Harmonizing Health In The Lone Star State

Integrative medicine, a health care approach that is gaining a foothold in modern care settings, is a burgeoning sector of the US health-care market. As a coordinated effort to treat the whole person, integrative medicine incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside orthodox methods of diagnosis and treatment. Seen as an answer to the growing demand for more patient-centered care, the business of integrative health care has emerged as a dynamic and multifaceted industry. Behind this paradigm shift lies a tapestry of compelling statistics, revealing the widespread adoption, economic impact, and patient preferences reshaping how we perceive and invest in health care.

Market analyses indicate that the global market for integrative medicine is experiencing a robust growth trajectory, projected to reach billions of dollars in revenue over the next decade. Statista predicts that at the end of 2023, integrative health care revenue will be $30.6 billion, a 41 percent revenue increase over the last decade.

According to the Complementary and Alternative Medicine Market, the industry is expected to reach $362.97 billion by 2029 at a growth rate of 17.9 percent. This expansion is attributed to increasing public awareness, shifting attitudes toward preventive care, and a growing body of research supporting the efficacy of integrative practices.

Additionally, more than 60 percent of adults in the United States have used some form of complementary health approach. This figure underscores a growing trend in patient preferences, where individuals are seeking holistic approaches to their health concerns, according to a recent National Center for Complementary and Integrative Health survey.

As a result of the ever-increasing adoption of integrative health practices, health care providers, entrepreneurs, and investors alike are recognizing the potential of integrative medicine not only to improve patient outcomes but also to revolutionize the business of health care.

In the Clinical Field

The People’s Community Clinic (PCC) has been focused on the whole patient since it started in the basement of a church across the street from the University of Texas at Austin campus. This nonprofit primary care facility strives to provide high-quality health care to the medically underserved and uninsured, offering a multitude of health and wellness services, ranging from integrative pain management to prenatal to eldercare.

Formally trained in modern medicine, Dr. Sharad Kohli, a family medicine physician at PCC, was drawn to the health center for its consideration of underlying issues impacting people’s health. Kohli stresses the need to consider the socioeconomic factors of PCC’s demographic, such as how poverty, racism, and lack of food and housing impact people’s health.

Many patients don’t want to be on any medications, especially with the opioid epidemic, Kohli says. But if insurance covers mainly drugs, do they have access to any evidenced-based nonpharmacologic options that may actually be safer and more effective long term?

Kohli was a cofounder of the nonprofit organization Integrative Medicine for the Underserved (IM4US), which supports affordable health care accessibility to underserved communities, such as the demographic treated at PCC. IM4US and PCC are two organizations blending contemporary and holistic approaches to health care to educate the public about integrative health care.

PCC patients often struggle with health care accessibility issues, such as insurance coverage. The clinic offers medical assistance, but with limited funding and support, it can lead to a frustrating cycle for everyone involved.

At the US Department of Veterans Affairs’ hospitals and clinics, the Whole Health program shifts the narrative from what’s the matter with you, to what matters to you, and veterans nationwide are asking for this program. But getting the word out that change is coming is a struggle, says Dr. John Finnell, the clinical director of Whole Health at Central Texas Veterans Healthcare System.

“We’ve definitely seen quite a bit of growth across the state,” Finnell says. Finnell, a naturopathic physician, sits on the data and outcomes team representing the Whole Health Program for the Veterans Integrative Service Networks 17 (VISN 17). A VISN is a regional care system that works to better connect local health care needs to provide greater care access. There are 18 VISNs across the United States; VISN 17 is the Heart of Texas Healthcare Network, while Houston is covered by VISN 16.

“In fiscal year 23, around 30 percent of veterans, who received care through the VA, accessed some type of Whole Health service,” Finnell says. “We’re seeing quite a bit of increase in participation in Whole Health services, and it starts with awareness. It does take time to get the word out, and it’s a cultural transformation. That means not only do we transform how we deliver care, but that means that we’re reeducating our providers. We’re reeducating our veterans, too, because they are used to a certain model of health care. So, this is different. What we found is that not only our employees but our veterans also are very welcoming and accepting. But you have your early adopters, and then you have your skeptics. So, it does take time to make this transformation, and it is going to be a long-term implementation across the VA.”

The tides have also been shifting in contemporary medical settings. Baylor Scott and White started an integrative program in 2013 at the Baylor Charles A. Sammons Cancer Center in Dallas. This was the first hospital-based integrative health program in North Texas at the time. In Houston, Memorial Hermann Hospital and Houston Methodist include integrative medicine in their toolkits to provide a more holistic view of patient care.

The Next Generation of Providers

Austin’s AOMA Graduate School of Integrative Medicine is producing the next generation of integrative medicine doctors, practitioners, and researchers. Students graduate with a master’s or doctoral degree and are eligible to get their license in the state of Texas. Acupuncture and herbal pharmacy are two of the most sought-after offerings.

“COVID impacted enrollment quite a bit, and we’re just coming out of that,” says Mary Faria, AOMA president and CEO. AOMA has an average class size of 12 students, with 130 enrolled and an alumni network of 847. “Most students go into private practice, a growing percentage look for work in the health care systems, including the VA,” Faria adds.

