Ruthann Russo - Integrative Population Health Management - White Paper Part 2

Well-being. Performance.
www.medalagroup.com
Table of Contents
Introduction.................1
Definitions....................2
Fundamental
Criteria: Safety
and Efficacy .................4
Crucial Support: The
Medical Staff................7
Data-driven
IHSP Design..................8
Patient Centered Care
Approach......................9
IHSP and the
Stategic Plan............. 10
IHSP Key Metrics...... 12
Summary................... 13
References................. 15
The Value of Integrative Health
Services Programs (IHSP) in
Healthcare System Strategic Planning
Approximately two-thirds of U.S. academic medical centers have an integrative
health program in place.1
Since the publication of the Institute of Medicine’s Use
of Complementary and Alternative Medicine in the United States in 2005, many
hospitals and healthcare systems have either implemented similar programs or
begun to explore the possibility of integrating complementary and alternative
medicine (CAM) services for their patients. Every program must not only ensure
that these services meet evidence-based standards of safety and effectiveness,
but also that every program is efficiently and efficaciously implemented for
increased revenue, patient satisfaction, profit margins, patient retention, and
decreased length of stay and costs.
Patient demand for Integrative Health Modalities (IHM) services, as evidenced
by healthcare consumers’ willingness to spend up to 12% of out-of-pocket
healthcare expenditures on IHM, is continuing to grow. Patients benefit from
appropriate IHM services offered as an adjunct to their conventional medical
care in a trusted, structured, well-regulated environment such as a hospital
or healthcare system. In addition, a healthcare system can integrate all IHM
services; whereas currently, many patients may visit two to three different
practitioners. Similarly, physician oversight and quality control can bring
additional peace of mind to the patient.
Studies show that the use of integrative health and medicine is as high as
90% for certain patient populations in the United States2
and 38% for all adult
Americans.3
Another 62% of Americans reported using some form of IHM within
the 12 months that preceded a recent survey.4
In 2007, American adults spent
an estimated $34 billion on purchases of IHM services and products, an increase
of 26% from the last survey, conducted in 2004.5
Part 2 of a 3 Part Series on Integrative Health
Ruthann Russo, PhD, MPH, LAc

2
The Value of Integrative Health Services Programs (IHSP) in Healthcare System Strategic Planning
Meanwhile, hospital expenditures are approximately $650 billion annually.6
Depending
on the patient population being served, a hospital with an Integrative Health Services
Plan (IHSP) that offers IHM therapies could increase its revenue by an additional
5-10%. Providing education around IHM therapy for those patients not currently aware
of the benefits could increase that growth revenue further. Additionally, pending
legislation that would make acupuncture a reimbursable Medicare service for certain
diagnoses would increase the demand for acupuncture alone, a demand that already
tripled from 2004 to 2007.7
The following paper provides suggestions for implementation of an IHSP, as part of
the organization’s strategic plan, that can sustain, reproduce and measure results for
patients. First, the facts and resources are presented for evidence-based research-
driven complementary and alternative medicine in the United States. Second, the
current approach for integrating IHM services is charted and explained through the lens
of the hospitals and healthcare systems that are actively implementing the services.
Finally, the incorporation of an Integrative Health Services Program (IHSP) into a
healthcare system’s strategic plan is described by using a research-based, data-driven,
and patient-centered care model.
DEFINITIONS
Integrative Health Modalities (IHM)
Integrative Health Modalities (IHM) are defined as patient-focused approaches to
healthcare that address the full range of physical, emotional, mental, social, spiritual,
and environmental influences that impact an individual. They include practices that
focus on the interactions among the brain, mind, body, and behavior with the intent
to use the mind to affect physical functioning and promote health, as described
by the National Institutes of Health (NIH). Examples of these types of IHM include
meditation, guided imagery, progressive relaxation, yoga, breath-work, Qi Gong, Tai Qi,
Hospital expenditures are approximately
$650 billion annually. Depending on the
patient population being served, a hospital
with an Integrative Health Service Plan
(IHSP) that offers IHM therapies could
increase its revenue by an additional 5-10%.

