VA Shifting to Integrative Medicine to Provide Relief for Veterans

As early as the 1990s, national surveys show that at least 1 in 3 adult Americans use complementary and alternative medicine (CAM) to treat their bothersome health conditions.  Indeed, there is ample evidence to suggest that Complementary and Integrative Health (CIH) practices such as acupuncture, yoga, meditation and tai chi have a positive effect on the well-being of veterans in particular.

Recently, the Veterans Health Administration (VHA) has been shifting towards a more holistic approach to veteran healthcare. In May 2017, for example, the agency issued VHA Directive 1137, which provides policy guidance on how CIH approaches will be incorporated into the standard veterans’ medical benefits package. Currently, the program is undergoing implementation and rebranding, though the CIH practices to be used remain the same.

Guiding Principles of VHA Directive 1137

It’s worth noting that the goal of the CIH Directive is to expand veterans’ existing healthcare options, not replace conventional treatments altogether. To quote Paragraph 4 of the Directive:

It is VHA policy that VA practitioners proactively offer and include, as appropriate (based on the individual clinical facts of each patient), any of the CIH approaches identified in the electronic lists described in paragraph 6, and to effectively integrate their delivery with Veterans’ receipt of conventional care. It is VHA policy that CIH is not to be used as an alternative to conventional medicine; it must only be used to complement conventional medicine. VA Practitioners are not to offer a CIH approach that is not on one of the two lists described… below.

List I CIH Approaches

List I approaches are defined as those with “evidence of promising or potential benefit,” and are vetted by the Integrative Health Coordinating Center (IHCC) Advisory Group. These approaches include:

• Acupuncture

• Meditation

• Tai Chi

• Yoga

• Massage (for treatment)

• Guided imagery

• Biofeedback

• Clinical hypnosis

List I approaches are to be made available to veterans across the VHA system, either through a VA facility or the local community. They must be recommended by the veterans’ healthcare team, and must be on List I at the time the specific approach is to be used for treatment.

List II CIH Approaches

List II approaches, on the other hand, are optional for inclusion in VA facilities. They’re generally considered safe by members of the medical community, and there is “reasonable certainty that [these approaches are] not harmful under the conditions of intended use.”

List II approaches include:

• Healing touch

• Acupressure

• Alexander technique

• Reflexology

• Reiki

• Therapeutic touch

• Emotional freedom technique

• Animal-assisted therapy

Like List I approaches, List II approaches must be recommended by the veterans’ healthcare providers, and must be specified as such on VHA’s Intranet Sharepoint site at the time of their use. (Note: The comprehensive list of VHA’s List I and II CIH approaches is not available to the public.)

If a veteran will use any of the above through a community, he or she must first consult the local Office of Community Care, or any related business office, to determine eligibility for CIH contract care within that community.

CIH Approaches Outside List I and II

If a veteran will use a CIH approach not included on List I or II, his or her VA healthcare provider must submit a request to the Integrative Health Coordinating Center Advisory Workgroup (IHCCAW).

The IHCCAW will escalate the request to the IHCC, which in turn will escalate to the Whole Health Experience Committee (WHEC), and then to the Under Secretary for Health. The Under Secretary for Health has the final authority to approve the request, though the IHCC may also deny the request unilaterally.

In any case, the IHCCAW will be the one to inform the requestor regarding the final decision. If the Under Secretary approves the request, the list of sanctioned CIH approaches in the VHA system will be updated accordingly.

As of this writing, the CIH program is in the implementation phase, meaning that the specifics of the program may still be changed or updated. Regardless, there’s no doubt that holistic healthcare for veterans is now more accessible, more systematized, and more able to serve veterans’ medical needs.