Ruthann Russo - Integrative Population Health Management - White Paper Part 3

Well-being. Performance.
Table of Contents
Introduction.................1
Establish Potential
IHM Treatment
Opportunities...............4
Identify Current
Patients Who Can
Benefit From IHM........6
Determine Treatment
Methodology............. 10
Conclusion................. 16
References................. 17
Population Health Management:
How Healthcare Systems Can Obtain
the Highest ROI from a New or Existing
Integrative Health Service
An integrative health inpatient intervention at Beth Israel Medical Center in New
York City resulted in a $153 cost savings per patient stay.1
Based on an analysis
of inpatient data for the state of Maryland, this same intervention would have
resulted in a $76.5 million savings across the state.2
Of the 589,253 patients
hospitalized in the state of Maryland in 2013, 86.3% could have been similarly
helped with the use of effective, inexpensive Integrative Health Modalities.3
Yet these therapies were not widely offered. Integrative Health Modalities
(IHM) have been proven to inexpensively manage common chronic diagnoses
and symptoms. In addition to the clear patient health benefit, offering these
therapies would have led to reduced inpatient hospital costs during current and/
or subsequent stays.4
If extrapolated on a national scale, these missed patient
benefits and unrealized healthcare savings would be astonishing. With outcomes
such as these in reach, yet not experienced by the majority of hospitals across
the country the simple question is: Why not? It is clear that organizational
leaders seeking these advantages are in need of both research-based evidence
in support of IHM as well as effective methodologies and a proven plan for
implementation or growth of an IHM program.
IHM practices are inexpensive to implement, are simple, powerful, effective,
and contribute to improving patient engagement and patient health and
wellbeing. These practices include invoking the relaxation response, meditation,
yoga, tai qi, qi gong, deep breathing and other therapies that are provided by
a licensed or certified healthcare professional such as massage, acupuncture,
biofeedback, hypnosis, music and dance therapy.5
Proven benefits provided by
integrative health modalities include: decreased pain levels; increased patient
satisfaction; decreased length of stay; decreased post-operative pain; decreased
post-operative pain medications; shifted resources to less costly personnel; and
importantly, increased patient engagement, a key to partnering with community
groups as the healthcare system prepares for Accountable Care Organizations
(ACOs).6
Table 1 summarizes the known benefits of IHM:
Part 3 of a 3 Part Series on Integrative Health
Ruthann Russo, PhD, MPH, LAc
www.medalagroup.com © 2015 Medala Group LLC. All rights reserved. 732-820-0445

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Population Health Management: How Healthcare Systems Can Obtain the Highest ROI from a New or Existing IHS
Table 1. Established Benefits of Integrative Health Modalities
The following healthcare systems (among others) have reported decreased costs
attributed to the use of IHM in the inpatient setting: Beth Israel Medical Center in New
York City, Beth Israel Deaconess Medical Center in Boston, MA, Inova Fairfax Hospital
in Fairfax Virginia, and Cleveland Clinic. In addition to an estimated conservative cost
savings of $994.75 on average per patient, all healthcare systems reported further
benefits including increased patient satisfaction and quality improvement metrics.
Moreover, Cleveland Clinic reported reduced anxiety, reduced pain, decreased narcotic
requirements and increased patient satisfaction. Table 2 summarizes the more
significant studies on healthcare cost savings as the result of IHM services. (next page)

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Table 2. Healthcare System Cost Savings Resulting from Implementing IHM Interventions
Integrative
Health Modality
Guided imagery for Cardiac
Surgery
Optimal Healing
Environment including
yoga, holistic nursing for
Cancer unit
Hypnosis as an adjunct to
guided radiation
Imagery, relaxation,
breathing exercises before
colon surgery
Lifestyle Change Program
(Diet, stress management/
meditation, moderate
exercise, psychosocial
support), an 8 Hospital
Study to prevent the
need for revascularization
following CABG or PTCA
Lifestyle Change Program
(same as above) following
diagnosis of CVD/CAD
Lifestyle Modification
Program (healthy diet,
moderate physical activity,
health coaching/behavior
modification) to prevent
diabetes in pre-diabetics
Hospital or
Healthcare System
Inova Fairfax Hospital,
Fairfax, VA
Beth Israel Medical Center,
New York, NY
Beth Israel Deaconess
Medical Center, Boston, MA
Cleveland Clinic, Cleveland,
OH
Alegent Immanuel MD +,
Alegent Bergen Mercy MC,
Omaha, NE; Beth Israel MC,
NYC; Mercy Hospital, Des
Moines, IA; Broward Gen MC,
Ft Lauderdale, FL; Palmetto
Richland Mem Hospital,
Columbia, SC; Mt Diablo MD,
Beth Israel Deaconess MC,
Boston, MA; Scripps Health,
La Jolla, CA
Pacific Presbyterian Medical
Center; Moffit Hospital of
the UCSF School of Medicine
University of Michigan
Health System; University
of Colorado Health Sciences
Center; Indiana University
of School of Medicine
Actual savings or basis
for savings estimate
1.5 day shorter LOS; $288
less per patient in pharmacy
costs7
$153 per patient per
hospital stay8
$338 per patient9
$3200 (due to reduced
LOS of 1.6 for intervention
group)10
$29,529 (healthcare cost
savings for the intervention
group costs versus the
control group; health
savings over a patient
lifetime was estimated to
be $1,000,000)11
$30,000 savings per
patient in the first year
after treatment (estimated
by Mutual of Omaha)12
$21,100 savings per
patient in quality life years
in the intervention group13