3
movement therapies, hypnosis, and biofeedback. Most IHM therapies can be carried out
autonomously after patients have received adequate instruction from a therapist. This
ability for the patient to practice the therapies independently can also increase patient
empowerment, engagement, and possibly overall health. Common IHM modalities that
require a licensed therapist (in most states) to deliver the service include acupuncture
and massage. Table 1 illustrates common IHM and their effectiveness for managing the
CDC’s eight most common chronic conditions.
Table 1. Common IHM and Their Effectiveness
Integrative Health Services Program (IHSP)
An Integrative Health Services Program (IHSP) is a program created and managed
by a hospital or healthcare system that integrates safe, effective IHM with existing
conventional medicine. Qualified physicians, nurses, and other clinicians within the
hospital or healthcare system may deliver the IHSP’s modalities or the services may
be delivered by licensed or certified clinicians and professionals employed by the
healthcare system. An IHSP may be offered to inpatients or outpatients, depending
on the organization’s plan. The IHSP may be centralized (housed in one department)
or decentralized (housed within each service or care area). Some organizations begin
the IHSP in the department of pain management and then branch out from there.
Others may house the IHSP in the rehabilitation hospital. In the rehabilitation hospital
setting, IHM practitioners can integrate easily with the many other practitioners
who serve on the patient’s care team. Once the model has worked well in one area,
it can be introduced to other care settings in the healthcare system. In addition, an
IHSP may focus on the delivery of two or three specialized services or may provide a
comprehensive set of therapeutic choices to patients. The system’s patient population
as well as its values, vision, and mission statement should drive the determination of
IHM services to offer and how they should be delivered.

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FUNDAMENTAL CRITERIA: SAFETY AND EFFICACY
The most fundamental criteria for any IHSP are to ensure that only safe and effective
practices are included in the program. All organization leaders must first determine
the specific symptoms and conditions for which they will provide IHM services (as an
optional or adjunctive treatment), based on patient population and mission. Ideally,
administrators should build these services into their organization’s strategic plan
and hospital leaders must then determine which services are safe and effective for
each symptom or condition. Figure 1 illustrates Medala Group’s methodology for IHM
inclusion and shows the relationship between IHM, safety and efficacy. Medala Group’s
methodology for IHM inclusion is regularly updated against current evidence-based
research, clinical trials, systematic reviews (such as the Cochrane Collaborative), and
meta-analyses.
Figure 1. Safety-Efficacy Criteria for IHM Therapies
Medala Group eliminates therapies from consideration that are either high efficacy-
low safety or low efficacy-low safety. Selecting which modalities to include in a
program is an important consideration and one that Medala Group has worked with
extensively.
Research results classify a given IHM somewhere along the spectrum of safety and
effectiveness. If a therapy is both safe and effective in the absence of patient-specific
contraindications, it should be offered as an alternative during the informed consent
process.
Therapies that are high safety-low efficacy are the most difficult to address. Many
hospitals have seen significant benefits through the use of these therapies for their
patients. A good example of patient demand for a high safety-low efficacy therapy was
addressed at Mercy Medical Center in Merced, California, which has a large population

