Integrative Health Group Visits As Core Delivery Strategies

by John Weeks, Publisher/Editor of The Integrator Blog News and Reports

Integrative health group visits was the topic of an April 28, 2016 grand-rounds webinar with the Academic Consortium for Integrative Medicine and Health, the organization of 68 academic medical centers promoting the integrative model. The two speakers were Katherine Gergen-Barnett, MD (pictured right) with Boston Medical Center (BMC), and Ilana Seidel, MD (pictured below) from George Washington University Medical School.

The growing exploration of “integrative health group visits” as core delivery strategies has developed from a need to consider strategies for cost savings as well as a number of other reasons including the following:

• A focus on education and empowerment in integrative health and medicine.
• Evidence that adults learn best when they are not merely being passive recipients
• The whole person philosophy that success in creating health is ultimately in the hands of the individual seeking care rather than the practitioner who provides it

Gergen-Barnett opened the recent webinar by speaking to the power of the approach: “The idea of group visits is that we as human beings are built for community – and when we get sick we are often alone […] Group visit theory is that patients working together as a group can manage conditions better [and] not about the provider being in the room.”

Gergen-Barnett continued by explaining the group visit experience from the provider perspective: “This has been one of the most satisfying parts of my practice. Group visits take the onus off of me [as the practitioner]. In group visits, everyone is a learner and a teacher.” She went on to add that the value of these visits is more time with the patients. The sessions typically last between 2.5 and 3 hours. She also indicated that most patients have proven to be receptive to the experience. “There is a lot of evidence that even patients who are reticent about the group model come to like it.”

The webinar presentation explored two forms of group visit delivery. The first is the “closed model” that has been used at BMC and is currently the subject of a $1.8-million Patient Centered Outcomes Research Institute (PCORI) study. In this format, patients sign up for a a series of 2-3 hour visits over a period of weeks. Each billable session includes a mix of one-to-one time with an integrative professional, as well as group interactive and didactic time. The BMC model is based heavily on the Mindfulness-Based Stress Reduction format.

The other is an open model, pioneered by Jeffrey Geller, MD at the Greater Lawrence Family Health Center. In this model, patients are provided with certain times of the week that the doctor will be available and the session is shared by those who show up to participate. The model can function well with patients who face a wide variety of medical issues given the common roles of one’s relationship to stress, sleep, nutrition, mindfulness, and movement resolving or aggravating conditions.

During the webinar, Gergen-Barnett indicated that she expects even greater value and application of these methods as medical industry’s shift away from the production of services toward a “value-based” approach. Seidel echoed the opinions of Gergen-Barnett, indicating that her own experiences in practice have demonstrated that “group visits are not only good for battling loneliness but also for empowerment.”

Comment: Gergen-Barnett in particular has been championing the outcomes and the potential of the model. Her 2015 blog in the influential Health Affairs was entitled: “The Call to a New Kind of Care: Integrative Medicine Group Visits Offer Promise in the Treatment of Chronic Pain and Depression.” She spoke on the topic at the Integrative Medicine for the Underserved (IM4US.org) conference. (IM4US maintains an open source group visit resource here.) At Global Advances in Health and Medicine, Gergen-Barnett’s title was simply: “Group Visits - The Future of Healthcare.”

This is terrific work in an area in which the integrative health community should, by philosophy, be pushing the envelope. An additional resource is this posting from integrative center consultant Glenn Sabin: “4 Reasons to Consider Integrative Medicine Group Clinic Visits.”