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This paper presents a blueprint for successful implementation of a new integrative
health service or an expansion of an existing service that will lead to increased patient
benefits and reduced healthcare costs. Healthcare systems should map their strategy
before operationalizing IHM services, as addressed in part two of this three part
series, The Value of Integrative Health Services Programs (IHSP) in Healthcare System
Strategic Planning. This paper provides recommended methodologies for identifying
which patients can benefit from IHM intervention as well as guidance on delivering
services.
ESTABLISH POTENTIAL IHM TREATMENT OPPORTUNITIES
Hospitals should first identify which patients present with conditions that can be
effectively managed using IHM. While some healthcare professionals argue that certain
IHM can have a positive impact on virtually every patient, it is important to match
treatment to both patient preferences and presenting symptoms. Both evidence-
based medicine research and empirical use of IHM provide reliable data for making
these decisions. Medala Group strongly recommends using this data and advises every
organization to provide an analysis of existing datasets to determine precisely the
opportunity for improvement within their patient population.
Evidence-based medicine. There is significant evidence-based medicine research
to support the use of IHM for certain symptoms and conditions. Summaries of this
evidence can be found in various professional guidelines and publications.14
Medala
Group’s evidence-based tools for determining which IHM are appropriate for which
patients rely upon these summaries as well as current, primary research studies.15
Clinician experts responsible for managing the organization’s Integrative Health
Services (IHS) must ensure policies, procedures, and practices are consistent with
current IHS research.
Experiential. Successful organizations understand patient preferences, symptomology,
and diagnostic data prior to determining which modalities to include in their IHS.
In addition to research, these organizations can look to successful IHM case studies
published by leading healthcare organizations for guidance. For example, in 2012,
the Bravewell Collaborative published a series of reports outlining the results of
a nationwide Integrative Medicine Survey conducted at 60+ sites.16
Likewise, in
2010, 714 hospitals participated in the Samueli Institute Integrative Medicine
survey.17
Samueli measured the most common inpatient and outpatient services and
Bravewell grouped services under one umbrella. Table 3 points to the importance
of organizational strategy, research and planning prior to IHS services design and
implementation:

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Table 3. Top Six IHM Interventions Reported Through Surveys
Analysis of existing patient datasets. Medala Group conducted a detailed analysis
of the inpatient data set for all patients hospitalized in the state of Maryland during
calendar year 2013. Primary data points included all evidence-based research available
for IHM by diagnosis or symptom. Medala Group ran these data against the uniform
inpatient hospital discharge dataset. Significantly, results showed that of the 589,253
hospital inpatients, 509,044 (or 86.3%) had diagnoses or symptoms that could be
treated adjunctively with IHM. One of the key findings in the analysis showed that
the total hospital charges for the 598,253 patients who could have been managed
using IHM adjunctively was 34% higher than patients who would not have benefited
from IHM, suggesting IHM can produce significant savings. The top 10 diagnoses or
symptoms that can be adjunctively managed by IHM in the Maryland inpatient dataset
are listed in Table 4. (next page)

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Table 4. Top 10 Inpatient Diagnoses Managed by IHM in Maryland Hospitals (2013)
Table 4 represents all hospitals. When Medala Group examined hospital data
individually, the top 10 diagnoses varied significantly. In addition, the percentage of
patients who could be helped by IHM ranged from a low of 78.8% to a high of 97.6%.
The charge differential for patients who could be managed using IHM ranged from
6% to 47%. These differences by hospital demonstrate that each organization must
analyze its own patient data and not rely solely upon generic findings. Hospital-
specific data should be used as the basis for determining which patients (based upon
procedure, diagnosis, and/or symptom) and which modalities should be developed in
their customized IHS program in order to achieve significant patient benefits and cost
savings.
IDENTIFY CURRENT PATIENTS WHO CAN BENEFIT FROM IHM
Once an organization has performed a thorough analysis, these data can be used to
accurately identify and treat current patients. The data serve as a validated map to
ensure that an IHM strategy will be as effective as possible. Importantly, IHM can be

7
used to manage symptoms for patients in both hospital and outpatient settings. In
addition, healthcare systems can reach out to members of the non-patient community
by offering classes or groups to promote health and prevent illness in support of their
healthcare mission overall. Concurrent to identifying which patients will be offered IHM
services, the organization must decide how the services will be charged, funded, or
budgeted, also addressed in this section.
Inpatients. Organizations should use hospital-specific data analysis to identify
common diagnoses for IHM intervention in their hospitals. Then they can use their data
to identify hospital units where patients with these diagnoses are most likely to be
located, and IHM treatment teams can be deployed to the corresponding hospital units.
Alternatively, organizations can use the integrated and collaborative model described
in the methodology section below.
Other targeted processes can also be used to identify and deliver IHM. For example,
patients who undergo certain procedures such as orthopedic or cardiovascular surgeries
are likely to benefit from IHM. As a result, a hospital’s EHR can be programmed to
flag these patients upon admission for IHM intervention. Demographic data can also
be used to flag patients most likely to benefit from IHM. For example, in the state of
Maryland, while 86% of all patients would benefit from an IHM intervention, 97.9% of
patients over age 64 were likely to benefit. An additional consideration is in regard to
patients with the possibility of an avoidable readmission. Patients who fit the profile
for a likely avoidable readmission can also be targeted for IHM intervention. Where
possible, these patients can be taught practices that will help them engage in safe,
effective self-care. Table 5 summarizes the strategies for identifying hospital inpatients
for IHM interventions.
Table 5. Identifying Inpatients for IHM Intervention
Outpatients. IHM can be delivered effectively in outpatient settings within a healthcare
system. Similar to the inpatient setting, healthcare systems can analyze outpatient
data to identify the most common diagnoses to be managed by IHM. In the case of
outpatient visits, healthcare systems can analyze data by location. Minimally, an