5
of Hmong residents. To meet Hmong patients’ requests, a shaman traditional healer
program was implemented to strengthen trust between doctors and the Hmong
community. One goal of the policy was to expedite medical intervention by having a
“healing ceremony” coincide with a hospital stay, rather than waiting days to admit a
patient after he has had time to confer with family and clan leaders after a ceremony
at home.8
Although this particular therapy has not been proven effective through
clinical research, it embraces patients’ cultural beliefs and needs and may play a role
in recovery and improved patient satisfaction, while also posing no risk to the patients
utilizing the practice.
In the past 20 years, significant research has been conducted to validate the safety and
efficacy of IHM. Additionally, the National Center for Complementary and Alternative
Health (NCCAM) funds over $200 million of additional research annually. Some IHM,
like Mindfulness-based Stress Reduction (MBSR), are extremely safe and can be used
for most patients with appropriate symptoms or diagnoses. The American College of
Physicians (ACP) has published a compendium of evidence-based research by symptom
or condition, The ACP Evidence-Based Guide to Complementary and Alternative
Medicine. The manual provides a solid basis to begin the process of identifying
appropriate therapies for a healthcare system’s patient population.
One condition for which the ACP examines the safety and effectiveness of CAM is
anxiety, with 11 different CAM therapies currently analyzed. Relaxation training for
anxiety is graded as strong in favor and meditation is graded as weak in favor. While
both therapies are considered equally safe, the research studies on relaxation training
are more robust than those on meditation. This result demonstrates the need for some
level of subjective decision making by healthcare providers to determine which safe
therapies to offer or recommend to patients.
The Bravewell Collaborative reports that the top five conditions for which patients seek
IHM are chronic pain, gastrointestinal disorders, depression/anxiety, cancer and stress.
They also report that healthcare systems report the most clinical success in treating
these conditions with IHM.10
In the past 20 years, significant research has
been conducted to validate the safety and
efficacy of IHM.

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Figure 2. Clinical Success with Integrative Health Modalities
The same study found that some of the most common IHM therapies used by patients
include deep breathing techniques, progressive relaxation, yoga, Tai Chi, Qi Gong,
meditation, and massage. As information about safe and efficacious IHM therapies
becomes more disseminated, physicians will have a duty to inform patients about
these alternatives, since they are proven to be low risk, inexpensive treatment
supplements with high success rates. At a minimum, physicians should be able to
answer basic questions about certain IHM therapies that their patients may ask.
Patient expenditures on IHM, estimated to be 12% of out-of-pocket spending, can
be used as another indicator of choice of IHM services, after validation of safety
and efficacy. About 35 cents of each alternative therapy dollar is for visits to
acupuncturists, chiropractors, massage therapists and other practitioners, mostly
for pain relief. This total represents nearly $12 billion, or about one-quarter of what
Americans spend on visits to mainstream physicians.11
As an example, acupuncture
as an IHM modality is perceived to be effective by most patients who use it to treat a
specific condition.12
Additionally, acupuncture has been considered to be both highly
safe and highly effective by the American College of Physicians (ACP) for migraine
headaches and postoperative nausea and vomiting. The ACP has rated acupuncture,
based on current evidence-based research, to be highly safe and moderately effective
for chemotherapy-induced nausea and vomiting, cancer pain, anxiety, pregnancy-
induced nausea and vomiting, acute gastrointestinal pain, premenstrual syndrome

Common
condi)ons
for
which
healthcare
systems
report
the
most
clinical

success
with
Integra)ve
Health
Modali)es
(Source:
Bravewell
Collabora)ve,
2010)

