Abstract
Abstract: The integration of complementary and alternative medicine (CAM) with conventional medicine continues across practice settings and modalities. Managed care is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. Within health maintenance organizations (HMOs), availability, coverage, and support of CAM are variable. We present an organizational model within which we identify factors that influence the degree of CAM integration within HMOs. We describe avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW). We also describe research methods applicable to the study of CAM integration within HMOs.
THE INTEGRATION OF complementary and alternative medicine (CAM) with conventional medicine continues at varying speeds across practice settings and modalities. Given its prominence in American health care, the managed care context is of particular interest to practitioners, policy makers, and researchers concerned with the evolution of CAM integration. In fact, networks of CAM practitioners have arisen in recent years that replicate many of the procedures and practices first developed within managed care. Yet, within traditional health plans, eg, the health maintenance organization (HMO), the availability, coverage, and support of CAM remains quite variable. In this article, we present an organizational model based on the classic structure/process/outcome approach within which we identify and explain factors that influence, whether positively or negatively, the degree of integration of CAM and conventional medicine in HMOs (Donabedian, 1966). Along the way, we will describe some of the avenues through which CAM is currently available within the Northwest Region of Kaiser Permanente (KPNW), a 450,000-member group-model HMO. We also describe research methods applicable to the study of CAM integration within HMOs.
For our purpose, we define integration as the coordination of CAM and conventional practice into a health care process within a health care delivery system. We emphasize coordination, rather than a merging, of care systems because we believe that the history, traditions, and context in which CAM has developed and is currently practiced are placed at risk if CAM is truly merged with conventional care.