Integrative Health Coordinating Center (IHCC)
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Definition of Integrative Medicine and HealthIntegrative medicine and health reaffirms the importance of the relationship between practitioner and patient; focuses on the whole person; is informed by evidence; and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals, and disciplines to achieve optimal health and healing.1
VHA established the Integrative Health Coordinating Center (IHCC) within the Office of Patient Centered Care and Cultural Transformation (OPCC&CT)2 in 2014 to:
• Identify and address barriers to providing CIH across the VHA system
• Serve as a resource for clinical practices and education for Veterans, clinicians, leadership, and staff
PolicyVA has developed policy and guidance required to implement CIH services that meet the definition of basic care as described in the standard Medical Benefits Package and are in accord with generally accepted standards of medical practice. A memorandum was signed by the Under Secretary for Health in May 2016 to approve the process for vetting CIH services deemed appropriate for use across VHA, and to recommend the formation of an IHCC Advisory Workgroup to serve as subject matter experts across program offices.
VHA Directive 1137 - Provision of Complementary and Integrative Health (CIH) was approved by the Acting Under Secretary for Health on May 19, 2017 establishing policy regarding the provision of CIH approaches, representing a significant change in how care is to be delivered across the VHA system.
AUTHORITY: Title 38 United States Code (U.S.C.) 7301(b); 38 U.S.C. 1710; title 38 Code of Federal Regulations (CFR) 17.38. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5401
Approved CIH approaches (Directive “List 1”)3 covered by Veterans Medical Benefits package to be provided on site or in the community if deemed appropriate by Veteran and care team currently include:
- Clinical Hypnosis
- Guided Imagery
- Massage Therapy
- Tai Chi / Qi Gong
Approaches included on “List 1” must show evidence of safety and, at a minimum, promising or potential benefit and go through a review and vetting process by IHCC, the IHCC Advisory Workgroup, and the Whole Health Experience Committee (Subcommittee of the National Leadership Committee) prior to being presented to the Under Secretary for Health for review and approval.
Current State of CIH Services
- CIH is delivered within the context of the Whole Health System, a transformed model of care designed to empower and equip people to take charge of their health, well-being, and to live their life to the fullest.4
- All facilities are offering CIH approaches, however facilities are at various stages of implementation of the full CIH Directive “List 1”. Provision of CIH List 1 approaches has been growing exponentially over the past few years with a notable increase in the year following the release of the Directive.5
- To assist with the expansion of access, VHA has been delivering some approaches via telehealth, volunteers, community partners, and online resources.
- VHA continues to work on coding and tracking infrastructure and guidance for the field to accurately account for CIH approach provision.
ResearchThe VA Evidence-based Synthesis Program (ESP) in conjunction with OPCC&CT and Patient Care Services has examined the scientific literature on various CIH services and have presented the findings in the form of evidence maps for: acupuncture, yoga, Tai Chi, mindfulness, massage therapy, health coaching, and guided imagery, hypnosis and biofeedback (currently available on intranet only). Reports in progress include one on Aromatherapy and Essential Oils.
Along with identifying the challenges and successes of CIH implementation in VHA, our research partners from Health Systems Research & Development and Quality Enhancement Research Initiative continue to examine patient-reported health outcomes, clinical outcomes, cost impact, and Veteran satisfaction measures.
CIH Research Office of Research & Development
- New Occupations: VHA has developed qualifications standards for acupuncturists6 and massage therapists7 to be covered under 38 U.S.C. §7401(3). This allows VA to hire acupuncturists and massage therapists as Hybrid Title 38 employees to provide acupuncture and massage therapy services to Veterans. IHCC has developed nationally classified position descriptions for Whole Health Coaches, Yoga Instructor, and Tai Chi/Qi Gong instructor.
- TeleWholeHealth: Offering CIH approaches via Telehealth allows sites to share with Community Based Outpatient Clinics, other medical centers and non-VA locations, expanding access to these services. TWH services may include: Yoga, Meditation, Mindfulness, Tai Chi, Qi Gong, Whole Health Coaching, Whole Health Clinical Encounters, Intro to Whole Health Classes and Whole Health Facilitated Group
- Free Mobile Apps and Online Tools: list of vetted materials for Veteran use: https://www.va.gov/WHOLEHEALTH/veteran-resources/MobileApps-OnlineTools.asp
- Whole Health Library: https://wholehealth.wisc.edu/
- Battlefield Acupuncture: to increase access to acupuncture, the VA Battlefield Acupuncture (BFA) program has continued to train BFA providers in a specific form of auricular acupuncture for pain management. Over 2,900 have been trained to offer BFA and 86 instructors are available to continue to teach this approach.
- Internal Trainings: to help meet demand VA is developing internal CIH Provider Trainings to train internal VA staff to provide select List 1 CIH Approaches in addition to the BFA trainings.
1 ACIMH 2016
2 VHA OPCC&CT Website
3 NOTE: Chiropractic Care was approved for use at VA in 2004 so is not on the list of recently approved CIH approaches but should be a part of VA Whole Health care
4 VHA OPCC&CT Website
5 VHA Centralized Data Warehouse