0

20

40

60

80

100

Chronic
Pain
Gastrointes)nal

Disorders

Depression/

Anxiety

Cancer
Stress

75%

59%

55%

52%

52%

7
(PMS), infertility, incontinence (female), low back pain (acute and chronic), neck pain
(acute and chronic), and osteoarthritis of the knee.13
Likewise, many IHM therapies
are evidence-based and research-driven with significant success rates—each of these
are inexpensive and low-risk for any hospital to implement as a supplemental or
alternative therapy for specific conditions.
CRUCIAL SUPPORT: THE MEDICAL STAFF
The development and continued maintenance of a positive, productive, and mutually
beneficial relationship between the hospital and its physicians can be one of the most
challenging issues for any healthcare administration. Every undertaking that has an
impact on patients should actively involve the medical staff, including nurses and
physicians. Because most physicians are not hospital employees and have multiple
competing priorities, it can often be difficult to obtain their participation. However,
their active involvement is crucial to the success of any IHSP program, in order to see
and maintain success levels for patients. The implementation of a successful program
requires symbiosis between both parties: The hospital needs the physicians to assess
patient-specific therapies, order appropriate therapies, and manage patients’ overall
care, and the physicians need the hospital to provide appropriate staffing, training
about the program, and continuous updating of new IHM research findings.
For an IHSP to be effective, the physician must order or recommend the therapy to the
patient. Before a physician is willing to place an order or recommendation for IHM, he
must believe in the safety and efficacy of the therapy for his patient. The hospital can
deliver education and information to physicians to enable them to make good decisions
about IHM and integrative medicine in a structured, proactive manner. With massive
changes to the healthcare landscape over the past decade with increasing patient
demands, new research, and policy changes in support of IHM, it is now incumbent
upon healthcare systems to provide relevant resources and information to the
physicians on their medical staff about such topics. The approach to education, how the
information is presented, and the organization’s philosophy are important components
of physician training.
To obtain the best results from education and training, the use of self-efficacy-
based training has been found to be most effective. Medala Group developed the
CAMP™ Method for training physicians through research conducted with physicians
and residents at The Hospital of the University of Pennsylvania. The CAMP Method,
which uses a proven process involving coaching, asking, mastering, and peer learning
produced measurable results with statistical significance from the experimental group.
Additionally, training results of the experimental group were found to be significantly

8
better than either the control group or the group trained using traditional hospital-
based physician education methods. The CAMP methodology is published in the two-
volume text, A Compelling Case for Clinical Documentation.15
A healthcare system intent on obtaining medical staff support for an IHSP will pull
members of the medical staff into the development process. One of the first steps
to successfully organizing this development process is through acknowledging
differences that exist among different medical and surgical specialties, how IHSPs
will vary for each area, and providing strong supporting material for the specialists.
Medala Group’s recommended resources include the many position statements from
professional organizations that speak to IHM. In addition to the American College of
Physicians, addressed earlier, the American College of Cardiology published Integrating
Complementary Medicine into Cardiovascular Medicine.16
The paper contains a brief
review of 134 cardiovascular-related integrative medicine research studies. The
Academy of Integrative Health and Medicine provides further resources including
their 2014 white paper entitled, Creating Health and Wellness on a Global Scale.
Additionally, two neurologists, Barry S. Oken, MD and Allen C. Bowling, MD, PhD have
published books on CAM. Dr. Oken wrote Complementary Therapies in Neurology: An
Evidence-based Approach, and Complementary and Alternative Medicine and Multiple
Sclerosis was written by Dr. Bowling. Other resources and position papers on CAM and
integrative medicine are available from specialty associations.
Similarly, there are multiple Continuing Medical Education (CME) opportunities available
to physicians on integrative health and medicine, in order to provide further support
for physician education in this area. The Academy of Integrative Health and Medicine
offers numerous web-based CMEs for physicians, clinicians and healthcare leaders.17
In
addition, for physician convenience and schedule needs, Medala Group offers onsite or
webinar based IHM training for CME credits for physicians.
DATA-DRIVEN IHSP DESIGN
To be effective, an IHSP must be driven by hospital-specific patient care data. In
particular, an organization should have access to solid, reliable data that shows the
types of patients the system treats and where they are treated within the hospital
or healthcare system. The first step in this process is to identify the symptoms
and conditions that can be effectively treated with IHM therapies. Using this list of
symptoms and conditions, hospitals should identify the number of patients who
meet these diagnostic criteria. It is essential to know where patients with these IHM-
treatable conditions received care, whether as inpatients, clinic patients, rehabilitation
patients, or at other locations in the system. The diagnostic criteria, together with the

