"Perverse incentives" and the triple aim: overcoming the troubled path to economic integration for integrative medicine and health.

Abstract

In early 1996, I was asked by a medical publisher, St Anthony's (now part of UnitedHealth Group Inc, Minnetonka, Minnesota), to investigate and report a practical, best-practices type, hard-copy, $200/year, monthly newsletter on business strategies for merging “complementary and alternative medicine” with usual payment and delivery. These were the early days of the movement now known in multiple nations as integrative health and medicine. Hospitals, insurers, employers, and government agencies in the United States were trying to discover how to best respond to new data out of Harvard University that found that a vast subsection of the population was not only using some forms of “unconventional medicine” but were also spending billions out-of-pocket to support their choices. I had already been in the field a dozen years and shared some of my colleagues' bias about the potential value these represented. Our internal consensus held that these typically less invasive, relationship-intensive, prevention-orient...