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Presenting the 50-year history of the evolution of the movement for integrative health and medicine in the United States for a largely European audience requires some translation. The form and course of the movement resulted in part from mainstream policy realities in the US. A central factor was the peculiar circumstance that the US is alone among wealthy nations to not have a national healthcare system. Medicine in the United States is fragmented. While the past two decades show some signs of change, US medicine has been best characterized as a medical industry, focused on volume rather than value (Miller 2009).

This peculiar circumstance created both opportunities and obstacles for the emergence of the integrative movement. Competitiveness between hospitals and insurers created opportunities. The nominally not-for-profit medical institutions battle fiercely for market share. When a survey published in the New England Journal of Medicine in 1993 (Eisenberg et al. 1993) showed that over a third of adults were using some form of “unconventional medicine” spending $ 13.7 billion per year, the competing interests woke up. The competition was used as leverage by integrative health activists. Who wanted to be left behind if a competing hospital was developing an Integrative Medicine center, or an insurer a benefit plan that covered acupuncture or naturopathic medicine or chiropractic or massage?

Yet at the same time, the fundamentally capitalist motivation proved also to be a major obstacle to integrative health’s advance. The volume-oriented industry prefers the margins from high cost specialist services and tertiary care than primary care and community clinics. Pitches that lower cost, high touch, time intensive integrative services delivered in an outpatient clinic might cut needs for services ran squarely against the dominant business model in the volume-oriented industry. These so-called “perverse incentives” in medicine have proved an enduring barrier to optimal use of complementary and integrative practices and practitioners (Weeks 2015). A report on medical harm from inside the dominant school of medicine in 2000 began to open the dialogue. The effort to shift “from volume to value” known as “value-based medicine” or as the “Quadruple Aim” created more interest in integrative contributions (Bodenheimer and Sinsky 2014).

The history shared in this chapter is one of a convergence of these two movements to transform the medical industry. The focus is on the one that began in the grassroots. The other grew from inside organized medicine. The reformers in both camps recognized that the now $ 3.4-trillion US medical industry has a deeply troubling resume. A third to fifty percent of what is done in regular medicine is estimated to be waste, and much of it harmful (Boat et al. 2008). Public resources are siphoned into tertiary care rather than invested preventively in community medicine and public health (IHI Leadership Alliance [n.y.]). Researchers at Johns Hopkins estimate that patient-safety issues alone are such that the regular practice of medicine kills 250,000 annually (Makary and Daniel 2016). As this chapter will show, the worlds of value-based medicine and integrative health and medicine are increasingly aligned in an effort to shift the incentives of the medical industry toward a system that focuses on creating health.