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organization should be able to identify the most common outpatient conditions and
highest percentage of outpatients who will benefit from IHM by outpatient location
such as the emergency department, ambulatory surgery centers, clinics, affiliated
primary care practices, and primary care medical homes. Initially, healthcare systems
can target outpatient locations with the highest percentage of patients who will
benefit from IHM.
Specific IHM interventions are highly effective for certain outpatient visits. For example,
guided imagery has been found to decrease anxiety and the amount of post-operative
pain medications needed following surgery.18
In the case of ambulatory surgery, staff
can provide patients with literature on guided imagery during pre-operative testing.
Outpatients who elect to participate in the guided imagery program can either attend
a group session or participate via telephone when hospitals provide long distance
sessions. Similarly, some emergency room staff use hypnosis to facilitate acute pain or
trauma treatments.19
Additionally, primary care physicians, physician assistants, and/
or their nurse practitioner can be trained in IH skills such as breathing, mindfulness
meditation, and even simple biofeedback. Staff can share these practices with
individual patients or they can conduct groups where outpatients learn several IH
practices over the course of one or more weekly sessions.
Table 6. Common Outpatient Integrative Health Modalities
Community Outreach/Population Health Management. A healthcare system
can model IHM as the foundation for an effective population health management
component to an Affordable Care Organization (ACO). IH modalities are essential
building blocks for health and wellness.21
There are no reasons to exclude IHM as a
core healthcare system strategy. In fact, as just one example, IH modalities can be

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incorporated into all patient visits. Jim Gordon, former director of NIH’s NCCAM and
Professor of Medicine at Georgetown University School of Medicine, describes a minute
of full body relaxation and focused breathing as an effective beginning to every
patient visit.22
Gordon himself has had so much success practicing this method with
his patients that he created the Center for Mind-Body Medicine in Washington, DC that
now trains thousands of healthcare providers and patients worldwide in basic IHM.
In another example, when Allina Healthcare System used The Center for Mind-Body
Medicine’s resiliency program to train their employees, Allina calculated productivity
and presenteeism savings from the program to be $2,181 per employee per year.23
Blue Cross and Blue Shield of Iowa enlisted 6,148 meditation practitioners in two
different, but related studies to determine whether meditation has an impact on
healthcare utilization. The first study found that meditators had 53% lower inpatient
admissions and 44% lower outpatient admissions. The second study found 92% lower
hospital admissions for meditators.24
These findings provide strong support for the
use of meditation as both a strategy and a core intervention for population health
management.
Payment or budget items. The majority of healthcare systems reporting the delivery
of IHM primarily charge cash for the services they provide to patients. 79% of the
services reported are outpatient visits and, of those visits, 82% are delivered through
an integrative health center. Samueli Institute reports that 69% of services are self-
pay and Bravewell reports that certain services such as acupuncture and nutritional
counseling are partially reimbursed by health plans.25
To obtain the essential value from IHM, organizations must think past the separate silo
of integrative health and medicine being delivered in a separate “center.” By thinking
past this paradigm, organizations can create a synergistic, collaborative care model
with a significant return on investment (ROI). While IHM services can continue to be
delivered as a cash-for-service model, it is essential that healthcare systems build
an IHS that is economically sustainable and beneficial to patients, employees and
the organization. Such a model is presented in the section below on methodology.
The strategy for creating an economically viable model begins with the organization
identifying benefits, setting key metrics, and consistently measuring to validate and
continually improve the model. While the patient and financial benefits identified in
Table 1 at the opening of this paper continue to be at the heart of this strategy, Table
7 below adds other organization-specific benefits that have been identified by certain
healthcare systems. (next page)

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Table 7. Core Benefits of Integrative Health Modalities
DETERMINE TREATMENT METHODOLOGY
Delivery of IHM services is a critical component of the implementation process. Because
inpatient and outpatient settings vary greatly, considerations must be suited to both
the patient and the location of care. Just as with all healthcare services offered, the
qualifications of the clinicians and exactly how care will be delivered are important
considerations. First it is necessary to understand the current model(s) used in
delivering IHM in U.S. healthcare systems. Figure 1 below represents close to 100%
of integrative health delivery models, which tend to be limited in distribution and
contained within certain sections or divisions of a system.

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Figure 1. Current/Common Integrative Health/Medicine Model
Inpatients: Consult versus outreach. The most common process for providing IHM is
a patient’s physician, nurse practitioner or physician assistant places an order for an
IH consult. Nursing staff, social workers, case managers or even patients themselves
can request an IHM consultation. However, in most hospitals, the patient’s physician,
nurse practitioner or physician assistant must approve requests from these individuals.
Healthcare systems can also consider the use of standing orders for patients with
one or more conditions on their existing problem list that can be managed using IH
modalities.

