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Healthcare Policy and Functional Medicine

By Bill Reddy, LAc, Dipl. Ac.

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A Model for Integrative Health in the U.S.

This past March I met Dr. Benjamin Kligler, national director for the Integrative Health Coordinating Center of the Veterans Administration (VA), at an Integrative Health and Wellness Congressional Caucus briefing, where he presented on the VA health care system. He gave a brief overview of how pain is handled within the VA system and shared that it is the largest health care system in the U.S. with 1,243 facilities across the nation, treating more than 6 million veterans annually. Kligler intends for the VA system to be the model of integrative health care in the U.S.

A whopping 93 percent of the centers offer some kind of integrative health service, although the type of service varies from one medical center to another ranging from tai chi and yoga to acupuncture and chiropractic care. In a discussion with Dr. Kligler post-briefing, I found that the February 2018 issue of the VA handbook now contains qualification standards for employing licensed acupuncturists in the VA health system and queried if he'd be willing to be interviewed for Acupuncture Today.

A Model for Integrative Health in the U.S. - Copyright – Stock Photo / Register Mark Bill: What role do you play in the VA health care arena?

Dr. Kligler: I am director of the Integrative Health Coordinating Center, which is a branch of the Office of Patient Centered Care and Cultural Transformation. I am also director of Research and Education for OPCC&CT.

Bill: Can you tell me a little about the genesis of integrative health in the VA?

Dr. Kligler: This has been growing for quite some time—at least a decade. Major drivers have been veteran demand and provider interest. Most recently the opioid crisis has been a major driver, with the need for a wider range of tools for treating pain. Congressional interest has also grown, as reflected in the Comprehensive Addiction and Recovery (CARA) legislation in 2016 that mandated, among other things, that VA expand complementary and integrative health clinical offerings as well as research and education.

Bill: You recently created a formal designation for licensed acupuncturists in your health care system. Please share the details.

A Model for Integrative Health in the U.S. - Copyright – Stock Photo / Register Mark Dr. Kligler Dr. Kligler: The Acupuncture Qualification Standard has been years in the making and required dedication from many supporters of acupuncture in the Veterans Administration. Luckily, we had a persistent group of advocates who really wanted to see this succeed.

Prior to the publication of the Acupuncture Qualification Standard, the occupational class "acupuncturist" was not recognized as a standalone professional category, so it was not possible to hire a licensed acupuncturist unless they held another classification (like DC, RN, PA). The Qualification Standard allows an LAc to be hired directly by local VA hospitals under their licensure. Licensed acupuncturists have the greatest amount of training in acupuncture and East Asian medicine. We are greatly looking forward to an influx of licensed acupuncturists to provide exceptional care to our veterans.

Bill: Rhode Island recently completed a Medicaid integrative pain management pilot program where there was an 86 percent reduction in opioid prescriptions, 61percent reduction in ER visits, and a 27 percent reduction in annual medical costs per patient. Can you tell me some of your successes?

Dr. Kligler: Many of our pilot programs at facilities around the VA have shown decreased pain, improvement in well-being and quality of life, and early signs of a decrease in opioid use in some patients using Complementary and Integrative Health (CIH) with no adverse events reported. In addition to acupuncturists, we use physicians and nurses, physical therapists, psychologists, social workers, recreational therapists, chiropractors, massage therapists and dietitians. Veterans also do yoga, tai chi, and mindfulness meditation.

A Model for Integrative Health in the U.S. - Copyright – Stock Photo / Register Mark Bill: What common conditions are you using acupuncture to treat beyond pain and PTSD?

Dr. Kligler: Each facility is free to utilize acupuncture as it fits their needs. While pain and PTSD are very common referral categories for acupuncture, the broader scope of mental-emotional conditions (depression, anxiety and insomnia) are also common reasons for treatment. In general, we use evidence-based guidelines for what is likely to respond to acupuncture. Resources like the HSR&D Acupuncture Evidence Maps and the Acupuncture Evidence Project are often considered when choosing an acupuncture referral.

However, well-being is part of a greater mission for complementary and integrative health in the VA, so acupuncture may be used for a variety of concerns, as long as it is part of a veteran's treatment plan.

Bill: Where do you see the future of the VA health care headed?

Dr. Kligler: The VA is committed to providing a whole health approach to care, which focuses on well-being and on what matters to the veteran, rather than what is the matter with them—while still offering outstanding disease management as well. This approach actively incorporates CIH therapies including acupuncture, as well as health coaching, peer to peer support and partnering, and self-care strategies like yoga, tai chi and meditation. Although we are still early in the spread of this approach across the VA, there is a strong commitment from VA leadership as well as a tremendous grass roots interest from veterans and clinicians in adopting this approach.

Bill: Is there anything else you would like to share with our readers?

Dr. Kligler: The best way to keep up to date with job postings for licensed acupuncturists in the VA is to use www.USAJobs.gov. You are able to set up an account and create notifications for any time a job is posted for an acupuncturist.


Editor's Note: The salary for an acupuncturist working for the VA is $61,486 - $79,936

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