Burlington Standard

From a conference room in the clinic of UVM Medical Center’s Comprehensive Pain Program, with windows framing a panoramic view of the Green Mountains in the background, Dr. Jon Porter discusses the challenge of treating chronic pain. The condition can impact every aspect of a person’s life - from their ability to work, to their family and social relationships and mental health.

“Our focus in designing the program was how to address that entire 360 degree experience,” says Porter. A family medicine physician and assistant professor in the Larner College of Medicine, Porter joined the clinic in 2018 as founding medical director and division chief of comprehensive pain management.

At a time when Vermont Department of Health data show a 33% increase in opioid-related fatal overdoses year-over-year (from 158 deaths in 2020 to 210 in 2021), Porter and his team are well on the way to developing sustainable alternatives to prescription opioid medication for treatment of chronic pain. Their integrative model has drawn national attention for its transdisciplinary team approach and innovative bundled payment system for services through Blue Cross Blue Shield of Vermont.

A response to address the adverse impacts of over-reliance on the prescription of opiate medications for pain, The Comprehensive Pain Program combines modern medicine and evidence-based complementary and alternative therapies including acupuncture, massage therapy, and mindfulness to address the whole person: mind, body, and spirit. Services are uniquely delivered within the context of a supportive community of staff, clinicians, treatment providers, group session facilitators, and program participants. Over the course of 16 weeks, participants learn to reframe their experience of chronic pain, and often begin participating in activities they missed, some as simple as spending time in the backyard with their dog or attending family gatherings, Porter says.

“We're just getting going and see statistically significant change in terms of improvements in lots of different arenas in people's lives,” says Porter. “And markedly reduced use of emergency room services in the program, so I have a sense that we're on a good path.”

Thanks to a $5.5 million endowment from the Bernard Osher Foundation, The Comprehensive Pain Program joined UVM Integrative Health and Integrative Therapies at the University of Vermont Medical Center this summer to become the Osher Center for Integrative Health at the University of Vermont. The powerful connection places UVM among an international network of ten academic institutions—ranging from Harvard and Northwestern to the University of Washington and UC San Francisco—in the Osher Collaborative for Integrative Health.

Awareness of integrative healthcare, which focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches to achieve optimal health and healing, continues to increase as healthcare systems and providers search for effective value-based solutions for a range of chronic conditions. Integrative approaches can often deliver positive outcomes at a lower cost than some traditional approaches.

The Osher Center for Integrative Health at UVM will work to promote whole patient care, research, education, and health policy centered on treatments that incorporate proven methods from a variety of fields complementing allopathic medicine, and serve as a central hub to convene partners, foster innovation, and move policy forward to support the widespread adoption of integrative health as the standard of care. Through membership in the Osher Collaborative for Integrative Health, the Osher Center will also seek insight into the use of integrative health practices with diverse populations to ensure health equity and address health disparities for chronic conditions among Chittenden County’s growing racially and ethnically diverse population and Vermont’s more than 50% rural, socioeconomically diverse population statewide.

The new Osher Center will include enhanced educational and community spaces on the University of Vermont main campus in addition to the Comprehensive Pain Program’s clinical facilities in South Burlington. The center’s programs will include Integrative Therapies at the UVM Cancer Center and UVM Children’s Hospital, which offer acupuncture, yoga, massage, Reiki, gardening, health coaching, and group medical visits for adults with cancer, and massage and music therapy for children and their caregivers; as well as an integrative health and wellness coaching faculty practice offering services to UVM and UVM Medical Center employees.

Additionally, integrative medical education and a biannual integrative pain management conference will be offered through the Osher Center. Practitioners, faculty members, researchers, and students from UVM’s College of Nursing and Health Sciences and Larner College of Medicine will work together through the network to serve the patient populations and clinics of the UVM Medical Center, the UVM Cancer Center, and the entire UVM Health Network.

INTRO TO INTEGRATIVE HEALTH

Down the hall from the Comprehensive Pain Program’s conference room, past a yoga studio and treatment rooms for acupuncture, massage, and Reiki, Cara Feldman-Hunt offers a warm hello to a program participant seated in the waiting area. Her role as associate director for the Osher Center provides a full view of the potential for integrative health practices to improve lives.

“So often, when people are in a health crisis, they start to forget what's important to them,” says Feldman-Hunt. “I think what we do really well is help people figure that out. Whether it's a cancer patient or somebody with chronic pain, it's about finding tools and ways to live a happier life.”

Feldman-Hunt has been working to advance integrative care since a chance meeting with Laura Mann, a homebirth nurse-midwife, in the waiting area of a car dealership in 2008. Feldman-Hunt was five weeks postpartum and well into the stage of mood swings and irritability that can come with it when Mann introduced her to integrative medicine.

“I was in a slump, and she told me what I was feeling and explained what was happening to my body and my mind,” Feldman-Hunt recalls. Mann also mentioned that she had Stage 4 breast cancer and was starting a nonprofit to promote integrative medicine in the state of Vermont.

“And I was like, what is integrative medicine? I had no idea,” says Feldman-Hunt.

Fourteen years later, Feldman-Hunt is working to ensure integrative, whole-person health care is accessible to every Vermonter. One major success so far has been the development of a bundle system with Blue Cross Blue Shield of Vermont that allows for payment of integrative services not traditionally covered by health plans.