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Another model used in some organizations such as Mount Sinai Beth Israel Medical
Center is the outreach model. In this case, acupuncture fellows at the medical center
are assigned to certain units or floors. Fellows attend regular morning rounds with the
patient care teams. If during rounding, a fellow identifies a patient who could benefit
from acupuncture, he requests to treat. In addition to regular rounding, the fellows
interact with the unit staff and request, based upon a review of the patient’s record, to
treat certain patients.
The consultation model is more effective and efficient than the outreach model for
inpatient treatment. The use of standing orders is superior to either of these two
models. If standing orders are used, then the IH team must be notified via the EHR of
any patient needing IHM intervention.
Individual versus group treatment. Group “treatments” can be a creative way to
reach out to the community and also make the receipt of independent IH modalities
affordable for most individuals. Organizations can also use group treatments as part
of their Population Health Management strategy. Many organizations offer mind-body
skills groups, community acupuncture or ear acupuncture, as well as yoga, tai qi, gi
gong, and journaling classes. In some cases, such as the Ornish Spectrum Diet classes
and Mindfulness Based Stress Reduction (MBSR) training, health plans cover the cost of
the classes. In others, charges per class can minimized to make participation affordable
based on the needs of the community. There are many ways to structure, market and
staff these classes that can ensure economic sustainability of the model. This includes
simple strategies such as holding classes on a regular basis, having participants agree
to take and pay for a “block” of four to eight classes or groups at a time.
Table 8. Common Group IH Treatments
Who will treat? The healthcare organization must create a treatment model that is
consistent with their strategy for IHM and concurrently meets financial sustainability
goals. Many existing Integrative Medicine Centers are led and staffed by physicians.
While physician support is a necessary component of this strategy, physician staffing

13
is likely not the best approach to ensure economic viability of an Integrative Health
Service. The same can be said of mid-level practitioners and nursing staff support.
Instead, organizations can begin first by looking within their organization to identify
licensed healthcare practitioners who are either also licensed or certified in one or more
IH modalities.
As a way to begin the search, organizations can determine which IH modalities are
in highest demand by their patient population. In an analysis performed by Medala
Group using the 2013 inpatient data set for hospitals in the state of Maryland, the
tables below list the top five practices and the top five therapies needed for these
patients. These data are not meant to be applied for planning purposes to a specific
organization. Each organization should perform their own analysis of their specific
data. These data are used here as an illustration only.
Table 9. Top 5 Integrative Health Practices* for All Maryland Hospitals (2013)
Table 10. Top 5 Therapies* for All Maryland Hospitals (2013)
* Therapies = the modality must be administered by a licensed/certified healthcare provider

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Using this data, Medala Group recommends that an organization begin its IHM staffing
search by identifying individuals within the organization who are already trained to
perform two or more of these modalities. This step will not only more fully utilize staff
expertise but also save cost of hiring new personnel where possible. For example,
many licensed counselors and therapists are also certified in mind-body skills groups.
This means that they can, at a minimum, deliver IH modalities such as breathing,
meditation, relaxation techniques, thermo-biofeedback, movement meditation,
journaling/drawing therapy, and guided imagery. It is highly likely that staff would be
eager to use their existing, but currently non-utilized skills to a greater level for both
patient and organizational benefit.
Licensed acupuncturists and massage therapists are another resource for staffing
IHM. In most states both are licensed healthcare professionals who have had to pass
both a state licensing and a national certification test in order to provide patient care.
As part of their required training, which is three to four years of graduate school for
acupuncturists and two years for massage therapists, most are formally trained in at
least basic mind-body modalities such as movement meditation (i.e. Qi Gong and Tai
Qi), basic meditation, breathing, and guided imagery.
Certified yoga teachers are in high supply in certain areas of the U.S. At one University
Medical Center where Medala Group worked, 6 of the 12 full time employees in the
IH department were certified yoga teachers in addition to being licensed to provide
occupational therapy, acupuncture, massage, or counseling. The last count of yoga
teachers nationwide in 2005 identified 70,000 teachers. Since that time, the number
of individuals interested in practicing yoga has grown from 6.1M to 104.4M, likely
resulting in a significant increase in the current numbers of yoga teachers nationwide.26
Certified yoga teachers are simultaneously trained in breathing and meditation.
Because yoga teachers are plentiful and cross-trained in other IHMs, healthcare
systems can benefit by including these professionals into their IHM team.
How to treat: Integrate and collaborate. Using the “integrated, collaborative” IHM
strategy, healthcare leaders can make IHM within the organization as common as
taking vital signs. The benefits to the patient of learning a simple IHM practice benefits
the patient and the organization long after the first encounter. According to Benson,
learning to “break the train of everyday thoughts” by focusing on a word or an object
for as little as two to three minutes invokes the relaxation response, calms the nervous
system, and provides the individual with a tool to better manage stress.27
This simple
process has also been proven physiologically to strengthen the immune system,
increase the size of the frontal lobe, and lengthen telomeres.28
Most importantly,
patients and employees develop skills for self-care that can be called upon over a
lifetime. This model is strikingly different from the current model for IHM delivery