9
care location, enable the system to begin to prioritize IHSP-planning activities. Knowing
where the most potential for IHM therapies exists in the organization also enables
hospital leaders to approach physicians who are most likely to treat those patients and
ask them to be involved in the planning process. As noted previously in the section
on medical staff support, obtaining involvement of physicians as early in the planning
process as possible is key to the success and long-term sustainability of the IHSP. It
is imperative that physicians involved in the team that reviews the new and ongoing
research for IHM therapies that the hospital may include in its IHSP.
PATIENT-CENTERED CARE APPROACH
The Institute for Healthcare Improvement defines patient-centered care as truly
patient-centered, in that treatment options consider patients’ cultural traditions,
their personal preferences and values, their family situations, and their lifestyles. A
successful IHSP should be an excellent example of patient-centered care. Specifically,
an IHSP makes the patient and their loved ones an integral part of the care team
by working with them to use the integrative therapies that will work best for the
patient and the patient’s problem. The patient is the key decision maker in IHSP
therapy selection: they should have responsibility for important aspects of self-care
and monitoring. This is true for most therapies such as yoga, Tai Chi, and meditation.
The IHSP is also a good place to build patient confidence in the ability to stick to a
plan and perform selected therapies independently. The initial stages of the therapy
usually begin at the IHSP site and, as patients increase their confidence and become
responsible for practice on their own time, some activities can be transitioned to home.
And then when patients have a need for more structure and/or encouragement, they
can return to the IHSP.
A component of the patient-centered care approach to the IHSP includes community
education and marketing the program to patients or prospective patients. Opening the
education about IHM therapies to the community and offering classes like yoga, Tai Chi,
and meditation lays the groundwork for satisfied patients as the organization begins
building relationships during the time when healthcare consumers are well. In a healthy
The patient is the key decision maker in
IHSP therapy selection: They should have
responsibility for important aspects of self-
care and monitoring.

10
state, the patient can better articulate her preferences and lifestyle needs to the
organization. Given sufficient demand, the healthcare consumer’s feedback can be the
source of positive change and evolution for the IHSP and the healthcare organization as
a whole.
Figure 3. Analysis of Current System-wide Integrative Health Services
IHSP AND THE STRATEGIC PLAN
Every organization must know the type of value it intends to provide and to whom.
In Redefining Health Care, Michael E. Porter’s seminal work on healthcare strategy, he
concludes that healthcare organizations need to compete on quality and focus on value
to the patient.18
Porter and co-author Elizabeth Olmsted Teisberg use their well-tested
theories of business strategy to explain a different, better future for healthcare where
competition is based on results and medical conditions over time, not per encounter.
Medala Group’s IHSP model allows for that transition to take place with positive impact
on the patient. When IHM is used as adjunctive therapy to conventional treatments,
the modalities and subsequent program serves as a bridge that allows patients to cross
more easily from sick patient to thriving healthcare consumer than if the therapies

11
were not available and used.
It is crucial to tie any strategic planning efforts directly into an organization’s already
existing values, vision, and mission statement (VVMS).19
Assuming the VVMS is
compelling and represents the organization, managers and staff should be enthusiastic
about connecting these efforts, since they help ensure the successful implementation
of overall strategy, as well as benefit patients and the organization as a whole.
While most healthcare systems have a VVMS that reflects their service and patient
care identities, those organizations that have crafted their VVMS to be as specific as
possible to their culture and philosophies have been found to be more successful than
those organizations with “boiler-plate” statements.20
Notably, this outcome is true
even if the VVMS is technically accurate for how healthcare systems approach their
care. If an IHSP reflects an organization’s VVMS, it will increase likelihood of success
since it acts as a direct supplement to the organization’s complete strategy, rather
than being one minor part of a whole. For optimal benefit, organizations should include
these goals:
• Increased patient satisfaction. This primary potential benefit must be
measured using standard patient satisfaction surveys. Other measures,
like a decrease in pain or stress scores, can also be added in order to
increase both qualitative and quantitative measurements. However,
each organization needs to determine what will work best for their
specific goals.
• Increased revenue. To achieve this potential benefit, it is important to
determine payers who cover these types of services or collaborate with
patients who will pay for the services personally. In some cases, grants
may also support the services and provide another form of revenue to
the organization.
• Increased profit margin. By cost shifting of some services to less
expensive clinical personnel, physicians are allowed time to focus on
higher clinical priorities and also generate a higher profit margin.
• Increased patient retention. Relationship building appears to be a strong
component of an IMSP as patients need to see organizations as to their
specific demands for certain CAM therapies.
• Decreased length of stay. This potential benefit can occur in some cases
as noted previously with postoperative recovery.
• Decreased costs. It is possible to see decreased costs as an outcome in
situations where therapies are used to decrease postoperative pain,
possibly resulting in a shorter length of stay or earlier discharge from
ambulatory surgery.

