The group also identified several major next steps. The first steps are to create a definition of integrative health care that engenders wide agreement and then to reach agreement on a standardized set of outcome measures. Next would be to inventory existing models and identify their pluses and minuses; to inventory the health provider arrangements that exist in various models and see how they might fit into a more coherent model or inform the future; and to inventory data and information systems to gain a comprehensive view of current best practices and effectiveness around work processes and decision support. Other important steps the group suggested would be for the Centers for Medicare and Medicaid Services to support demonstration projects, the National Institutes of Health to support clinical effectiveness studies, and the IOM to hold follow-up summits.

Discussion and Questions

The summit participants’ discussion of the assessment group report revealed a number of models that could be ripe subjects for demonstration projects in integrative medicine almost immediately, if funding for such studies were available. According to Sanfilippo, applications for such funding might come from a variety of places, including large employers and various communities positioned to move ahead fairly quickly. Some existing projects with potential to participate in a trial that might not immediately be thought of as integrative care models also were suggested, such as the life program of the University of Pennsylvania’s School of Nursing, which is a capitated, independent living program for elders that involves nurses, doctors, dentists, and occupational and physical therapists.

Another audience member cautioned against assuming more empowerment and health literacy than many people actually have. The participant noted that any demonstration model would be a helpful advance, especially if it included facilitators, health care advocates, language interpreters, and information technology specialists who could make care more accessible to everyone.

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