Most health systems in the United States aim to deliver “patient-centered care,” although the term, admittedly, has been interpreted in many ways since its rise to prominence more than 20 years ago. We subscribe to the definition of patient-centered care offered by Ronald Epstein, M.D., and Richard Street Jr. as involving “deep respect for patients as unique living beings and the obligation to care for them on their terms.”
We also believe that to accommodate true patient-centered care, the focus of our health care system must shift from only treating disease to also creating health and well-being. This requires adopting a new, integrated model that helps people fulfill their own health needs — an achievement that will ultimately deliver the cost and quality outcomes that health managers seek.
If a major goal of health care is to help people live with vitality for as long as they can, we must address the factors — as many as possible — that affect the course of their life-health trajectory. These factors include nutrition and exercise, managing stress and competing priorities, economic forces, and hurdles preventing access to care.
In addition to treating illness, health care’s goal must, therefore, be to promote well-being and prevention as well as to provide support in virtually all aspects of people’s lives. Such a holistic approach is at the very definition of patient-centered care and requires treating the body, mind and spirit using whatever combination of tools is most appropriate. By helping people fulfill their own health care needs in this way, we can achieve lower cost and higher quality.
Three care models
Currently, our health care system relies on three distinct — and often siloed — care models to manage and optimize health:
- The biomedical model primarily treats disease, once it appears, by using evidence-based medicine. Care tends to be physician-directed, episodic and focused on addressing pathophysiology.
- The integrative medicine model treats the whole person, not merely the disease, and employs conventional as well as complementary approaches. These can include a broad set of therapeutic modalities such as biologically based practices, mind-body medicine, energy medicine, and manipulative and body-based practices. IM is generally health-oriented and proactive, and it involves partnerships between patients and providers.
- The assistance model (a term we coined) is rooted in the notion that managing care and engaging people in their health requires a personalized service that addresses the contextual factors in their lives — those issues, be they emotional, logistical or economic, that stand in the way of what is optimal. It gives consumers the support they need — via a trusted adviser — to navigate the health care system, coordinate care, address life-context issues, and curate other health- and benefits-related services.
- We contend that the greatest advances in health — and savings in the cost of care — will come when all three models are employed in concert to help people achieve their health goals.
'Medical process errors'
When care is provided exclusively through the conventional biomedical model, consumers are often left to their own devices. They’ll skip preventive steps, allow conditions to go unchecked and seek treatment from the wrong providers.
These “medical process errors” (not to be confused with mistakes made in the practice of evidence-based medicine) result from decisions that consumers make either without all of the facts or when other obligations get in the way of the best health practices. The choices may be rational, given the options, but they nonetheless result in suboptimal health. One simple example would be a mother who chooses to miss her physical therapy appointment rather than leave her child waiting to be picked up at preschool.
Medical process errors lead to deteriorating health and the need for more-expensive interventions. The associated costs are astounding, with the following estimates reported by the PricewaterhouseCoopers Health Research Institute capturing just part of the picture:
- Unhealthy consumer behaviors (including smoking, obesity, alcohol use and nonadherence to medical advice) account for $303 billion to $493 billion in treatment costs annually.
- Unnecessary emergency department visits cost $14 billion each year.
An integrated model
When the three care models are combined, treatment and health programs can be tailored to each person’s unique perspective, goals and life context. And patients get the necessary help — whether it’s information, or it’s emotional, spiritual, economic or logistical support — to get the right care at the right time.
While demonstration projects are still needed to quantify the economic value of blending the three models, the benefits appear to be substantial. We already know that:
- IM can close care gaps and improve treatment effectiveness — particularly for patients with complex, chronic conditions — and it can improve the safety of primary care by improving communication between practitioners, as noted by Sandra Grace and Joy Higgs in a September 2010 article in the Journal of Alternative and Complementary Medicine ("Integrative Medicine: Enhancing Quality in Primary Health Care").
- Organizations that employ the assistance model are able to reduce their health care costs by 5 percent to 15 percent, according to calculations by our colleagues (using a validated methodology).
By employing all three care models in concert, it should be possible to optimize well-being, treat and prevent disease more efficiently, and reduce the medical process errors that are inflating health care bills.
Alan Spiro, M.D., MBA, is a co-founder of Accolade in Plymouth Meeting, Pa., and chairman of Accolade’s medical advisory board. Adam Perlman, M.D., M.P.H., F.A.C.P., is an associate vice president for health and wellness at Duke University Health System and the executive director of Duke Integrative Medicine in Durham, N.C.