15
presented in the beginning of this section. The following are the key components of an
integrated collaborative IHM:
• Patient centered
• IHM services offered in any location within the system where a patient
can be found, with some practices (i.e. breathing, relaxation response)
incorporated into every patient interface
• Physicians and health system leaders providing support while licensed,
certified IHM professionals provide individual patient care and group
interventions
• Staff who spend time face to face with the patient (i.e. nursing staff,
admissions representatives, medical assistants, patient care assistants,
technologists) trained in basic IHM, generating benefits to both the
employee and the patient
Medala Group’s overview of this integrated collaborative strategy for delivering IHM is
illustrated in Figure 2 below.
Figure 2. Collaborative Integrative Health Model

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CONCLUSION
Given the evidence-based benefits and financial savings of Integrative Health
Modalities, it is clear that IHM presents an important opportunity for healthcare
systems. With the ability to increase patient satisfaction and decrease healthcare costs
by offering inexpensive and effective IHM modalities as an adjunct to conventional
care, more and more healthcare systems are looking for models and guidance for
strategic and measurable actions as they implement programs. Once an organization
has created an IHM strategy they can operationalize services. Organizations should
use the second paper of this three-part series, The Value of Integrative Health Services
Programs (IHSP) in Healthcare System Strategic Planning for strategy development.
Once the IHM strategy is in place, the healthcare system should identify which patients
can be effectively managed using IHM by analyzing existing patient data sets in all
patient care locations against evidence-based IHM criteria. Healthcare system staff
can use these data to build out the structure to deliver IHM, including the delivery
methodologies and qualifications of the IHM team members. Use of the integrated
collaborative IHM model will ensure patients throughout the system and non-patient
members of the geographic community have access to these services. Importantly,
improved population health is the natural extension of access to and use of IHM.
Continuous refinement of selection and treatment criteria along with monitoring of
strategic key metrics strengthens the economic viability and overall sustainability of
this IHM foundational model for care.
On a final note, IHM includes concepts related to patient-centered care and shared
medical decision-making, essential components of both the Affordable Care Act and
The Joint Commission accreditation standards. IHM considers the physical, mental,
emotional and spiritual needs, as well as preferences and knowledge base of the
patient, and further emphasizes patient participation in the healing and treatment
planning process. IHM combines practices from conventional, complementary and
alternative medicine providing healthcare systems that effectively use this practice
with a competitive differentiation for individual patient and population health
management.

17
REFERENCES
1
Kligler, B., Homel, P., Harrison, L. B., Levenson, H.D., Kenney, J. B., & Merrel, W. (2011). Cost Savings in
inpatient oncology through an integrative medicine approach. The American Journal of Managed Care,
17, 779 – 784.
2
Maryland Statewide Hospital Inpatient Data (2013) were provided by the Health Services Cost Review
Commission, 2014.
3
Maryland Statewide Hospital Inpatient Data (2013) were provided by the Health Services Cost Review
Commission, 2014.
4
Medala Group. (2015). Analysis of State of Maryland Hospital Inpatients, data provided by the Health
Services Cost Review Commission.
5
Astin, J. A., Shapiro, S. L., Eisenberg, D. M., & Forys, K. L. (2002). Mind-body medicine: State of the
science, implications for practice. Journal of the American Board of Family Practitioners, 16, 131-147;
Bann, C. M., Sirois, F. M., & Walsh, E. G. (2010). Provider support in complementary and alternative
medicine: Exploring the role of patient empowerment. The Journal of Alternative and Complementary
Medicine, 16, 645-752. doi: 10.1089/acm.2009.0381; Dusek, J. & Knutson, L. (2012, May). The impact
of integrative medicine on inpatient satisfaction at Abbott Northwestern Hospital. International Research
Congress on Integrative Medicine and Health, Portland, OR; Grace, S. & Higgs, J. (2010). Integrative
medicine: Enhancing quality in primary care. The Journal of Alternative and Complementary Medicine,
16, 945-950. doi: 10.1089/acm.2009.0437; Greeson, J. M., Rosenzweig, S., Halbert, S. C., Cantor, I. S.,
Keener, M. T., & Brainard, G. C. (2008). Integrative medicine research at an academic medical centers:
Patient characteristics and health-related quality-of-life outcomes. The Journal of Alternative and
Complementary Medicine, 14, 763-767. doi: 10.1089/acm.2008.0114; Horrigan, B., Lewis, S., Abrams,
D., & Pechura, C. (2012). Integrative medicine in America: How integrative medicine is being practiced in
clinical centers across the United States. Minneapolis, MN: The Bravewell Collaborative; Maizes, V., Rakel,
D., & Niemiec, C. (2009, February). Integrative medicine and patient-centered care. Institute of Medicine
(IOM) Summit on Integrative Medicine and the Health of the Public. Seattle, WA; Myklebust, M., Pradhan,
E. K., & Gorenflo, D. (2008). An integrative medicine patient care model and evaluation of its outcomes:
The University of Michigan experience. The Journal of Alternative and Complementary Medicine, 14(7),
821-826. doi: 10.1089/acm.2008.0154; Ruggie, M. & Cohen, J.H. (2005). Integrative medicine centers:
Moving health care in a new direction. Integrative Medicine, 5, 9-16; Samat, R. L., Winterstein, J., &
Cambron, J. A. (2007). Clinical utilization and cost outcomes from an integrative medicine independent
physician association: An additional 3-year update. Journal of Manipulative and Physiological
Therapeutics, 30, 263-269. doi: 10.1016/j.jmpt.2007.03.004; Smeeding, S. & Osguthorpe, S. (2005).
The development of an integrative healthcare model in the Salt Lake City Veterans Affairs Healthcare
System. Alternative Therapies, 11(6), 46-51; Stewart, D., Weeks, J., & Bent, S. (2001). Utilization, patient
satisfaction, and cost implications of acupuncture, massage, and naturopathic medicine offered as
covered health benefits: A comparison of two delivery models. Alternative Therapies, 7(4), 66-70.
6
Halpin, L. S., Speir, A. M., CapoBianco, P., Barnett, S. D. (2002). Guided imagery in cardiac surgery.
Outcomes Management, 6, 132 – 137.
7
Kligler, B., Homel, P., Harrison, L. B., Levenson, H.D., Kenney, J. B., & Merrel, W. (2011). Cost Savings in
inpatient oncology through an integrative medicine approach. The American Journal of Managed Care,
17, 779 – 784.

