Getting on the patient's team

Anne Krishnan, Staff Writer
http://www.newsobserver.com

Matt Person has a vision for health care.

He imagines a family doctor referring patients for counseling or acupuncture simply by walking them next door. Cardiologists and nutritionists would cross paths daily. Physical therapists and personal trainers would help patients transition from rehabilitation to getting in shape.

Person and business partner James Stevens, a Raleigh doctor, are trying to make it happen at a new health complex in North Raleigh.

They teamed up with a diverse group of Triangle medical providers to form the American Institute of Healthcare and Fitness. The $30 million, 187,000-square-foot facility has doctors, nutritionists, physical therapists, counselors, a fitness center and more under the same roof.

The result is an environment that encourages teamwork to make patients well — and personalized planning to keep them that way.

That’s in stark contrast to the fragmented style more typical of modern medicine, Person said. “We’ve all had family members who had an illness or injury who ended up with two, three, four, five medical providers,” he said. “The system is not in place for them to coordinate with each other.”

What’s more, the health-care system encourages crisis management rather than disease prevention, driving up costs for patients and employers, Person said. “The only way I see to really impact health care costs is to make people more healthy,” he said.

The American Institute of Healthcare & Fitness isn’t the only voice calling for change. The health complex, which holds its grand opening Saturday, is part of a broader national movement promoting a collaborative, cross-disciplinary approach to patient care.

Often called integrative medicine, the concept has the support of major academic centers such as Duke University Medical Center, philanthropists and the federal government.

Patients and doctors have become disenchanted with the traditional approach to health care, said Linda Smith, director of programming for Duke Integrative Medicine.

“We want the best wisdom and we want to have time with our patients so that … [we] have a chance for partnership and the kind of deep listening that’s necessary to really affect healing,” she said.

Integrative medicine is often used as shorthand for the combination of traditional Western medicine with complementary and alternative therapies such as acupuncture, meditation or herbal supplements.

More broadly, it describes the integration of “all the available resources to meet the full health-care needs of the patient,” said Ralph Snyderman, chancellor emeritus for health affairs at Duke University and an outspoken advocate of integrative health care.

At AIHF, patients can consult with health and wellness practitioners who pledge to communicate about shared patients’ care. The practices, all individual businesses, range from sleep medicine to endoscopy to a spa.

When Dorothy Davis visited her doctor at AIHF in December, she mentioned that she should go on a diet. “He said, ‘That’s not my specialty, but I can send you to somebody who knows,’ ” said Davis, 57.

He called Healthy Diets down the hall, and within days, the Raleigh woman had an appointment to see a nutritionist. Now she’s on a plan to lose 36 pounds and lower her blood pressure.

In just a month, AIHF’s concept has won over Davis, who works for BellSouth. “I like to know that everything is right at my fingertips,” she said. “You just walk down the hall and pick this one, this one and that one.”

No one is obligated to visit more than one office, but AIHF’s providers hope patients will consider other options at the institute. Features such as child care are designed to make the complex even more convenient.

“It’s a unique opportunity,” said Eric Morse, an addiction and sports psychiatrist with Carolina Performance. Bumping into the other providers on a daily basis will remind them to refer patients for counseling, he said. “The proximity really helps,” he said. “If we were in some medical office building somewhere else, we would still be kind of isolated.”

Person, a hospital administrator and health-care consultant, and Stevens, president of Carolina Family Practice and Sports Medicine, put their heads together in 2001 to develop AIHF. Ultimately the building will house 35 businesses, with about 25 open by the end of February.

In addition to individual practices, the complex also will include an executive health center offering a full-day comprehensive medical work-up, a personalized health plan and 24-hour access to the center’s doctors. There’s a clinical research division and a 300-seat conference center for educational programming and community meetings.

It’s a concept that AIHF plans to expand, although perhaps not on the same scale. Person and Stevens plan to announce a second location, probably in the Triangle, in the next few months.

But there are barriers to widespread adoption of integrative care, frequently concerning money.

Most insurers refuse to pay for complementary and alternative therapies. That has held up the opening of AIHF’s holistic practice, which eventually will feature acupuncture, Oriental medicine and other specialties, Person said.

What’s more, doctors are rewarded more for treating disease than for keeping people healthy, Snyderman said.

“If a doctor sits and talks to you about what you can do to improve your health, to minimize diabetes, they get paid almost nothing,” he said. “I think the reimbursement system actually works against having a more rational approach with integrative medicine.”

Person and Stevens made it clear to potential tenants that AIHF’s model demands that they devote extra time to working collaboratively with patients and other health-care providers.

“We were looking for people who were team players, who were willing to make some personal sacrifice for the greater good,” he said.

Representatives of each individual practice have met monthly for the past three years to plan joint programs and services, such as regular health seminars for the public. Those meetings will continue as a forum for refining the concept as business builds.

There’s a community spirit at AIHF, said Flo Moses, owner of Sports & More Physical Therapy. Her business will take advantage of the pool at the 34,000-square-foot Healthtrax fitness center next door to start an aquatic practice.

“It’s an opportunity … to ideally provide a little more of the bigger picture of health care for our patients,” Moses said.

“There’s certainly an element of teamwork, of trying to work together to bring about something that may not have been done in exactly the same way elsewhere.”
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