“Our hope is to get other insurers involved in the bundle and most importantly, Medicaid,” says Feldman-Hunt. “The long term vision is that integrative care is part of our healthcare system - that no matter where you work, or if you don't work, or who your insurer is, you get access to this care.”

PROMOTING WELLNESS

“Many people are curious about what integrative health really means,” says Karen Westervelt, clinical associate professor in the College of Nursing and Health Sciences, who will serve as educational program director for the Osher Center. “I find a lot of people are already doing it on their own, because it makes them feel good.”

For example, students who practice yoga, take a walk to get some fresh air, or find someone to talk to when they’re feeling stressed are practicing integrative health and not even realizing it, she says.

Integrative health is already incorporated into UVM College of Nursing and Health Sciences nursing and physical and occupational therapy programs, and the Osher Center plans to expand residential, medical, and continuing education through curriculum development and initiatives such as the Laura Mann Integrative Healthcare Lecture Series, endowed in honor of Mann, who passed away in 2009.

“As more people learn about integrative health and we start looking at health of the whole person we will be able to transform our health care system away from a disease treatment approach to one that focuses on promoting health,” says Westervelt. Students and community members interested in integrative health careers, or just learning more about using integrative health practices on their own, can take advantage of the online Integrative Health and Wellness Coaching Certificate, which is available free to qualified Vermonters through the Upskill scholarship program.

MAKING INTEGRATIVE HEALTHCARE ACCESSIBLE

In addition to providing education and patient care, the Osher Center will serve as a hub for research and policy development. Integrative health research at UVM investigates clinical and educational outcomes, with recent efforts focused on the effectiveness of group health and wellness coaching for UVM and UVM Medical Center employees, and the health economics of this preventive care model.

“We know that we have something really special here and our outcomes are excellent - and this is the way we can share our outcomes and grow our program and share with our greater community,” says Feldman-Hunt. “We're a part of an academic institution where research is very important, and we know this is an area we need to put funding, time, and energy into.”

Making integrative therapies accessible through health care coverage is an important goal for the Osher Center. While the bundle insurance model is a good fit for participants in the Comprehensive Pain Program, the UVM Cancer Center’s massage, acupuncture, health coaching, and nutrition and exercise interventions are made possible by philanthropic support. Research related to integrative therapies is an important step toward improving insurance coverage for the services.

The policy arm of the Osher Center will capitalize on Vermont’s health care reform progress and the goal of achieving greater health equity, particularly in rural and underserved communities. Research that has shown promising results in urban areas will be tested in rural settings where people are located greater distances from their healthcare providers.

“UVM and UVM Medical Center have an important leadership role in the delivery of care in our region and the conversation about making quality care more accessible to the community,” says Patricia Prelock, provost and senior vice president of UVM, who will oversee Osher Center operations. “The Osher Center will showcase UVM at its best—building a healthier society.”

INTEGRATIVE INNOVATIONS FOR CANCER

For more than 4,000 Vermonters who the American Cancer Society predicts will be diagnosed with cancer (not including basal and squamous cell skin cancers) in 2022, and thousands more living daily with the aftermath of the disease, integrative therapies provide support both during and post-treatment, says Dr. Kim Dittus, who will serve as medical director of oncology supportive services for the Osher Center.

A medical oncologist, Dittus has spent more than a decade of her career observing the effects of integrative therapies such as massage and acupuncture, mindfulness-based stress reduction, and Reiki on patients receiving treatments at the UVM Cancer Center.

“We know that acupuncture helps with pain, and we know acupuncture helps with nausea. Similarly for massage,” says Dittus, adding that there are also many other ways that integrative therapies help reduce patients’ discomfort.

As an oncologist, Dittus believes in the power of integrative therapies to improve quality of life, particularly for people who have completed their treatment. Patients’ post-treatment needs are very personal, and can be physical, psychological, and sometimes spiritual, based on their cancer experience, Dittus says. She also sees an important role for integrative therapies at the end of peoples’ lives.

Health coaching to support behavior change is another promising addition to integrative therapy at the cancer center. Certified health coaches are now involved in a pilot project to help patients who are receiving immunotherapy treatments modify their diets to include more plants, based on research demonstrating the change can improve immunotherapy response.

Because proper nutrition and exercise are essential foundations to wellness, Dittus says the potential for the Osher Center to develop a culinary medicine program and teaching kitchen is an exciting one.

“If I were to pick one thing that would make the biggest difference for everybody in terms of their health, it would be changing their food choices,” she says. “Second, followed closely, would be getting them to move.”

Dittus considers Vermont’s agricultural roots and local, sustainable food culture to be prime assets to integrative health and wellbeing for its residents; and this fall she’ll attend the Rodale Institute Regenerative Healthcare Conference, the first effort of its kind to bridge the gap between farming and healthcare.

A FOCUS ON THE WHOLE

For Dr. Jon Porter, the integrative relationship between personal experience, health, and wellbeing is evident.

“I don't think you can be a family physician for more than a week without understanding that a lot of what you're seeing has an existential origin,” he says. Physicians are skilled experts in the treatment of acute conditions - from pneumonia to heart attacks. But a symptom such as chronic back pain requires consideration of other factors impacting a person’s experience. This perspective underpins the innovative model of integrative therapy used in the Comprehensive Pain Program, and the vision of the Osher Center for Integrative Health at UVM: the 360 degree experience of a person's life.

_{Source: https://www.uvm.edu/news/cnhs/moving-needle}