18
8
Lang, E. V., Rosen, M. P. (2002). Cost analysis of adjunct hypnosis with sedation during outpatient
interventional radiologic procedures. Radiology, 222, 375 – 382.
9
Tusek, D. L., Churh, J. M.,. Strong, Scott, S. A., Grass, J. A., & Fazio, V. W. (1997). Guided Imagery. Diseases
of the Colon and Rectum, 40, 172 – 178; Block, K. I. (2010). Cost savings with clinical solutions: The
impact of reforming health and health care economics. Integrative Cancer Therapies, 9, 129 – 135.
10
Ornish, D. et al. (1998). Avoiding revascularization with lifestyle changes: The multicenter lifestyle
demonstration project. American Journal of Cardiology, 82, 72 – 76.
11
Ornish, D., Brown, S. E., Scherwitz, L. W., Billings, J. H., Armstrong, W. T., Ports, T. A.,…Gould, K. L. (1990).
The Lifestyle Heart Trial: Can lifestyle changes reverse coronary heart disease? The Lancet, 336, 129
– 133.
12
Ornish, D., Brown, S. E., Scherwitz, L. W., Billings, J. H., Armstrong, W. T., Ports, T. A.,…Gould, K. L. (1990).
The Lifestyle Heart Trial: Can lifestyle changes reverse coronary heart disease? The Lancet, 336, 129
– 133.
13
Herman, W. H., Hoerger, T. J., Brandle, M., Hicks, K., Sorenson, S., Zhang, P.,…Ratner, R. E. (2005). The
cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with
impaired glucose tolerance. Annals of Internal Medicine, 154, 323 – 332.
14
American College of Physicians. (2009). The ACP Evidence-Based Guide to Complementary and
Alternative Medicine; Cochrane Collaborative Systematic Reviews. (2005 to present); Kotsirilos &
Vitetta. (2011). A Guide to Evidence-based Integrative and Complementary Medicine; Rakel, D. (2012).
Integrative Medicine: Expert Consult Premium Edition; Moss, McGrady, Davies. (2002). Handbook of
Mindbody Medicine for Primary Care; Ernst, Pittler, Wider. (2008). Oxford Handbook of Complementary
Medicine; Deng et al. (2009). Society for Integrative Oncology. Evidence-Based Clinical Practice Guidelines
for Integrative Oncology: Complementary Therapies and Botanicals.
15
Mind-Body Symptom Checker – web-based. (2014). CircleOfBalanceNJ.com. Retrieved from http://
circleofbalancenj.com/conditions-search/; Mind-Body Symptom Checker – iPhone APP. (2014). Retrieved
from https://itunes.apple.com/us/app/mbh-symptom-checker/id829914370?mt=8; Mind-Body
Symptom Checker – SmartPhone APP. (2014). Retrieved from https://play.google.com/store/apps/
details?id=com.acupuncturemindbody.symptomchecker&hl=en.
16
Bravewell Collaborative. (2010 – 2012). Integrative Medicine: Improving Healthcare for Patients and
Healthcare Delivery for Providers and Payors. Minneapolis, MN: Bravewell Collaborative.
17
Samueli Institute. (2010). 2010 Complementary and alternative medicine survey of hospitals.
Alexandria, VA: The Samueli Institute.
18
Halpin, L. S., Speir, A. M., CapoBianco, P., & Barnett, S.C. (2002). Guided imagery in cardiac surgery.
Outcomes management, 6(3), 132-137; Deishe, P., Soukup, S. M., Adams, P., & Wild, M. C. (2000). Guided
imagery: Replication study using coronary artery bypass graft patients. Nursing clinics of North America,
35(2), 417-425; Casida, J., & Lemanski, S. A. (2010). An evidence-based review on guided imagery
utilization in adult cardiac surgery. Clinical Scholars Review, 3(1), 22-20.
19
Wain, H. J., & Amen, D. G. (1986). Emergency room use of hypnosis. General Hospital Psychiatry. 8, 19
– 22.