12
IMSP KEY METRICS
Hospitals and healthcare systems cannot optimally manage what they cannot measure.
Therefore, it is essential for every organization to put key metrics in place to measure
the impact of the IHSP. The metrics are generally driven by the expected benefits of
the program that are identified during the strategic planning process. They must be
strategic and focused. Medala Group has found that the ideal number of categories
of metrics ranges from approximately six to eight (the six potential benefits listed
above are a good starting point for most healthcare systems). These specific metrics,
or results that the organization identifies as targets should be set as realistically as
possible during the first year. Going forward, the metrics should be based on actual
results and analysis of the need to revamp the IHSP and modify key indicators. It is
primarily important that the process for collecting data to measure each key metric
is clearly defined and documented by the organization. This historical information is
essential so that organizations can reproduce future metrics using the exact measures
and so organizations can compare results over time. Consistently tracking results
is vital to the success of an IHSP because it enables the organization to recognize
strengths as well as act on opportunities for improvement.
Although key metrics should be limited to six or eight primary measures, details will
vary according to specific hospital or healthcare system needs and priorities. For
example, a key metric that measures improvement in patient satisfaction for an IHSP
can vary greatly in terms of what data are collected, how they are collected, and how
they are reported. One organization may use IHSP patient data collected to measure
satisfaction of IHM therapies only. Another organization may reach out to all patients
through the standard patient satisfaction survey to determine whether the IHSP has
had a global impact. Another organization may blend together program specific and
system-wide surveys. As noted, it is crucial that every measure be clearly defined for
future use and reference.
Table 2 on the following page is an example of a key metric table that shows data
over a one-year period by quarter. Some organizations may wish to collect and
analyze data by month or even by week. Importantly, the specific targets are driven
by the organization, not an artificial standard that may or may not be relevant to the
particular challenges of the specific healthcare system or hospital. Similarly, the IHSP
target metrics should be viewed as a fluid and iterative process, specifically in the first
year. This combination of specificity and flexibility allows the metrics laid out in the
strategic planning phase to best capture the necessary data for hospitals, while still
allowing for changes as the organization adapts to a new program and advances or
grows into new healthcare areas. Most successful IHSPs go through several iterations

13
before finding a stable process that can be broadly applied and accurately measured.
This process when optimally managed and designed provides valuable data-driven
decision making for organizations.
While the metrics must be specific and adaptable, the overall categories of key metrics
are universal to the majority of organizations, as they should always include both
patient care as well as financial metrics. Patient care metrics should be given priority
and are generally greater in number than financial metrics. However, the tracking of
financial metrics has been found to be of equal importance to the long-term success
of a strategic plan as non-financial measures.20
Therefore, it is essential that every
IHSP key metric report include one or two financial measures and perhaps more, if
appropriate for the organization.
Table 2. Integrative Health Service Program (IHSP) Key Metric Reporting
SUMMARY
With increasing healthcare consumer demand for integrative health modalities (IHM),
it is imperative that healthcare systems integrate and implement an IHSP to improve
patient satisfaction, increase revenue and net income, and potentially decrease
costs through lower readmission rates and earlier discharges. Consumers paid $34
billion for IHM therapies in 2007 and the number continues to grow as IHSPs become

