Duke Integrative Medicine director Adam Perlman
on this transformational clinical healing and wellness model
In the audio interview (link below) with Frank Stacio, host of “The State of Things” at public radio WUNC in Charlotte, Duke Integrative Medicine director Adam Perlman, MD explains the current state, underlying principles for and clinical application of integrative medicine in one of the most lucid explanations of the subject that I have come across.
Although many independent practitioners of holistic or complementary and alternative medicine (CAM) practices are skeptical of the role played by academic health institutions like Duke Medicine, it is becoming clear that the inroads that several of these therapies have made into conventional care are establishing a clinical and business model that holds promise for sustained growth. Duke Integrative Medicine is a leader in this evolution.
Perlman’s description of how his center has incorporated integrative medicine approaches into practical care and healing reflects in part the coming changes to the traditional payment system prompted by the Affordable Care Act. Accountable Care Organizations (ACO) and Patient Centered Medical Homes (PCMH). They are designed to eliminate the costly fee-for-service model that has been a primary source of spiraling health care costs. At the moment, the clinic’s sustainability is built in part with a concierge payment structure ($1500/year) that Perlman maintains is how stability will be established as other payment structures come on line.
ACO and PCMH payment models are designed to encourage providers to keep people healthy. As Perlman explains, an essential if little understood clinical attribute of integrative practice is oriented around primary care that emphasizes wellness and that then supports people as they undertake lifestyle changes.
Duke is moving rapidly to apply these wellness approaches internally for its own employees (Perlman also directs that program for Duke). Unlike many other corporate wellness programs that may or may not include the likes of yoga, meditation or herbal therapies, the Duke program, on the same campus with own Integrative Medicine program, can embed integrative practices within its employee wellness program in ways that are not yet included in most employee wellness programs.
Perlman is a long time leader and innovator in the historically arduous process of combining integrative and conventional approaches that are patient and outcome-focused. His comments and Stacio’s good questions provide and excellent portrait of contemporary integrative medicine, even as it continues to move into and around the broader health landscape.
Follow this link to the audio (45 minutes, and well worth it)