AOMA, which began in 1993 as the Academy of Oriental Medicine at Austin, also operates two clinics that are open to the public. One is the students’ clinic, where licensed doctors oversee AOMA students as they treat patients. The other is a clinic where licensed doctors are primary providers who serve patients.

According to AOMA’s website, the “clinical internship offers our students hands-on experience and is a means of service to the greater Austin community.”

Another important aspect for students at AOMA is clinical rotations through Western facilities, Faria says. Through the clinics of hospitals, Veterans Affairs, and others such as PCC, students are able to treat patients and work with practicing physicians to provide integrative care.

Integrating Components from Around the World

“Integrative medicine treats the whole person. It takes into consideration all factors that influence your health: biological, behavioral, psychosocial, and environmental. To be truly healthy requires not only physical, but also emotional, mental and spiritual well-being,” according to Dr. Melinda Atienza, an osteopath at HonorHealth. Integrative health also uses a biopsychosocial model, which looks at the interconnection of the individual’s environment in conjunction with their good or bad health biologically, psychologically, and socially.

There are two foundational medicines within the integrative health model known today: Ayurvedic medicine and traditional Chinese medicine (TCM).

Ayurvedic medicine is ancient Indian medicine dating back to the sixth century BC. According to the National Center for Complementary and Integrative Health, ayurvedic medicine “is considered one of the oldest medical systems in history.” Ayurvedic is based on ancient scripts that use plants and herbs, diet, exercise, and lifestyle.

TCM dates back more than 5,000 years. It focuses on “a vital force of life, called qi, surges through the body. Any imbalance to qi can cause disease and illness,” according to the Johns Hopkins Medicine website. The interaction of two opposing energies, yin and yang, creates qi. There are several branches of TCM, including acupuncture, cupping, breathwork, and herbal medicine, among others.

Getting Access

The business of integrative medicine stands at the crossroads of innovation and profitability. Two major hurdles for this industry are the battle for accessibility involving socioeconomic factors and the difficulty of getting insurance to accept claims for integrative medical care.

The government and private insurers are exploring ways to incorporate integrative health therapies into conventional health care systems. Blue Cross Blue Shield and UnitedHealthcare are some of the first insurers to cover integrative practices, such as acupuncture and chiropractic care.

AOMA’s clinics may offer some coverage with certain insurers, such as Blue Cross Blue Shield and UnitedHealthcare. Still, some policy blockers are in place that make it harder to provide care to everyone.

“We’ve been trying for years to get Medicare to cover. Finally, they did. So now they cover only for lower back pain,” Faria says. Even so, there are conditions. “If we were to see a Medicare patient … you have to either be a medical doctor (MD) or be a nurse practitioner or if you are a licensed acupuncturist you need to be supervised by an MD or nurse practitioner for Medicare to cover.”

Earlier this year, the National Academies of Sciences, Engineering, and Medicine released a new report that recommended the VA and US Department of Health and Human Services come together and create a Center for Whole Health Innovation.

“They were looking at the Whole Health model of care and actually saying that the whole health-care system should move to that type of model,” Finnell says.

“What you’re seeing is private insurers, Medicaid, Medicare services, federally qualified health centers, and hopefully the states are looking at this as well, but they have their eye on what’s going on at the VA right now,” he adds “Hopefully some of the payment models and other things like that can be figured out so that this type of care is available more broadly, and it becomes what we’re used to when we go to the doctor.”

Not only does insurance stand in the way of accessibility, but so does a lack of trust some people have with the health care industry. At PCC, “you’re learning about that person. You’re building relationship and building trust. That’s one of the things I think that’s really common in integrated practitioners that you don’t necessarily always see in Western medicine,” Kholi says.

Breaking the Silos

Dr. Hans Kluge, WHO regional director for Europe, told the 2023 World Health Organization Traditional Medicine Global Summit, “Together, we have gently shaken up the status quo that has, for far too long, separated different approaches to medicine and health. By taking aim at silos, we are saying we will collaborate all the more to find optimal ways to bring traditional, complementary, and integrative medicine well under the umbrella of primary health care and universal health coverage.”

Changes are already surfacing and some silos breaking, such as some insurance companies accepting integrative health clinic costs and individualized care models expanding at the PCC and the VA.

In an era where health concerns are at the forefront of global discussions, an alternative approach to well-being is rapidly gaining ground across the United States. Holistic health, once considered an alternative fringe, is emerging as a crucial component of the health and wellness landscape.

As the paradigm of health care continues to shift, understanding integrative medicine is essential for health care professionals, business leaders, and policymakers striving to navigate this approach to patient care.

“It’s effective treatment,” Finnell says. “When we take all of that together and the new guidelines, whether it’s for pain, for cardiovascular disease, for autoimmune disease, it’s these first-line therapies, which are diet, exercise, lifestyle, sleep, good relationships, and self-efficacy, to manage your own condition. That’s where the great outcomes come from.”