19
20
See http://www.heartmath.com/
21
Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response. Psychiatry, 37, 37-46.
22
Gordon, J.S. (1996). Manifesto for a new medicine: Your guide to healing partnerships and the wise use
of alternative therapies. New York: Perseus Books. See also: http://cmbm.org/.
23
Private Communication between Bravewell Collaborative and Jeffrey Dusek, Research Director, The
Penny George Institute for Health and Healing at Alliana Hospital. (2010). As reported in Guarneri, E.,
Horrigan, B. J., & Pechura, C. M. (2010). The efficacy and cost effectiveness of integrative medicine: A
review of the medical and corporate literature. Encinitas, CA: The Bravewell Collaborative.
24
Orme-Johnson, D.W. (1987). Medical care utilization and the Transcendental Meditation program.
Psychosomatic Medicine, 49, 493 – 507; Orme-Johnson, D. W., & Herron, R. E. (1997). An innovative
approach to reducing medical care utilization and expenditures. American Journal of Managed Care, 3,
135 – 144.
25
Bravewell Collaborative. (2010 – 2012). Integrative Medicine: Improving Healthcare for Patients and
Healthcare Delivery for Providers and Payors. Minneapolis, MN: Bravewell Collaborative; Samueli Institute.
(2011). 2010 Complementary and Alternative Medicine Survey of Hospitals, Alexandria, VA.
26
Yoga in America Study. (2005).Yoga Journal.
27
Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response. Psychiatry, 37, 37-46.
28
Arias, A. J., Steinberg, K., Banga, A., & Trestman, R. L. (2006). Systematic review of the efficacy of
meditation techniques as treatments for medical illness. The Journal of Alternative and Complementary
Medicine, 12, 817 – 832; Bay, R., & Bay, F. (2011). Combined therapy using acupressure therapy,
hypnotherapy, and transcendental meditation versus placebo in type 2 diabetes. Journal of Acupuncture
Meridian Studies, 4, 183 – 186; Benson, H., Beary, J. F., & Carol, M. P. (1974). The relaxation response.
Psychiatry, 37, 37-46; Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., …
Rounsaville, B. J. (2011). Mindfulness training for smoking cessation: results from a randomized
controlled trial. Drug and Alcohol Dependency, 119, 72 – 80; Caldwell, K. L., Baime, M J., & Wolever, R. Q.
(2012). Mindfulness-based approaches to obesity and weight loss. Journal of Mental Health Counseling,
34, 310 – 317; Chung, S., Brooks, M. M., Rai, M., Balk, J. K., & Rai, S. (2012). Effect of Sahaja yoga
meditation on quality of life, anxiety, and blood pressure control. The Journal of Alternative and
Complementary Medicine, 18, 589 – 596; Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., &
Begay, D. (2010). Pilot study: Mindful eating and living (MEAL): Weight, eating behavior, and
psychological outcomes associated with a mindfulness-based intervention for people with obesity.
Complementary Therapies in Medicine, 18, 260 – 264; Daubenmier, J., Kristellar, J., Hecht, F. M., Maninger,
N., Kuwata, M., Jhaveri, K.,…Epel, E. (2011). Mindfulness intervention for stress eating to reduce cortisol
and abdominal fat among overweight and obese women: An exploratory randomized controlled study.
Journal of Obesity, doi: 10.1155/2011/651936; Daubenmier, J., Lin, J., Blackburn, E., Hecht, F. M.,
Kristellar, J., Maninger, N., ...Epel, E. (2012). Changes in stress, eating and metabolic factors are related to
changes in telomerase activity in a randomized mindfulness intervention pilot study.
Psychoneuroendocrinology, 37, 917 – 928; Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M.,
Muller, D., Santorelli, S. F.,…Sheridan, J. F. (2003). Alterations in brain and immune function produced by
mindfulness meditation. Psychosomatic Medicine, 65, 564 – 57; Davis, J. M., Fleming, M. F., Bonus, K. A., &
Baker, T. B. (2007). A pilot study on mindfulness based stress reduction for smokers. BMC.