14
more sophisticated, customized, and broad, helping to supplement a full range of
conventional care options. By offering these IHM therapies in a structured, strategic
plan, hospitals increase patient satisfaction as well as the speed of the recovery
process, leading to faster bed turnover and possibly decreasing readmission rates if the
therapies are continued in inpatient facilities or as an outpatient independent practice.
Creating a successful IHSP for these benefits requires that the plan be tied to the
organization’s overall strategy, so that it is customized for a particular healthcare
system’s VVMS, as well as the primary specialties offered by their medical staff. While
no two IHSPs should look exactly the same due to the necessity of this customization
and specialization, there are universal needs for all IHSPs, including an emphasis
on proven safety and efficacy by evidence-based research for all therapies offered.
Similarly, a thriving IHSP must be supported by the medical staff, make use of clinical
data to drive the selection of IHM therapies, use a patient-centered care approach,
and measure progress with consistent key metrics. While patient metrics are the
primary driver for the majority of hospitals, it is also crucial to tie financial gains and
cost savings to the key performance indicators in order to determine how to build on
current strengths and adjust opportunities for improvement in a way that benefits
every area of the organization’s strategy.
When all of these elements are in place and the IHSP is strategically and structurally
implemented in a way that is aligned with the overall strategic plan of an organization,
an IHSP is a cost-effective, clinically proven method for improving a healthcare system’s
bottom-line and most importantly, patient care.
...implement an IHSP to improve patient
satisfaction, increase revenue and net
income, and potentially decrease costs
through lower readmission rates and earlier
discharges.

15
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10
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11
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16
15
Russo, R. (2009). A Compelling Case for Clinical Documentation. vol. 1 & 2. Bethlehem, PA: DJ Iber
Publishing.
16
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17
Academy of Integrative Health and Medicine (AIHM). (2014). E-learning, CME Course Catalogue.
Retrieved from http://aihm.org/product-category/e-learning.
18
Porter, M. E. & Teisberg, E.O. (2006). Redefining health care: creating value-based competition on
results. Boston, MA: Harvard Business School.
19
Porras, J. & Collins, J. (1994) Built to last, New York, NY: HarperCollins.; Collins, J. (2001). Good to great.
New York, NY: HarperCollins.
20
Porras, J & Collins, J. (1994) Built to last, New York, NY: HarperCollins.
21
Porter, M.E.. & Teisberg, E.O.(2006). Redefining health care: creating value-based competition on
results. Boston, MA: Harvard Business School.
Appendix A:
Resources for Evidence-based Integrative Health Modalities.
The ACP Evidence-Based Guide to Complementary and Alternative Medicine: https://www.acponline.org/
atpro/timssnet/products/tnt_products.cfm?action=long&primary_id=330381000.
Journal of the Society for Integrative Oncology, Vol 7, No 3 (Summer), 2009: pp 85-120.
Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and
botanicals http://www.integrativeonc.org/component/option,com_rubberdoc/Itemid,116/id,66/
view,category.
The Journal of Complementary and Alternative Medicine: http://www.liebertpub.com/products/product.
aspx?pid=26.
The Cochrane Collaboration: The Reliable Source of Evidence in Healthcare: http://www.cochrane.org/
index.htm.
National Center for Complementary and Alternative Medicine: http://nccam.nih.gov.
CAM Research Center for Cardiovascular Diseases: www.med.umich.edu/camrc/index.html.

17
The Arizona Center for Integrative Medicine at the University of Arizona: http://integrativemedicine.
arizona.edu.
Mind-Body Symptom Checker App for Apple: https://itunes.apple.com/us/app/mbh-symptom-checker/
id829914370?mt=8.
Mind-Body Symptom Checker App for Google: https://play.google.com/store/apps/details?id=com.
acupuncturemindbody.symptomchecker.

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