

The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health—which will inform the Council—is directed to be “composed of not more than 25 non-Federal members to be appointed by the President.” In appointing members, the President is advised to ensure that “the Advisory Group includes a diverse group of licensed health professionals, including integrative health practitioners who have expertise in worksite health promotion; community services, including community health centers; preventive medicine; health coaching; public health education; geriatrics; and rehabilitation medicine.”

The Advisory Group will “develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.”

As of this writing, recommendations for this Advisory Group are being submitted to the White House.

Section 4002 

This section establishes a Prevention and Public Health Fund to be administered through the Department of Health and Human Services, Office of the Secretary. This fund will provide for “expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.” Five billion dollars will be appropriated between 2010 and 2014, with $2 billion appropriated each fiscal year thereafter. Funded programs will be focused on prevention and wellness.

Section 4003 

This section reauthorizes the Preventive Services Task Force as an independent task force that reviews the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, which will be published in the Guide to Clinical Preventive Services. This Guide will be directed to “individuals and organizations delivering clinical services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives.”

According to Nicholas Papas at the Department of Health and Human Services (HHS), “the process for selecting task force members is as follows: Open calls for nominations are posted annually in the Federal Register. Nominations are sought from clinicians in disciplines including pediatrics, obstetrics-gynecology, internal medicine, family medicine, nursing and behavioral counseling. The members are named by the Director of AHRQ to four-year terms, with one or two year extensions possible. Nominees are evaluated on the basis of: 1) Expertise in critical appraisal of evidence; 2) Knowledge about prevention in primary care; and 3) Primary care experience.”

Section 4004 

In this section, the Secretary of Health and Human Services is directed to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Among other items, the campaign is directed to disseminate information that encourages healthy behaviors linked to the prevention of chronic diseases, and to address proper nutrition, regular exercise, smoking cessation, and obesity reduction.

A competitive bid process will be utilized to award the contracts connected with this campaign, which will include the use of television, radio, Internet, and other commercial marketing venues, as well as a Web site that will provide science-based information on guidelines for nutrition, regular exercise, obesity reduction, smoking cessation, and specific chronic disease prevention.

Section 4103 

This section calls for Medicare reimbursement for an “Annual Wellness Visit” that will include the creation of a personalized prevention plan that includes the following: (1) a health risk assessment; (2) the establishment of, or an update to, the individual's medical and family history; (3) a list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications); (4) a measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements; (5) detection of any cognitive impairment; (6) the establishment of, or an update to a screening schedule for the next five to 10 years, as appropriate; (7) a list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions; and (8) a list of treatment options and their associated risks and benefits.

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Subtitle C: Creating Healthier Communities 

Section 4201 

This section requires the Director of the Centers for Disease Control and Prevention to award grants to state and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence base of effective prevention programming.

A series of “Community Transformation” grants will leverage existing evidence-based disease prevention programs, such as those that promote healthier eating and increased physical activity, and establish new programs in areas that currently do not receive funding. To be eligible to receive a grant, an entity must be a state governmental agency; a local governmental agency; a national network of community-based organizations; a state or local non-profit organization; or an Indian tribe.

Activities within the plan may focus on but are not limited to the following: (1) creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of healthy lifestyle, emotional wellness, and prevention curricula, and activities to prevent chronic diseases; (2) creating the infrastructure to support active living and access to nutritious foods in a safe environment; (3) developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, improve social and emotional wellness, enhance safety in a community, or address any other chronic disease priority area identified by the grantee; (4) assessing and implementing work site wellness programming and incentives; (5) working to highlight healthy options at restaurants and other food venues; (6) prioritizing strategies to reduce racial and ethnic disparities, including social, economic, and geographic determinants of health; and (7) addressing special populations needs, including all age groups and individuals with disabilities, and individuals in both urban and rural areas.

Information on the Community Transformation Grants will be made available on the HHS Web site in the coming months.

Section 4206 

This section requires the HHS Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers with individualized wellness plans that are designed to reduce risk factors for preventable conditions. Up to 10 community health centers will be funded under this section. An individualized wellness plan may include one or more of the following as appropriate to the individual's identified risk factors: nutritional counseling, a physical activity plan, alcohol and smoking cessation counseling and services, stress management, and dietary supplements that have health claims approved by the Secretary.

Section 4305 

This section directs the Institute of Medicine to convene a Conference on Pain that will increase the recognition of pain as a significant public health problem in the United States; evaluate the adequacy of assessment, diagnosis, treatment, and management of acute and chronic pain in the general population; identify barriers to appropriate pain care; establish an agenda for action in both the public and private sectors that will reduce such barriers and significantly improve the state of pain care research, education, and clinical care in the United States.

Additionally, the Director of the National Institutes of Health is encouraged to expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and potential treatments for pain.

The Secretary is charged with establishing an Interagency Pain Research Coordinating Committee that will coordinate all efforts within the HHS and other federal agencies that relate to pain research. In addition to the seven voting federal representatives appointed from agencies that conduct pain care research and treatment, 12 additional voting members will be appointed. Six will be chosen from among leading scientists, physicians, and other health professionals, and six members shall be appointed from members of the general public who are representatives of leading research, advocacy, and service organizations for individuals with pain-related conditions.

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Subtitle D: Patient-Centered Outcomes Research 

Section 6301 

This section requires the Patient-Centered Outcomes Research Institute to identify priorities for, and establish, update, and carry out, a national comparative outcomes research project agenda and creates the Patient-Centered Outcomes Research Trust Fund.

The Patient-Centered Outcomes Research Institute was created by the Patient-Centered Outcomes Research Act of 2009 as a private, nonprofit corporation to assist patients, clinicians, purchasers, and policy makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis.

The new law provides funding for the Institute and the Agency for Health Research and Quality to disseminate research findings of the Institute, as well as other government-funded research, to train researchers in comparative research methods, and to build data capacity for comparative effectiveness research.

The Institute is directed to identify national priorities for research, taking into account factors of disease incidence, prevalence, and burden in the United States, with emphasis on chronic conditions. It is further directed to consider the potential for new evidence to improve patient health, well-being, and the quality of care.

To do this, the Institute will establish a research project agenda. Contracts for conducting such research will be available to appropriate agencies and instrumentalities of the federal government, as well as appropriate academic research, private sector research, or study-conducting entities.

The section also requires the creation of a Methodology Committee to be composed of not more than 15 members. Members appointed to the methodology committee shall be experts in their scientific field, such as health services research, clinical research, comparative clinical effectiveness research, biostatistics, genomics, and research methodologies. This committee will work to develop and improve the science and methods of comparative clinical effectiveness.

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Other Provisions 

Under Section 399MM, to expand the utilization of evidence-based prevention and health promotion approaches in the workplace, the Director is instructed to provide employers with technical assistance, consultation, tools, and other resources in evaluating such employers' employer-based wellness programs.

Under Section 10408, the Secretary shall award grants to eligible employers to provide their employees with access to comprehensive workplace wellness programs. The Secretary is directed to develop program criteria for comprehensive workplace wellness programs that are based on and consistent with evidence-based research and best practices.

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Download the Act 

The entire bill, as passed, can be downloaded at: http://dpc.senate.gov/dpcdoc--sen_health_care_bill.cfm.