20
Complementary and Alternative Medicine, 7, doi:10.1186/1472-6882-7-2; D’Silva, S., Poscablo, C.,
Habousha, R., Kogan, M., & Kligler, B. (2012); Mind-body medicine therapies for a range of depression
severity: A systematic review. The Academy of Psychosomatic Medicine, 53, 407 – 423; Elwafi, H. M.,
Witkiewitz, K., Mallik, S., Thornhill, T. A., & Brewer, J. A. (2012). Mindfulness training for smoking
cessation: Moderation of the relationship between craving and cigarette use. Drug and Alcohol
Dependence, 130, 222 – 229; Epel, E. S. (2009). Psychological and metabolic stress: a recipe for
accelerated cellular aging? Hormones, 8, 7 – 22; Goldstein, C. M., Josephson, R., Xie, S., & Hughes, J.W.
(2012). Current perspectives on the use of meditation to reduce blood pressure. International Journal of
Hypertension, doi: 10.1155/2012/578397; Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).
Mindfulness-based stress reduction and health benefits: A meta-analysis. Journal of Psychosomatic
Research, 57, 35 – 43; Herzog, H., Lele, V. R., Kuwert, T., Langen, K. J., Kops, E R., & Feinendegen, L. E.
(1991). Changed pattern of regional glucose metabolism during yoga meditative relaxation.
Neuropsychobiology, 23, 182 – 187; Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect
of Mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consultation
in Clinical Psychology, 78, 169 – 183; Huges, J. W., Fresco, D. M., van Dulmen, L. E., Carlson, L. E.,
Jospheson, R., & Myerscough, R. (2010). Mindfulness-based stress reduction for prehypertension.
Psychosomatic Medicine, 71, 223 – 29; Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of
mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163-
190; Kabat-Zinn, J., Lipworth, L., & Burney, R. (1987). Four year follow-up of a meditation-based program
for the self-regulation of chronic pain. Clinical Journal of Pain, 2, 159-173; Kays, J. L., Hurley, R. A., & Taber,
K. H. (2012). The dynamic brain: Neuroplasticity and mental health. Journal of Neuropsychiatry and
Clinical Neuroscience, 24, 118 – 124; Kenny, M. A., & Williams, J. M. (2007). Treatment-resistant
depressed patients show a good response to mindfulness-based cognitive therapy. Behavior Research
and Therapy, 45, 617 – 625; Khare, K.C., & Nigam, S. K. (2000). A study of electroencephalogram in
meditators. Indian Journal of Physiology and Pharmacology, 44, 173 – 178; Koithan, M. (2009). Mind-
body solutions for obesity. Journal of Nurse Practitioners, 5, 536 – 537; Lazar, S. W., Kerr, C. E.,
Wasserman, R. H., Gray, J. R., Greve, D. N., Treadway, M. T.,…Fischl, B. (2005). Meditation experience is
associated with increased cortical thickness. Neuroreport, 16, 1893 – 1897; Ludwig, D. S., & Kabat-Zinn,
J. (2008). Mindfulness in medicine. Journal of the American Medical Association, 300, 1350 – 1352;
Manocha, R., Black, D., Sarris, J., & Stough, C. (2011). A randomized, controlled trial of meditation for work
stress, anxiety, and depressed mood in full-time workers. Evidence-based Complementary and
Alternative Medicine, doi: 10.1155/2011/960583; Morone, N. E.. Greco, C. M., & Weiner, D. K. (2008).
Mindfulness medication for the treatment of chronic low back pain in older adults: A randomized
controlled pilot study. Pain, 134, 310 – 319; Nidich, S. I., Rainforth, M. V., Haaga, D. A., Hagelin, J., Salerno,
J. W., Travis, F., …Schneider, R. H. (2009). A randomized controlled trial on effects of the transcendental
meditation program on blood pressure, psychological distress, and coping in young adults. American
Journal of Hypertension, 22, 1326 – 1331; Paul-Labrador, M., Polk, D., Dwyer, J. H., Velasquez, I., Nidich, S.,
Rainforth, M.,…Merz, N. B. (2006). Effects of a randomized controlled trial of transcendental meditation
on components of the metabolic syndrome in subjects with coronary heart disease. Archives of Internal
Medicine, 166, 1218 – 1224; Poulin, P. A., Mackenzie, C. S., Soloway, G., & Karayolas, E. (2008).
Mindfulness training as an evidenced-based approach to reducing stress and promoting well-being
among human services professionals. International Journal of Health Promotion & Education, 2, 35 – 43;
Ramel, W., Goldin, P. R., Carmona, P. E., & McQuaid, J. R. (2004). The effects of mindfulness meditation on
cognitive processes and affect in patients with past depression. Cognitive Therapy and Research, 28, 433
– 455; Rosenzweig, S., Greeson, J M., Reibel, D. K., Green, J. S., Jasser, S. A., & Beasley, D. (2010).
Mindfulness-based stress reduction for chronic pain conditions, Variation in treatment outcomes and role

21
of home meditation practice. Journal of Psychosomatic Research, 68, 29 – 36; Rosenzweig, S., Reibel, D.
K., Greeson, J. M., Edman, J. S., Jasser, S. A., McMearty, K. D., & Goldstein, B. J. (2007). Mindfulness-based
stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: A pilot study.
Alternative Therapies, 13, 36 – 39; Russo, R. (2013). Intel preliminary resiliency training results.
Unpublished manuscript, Doctoral Practicum Course, Saybrook University; Ruff, K. M., & Mackenzie, E. R.
(2009). The role of mindfulness in healthcare reform: A policy paper. Explore, 5, 313 – 323; Shapiro, S. L.,
Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care
professionals: Results from a randomized trial. International Journal of Stress Management, 12, 164
– 176; Tang, T., Lu, Q., Fan, M., Yang, Y., & Posner, P. (2012). Mechanisms of white matter changes induced
by meditation. Proceedings of the National Academies of Sciences, 109, 10570 – 10574; Teper, R., &
Inzlicht, M. (2012). Meditation, mindfulness and executive control: The importance of emotional
acceptance and brain-based performance monitoring. Social Cognitive and Affective Neuroscience,
doi:10.1093/scan/nss045; Xiong, G. L., Doraiswamy, P. M. (2009). Does meditation enhance cognition
and brain plasticity? Annals of the New York Academy of Science, 1172, 63 – 69; Zeidan, F., Grant, J. A.,
Brown, C. A., McHaffie, J. G., & Coghill, R. C. (2012). Mindfulness meditation-related relief: Evidence for
unique brain mechanisms in the regulation of pain. Neuroscience Letters, 520, 165 – 173.

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