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The Obama-era Affordable Care Act of 2010 marked the formal arrival of the volume-to-value movement in US medicine. Leaders of academic Integrative Medicine organizations agreed in a 2013 survey that value-based care was creating an environment in which they were perceived to have more value to their larger delivery organizations (Weeks et al. 2016). More specialty groups were exploring how the integrative model might assist them in achieving their needs. A subset of those surveyed saw increased investment of their integrative efforts from the parent organization. Over 88% of these leaders of clinical centers among the Consortium perceived that they were operating with stronger values alignment in the era of accountable care. This sense of alignment was affirmed by the CEO of a major health system in a presentation sponsored by the Bravewell Collaborative:

“When I first heard of integrative medicine in 2006, I thought of it as an expense. But as the Affordable Care Act’s payment structure kicks in that supports keeping people healthy, integrative medicine will be an asset.” (Paulus 2011)

The integrative movement was more prepared than ever. Evidence of cost savings began to emerge. The Collaborative gathered most of this evidence on their website (https://integrativehealth.org/reducepercapitacost). A first thorough examination of cost-effectiveness in complementary and Integrative Medicine led by Patricia Herman, ND, PhD found evidence of significant cost-effectiveness in 28 separate studies (Herman et al. 2012). A close examination of 4,200 patients at the Benson-Henry Institute at Harvard Medical School who had completed a multi-week mind body program found wildly confirmatory evidence. As compared with matched pairs, the completers averaged 42 percent lower use of conventional services (Stahl et al. 2015). The findings, which held across emergency room visits, prescriptions, physician visits, and hospitalizations, provoked the authors to declare that evidence based mind body programs should potentially be spread to the whole public with the same governmental backing as vaccines and drivers education.

This commences a truly integrative era in which certain complementary and integrative services were being explored as ways not just to lure patient but to meet declared values. In the United States, convergence in action began first in two areas: oncology and treatment of people with chronic pain. In the former, the Society for Integrative Oncology (SIO) had fostered, in the competitive oncology marketplace, expanding interest in complementary services. Integrative oncology began to be the norm rather than the exception in major oncology centers. Concurrent with the uptake, SIO, under the leadership of past-presidents Heather Greenlee, ND, PhD and Suzie Zick, ND, MPH, engaged an ongoing process of guideline development. It culminated in the influential American Society of Clinical Oncology endorsing a guideline for integrative practices in the treatment of patients with breast cancer (Lyman et al. 2018).

The second, broader, and potentially much more influential evidence of the arrival of complementary and integrative practices and practitioners was stimulated by the nation’s crisis in the treatment of people with chronic pain. This whole systems issue reached headlines and policy attention reductively as the nation’s “opioid crisis.” The challenges were first felt in the military, where problems of returning soldiers and veterans produced the first robust exploration of non-pharmacologic, integrative interventions (Jonas et al. 2010). Key research was provided over the period of a decade through the Samueli Institute led by the first influential director of the NIH Office of Alternative Medicine, Wayne Jonas, MD. A former US Army Surgeon General Eric Schoomaker, MD, PhD became an outspoken advocate for the integrative model. A survey of CAM use reported in 2017 found that of the 142 military treatment facilities in the military health system, 110 (83%) of the 133 respondent facilities offer at least one type of CAM and 5 more plan to offer CAM services in the future (Madsen et al. 2017).

The interest in the government health care systems of the military and the sprawling Veteran’s Administration (VA) led to the most remarkable leadership of the Integrative Medicine professionals in shaping US medicine. The founding director in 2011 of the VA Office of Patient Centered Care and Cultural Transformation, Tracy Gaudet, MD, and her successor in that position in 2019, Ben Kligler, MD, MPH, were each long-time leaders of the Integrative Medicine movement. Gaudet had directed programs at what is not the University of Arizona Andrew Weil Center for Integrative Medicine and Duke Medical School for 15 years. Kligler’s experience included chairing the Consortium and directing data-gathering in a Bravewell-funded network of integrative academic medicine clinical programs.

Together, these two and their team envisioned and built the VA’s Whole Health program that featured expansive use of integrative services including chiropractic, acupuncture, massage, Mind Body Medicine, yoga therapy, tai chi and others. The program, which conceptually placed the veteran and his or her family at the center of care (Weeks 2018b), was piloted and thoroughly researched in 17 of the VA’s medical centers. A broad array of positive outcomes (Bokhour et al. 2020) led the VA, three years later, to expand the program to 55 medical centers. Notably, this action was taken in the context not of the competitive, volume-based industry but in the single payer VA system. There, like in the United Kingdom, practitioners were employed. In the VA hierarchy, they could also be required to learn about integrative practices and practitioners. These cultural-economic traits of the VA operation supported the most intensive integrative environments in the US.

Yet in the world of civilian medicine, convergence was also evident. Other forms of integrative activity also accelerated. Research related to complementary practice and practitioners funded by the military and by the NIH created a body of evidence that, with policy nudging, began to shift the chronic pain dialogue. Members of the Consortium, as noted above, convinced a key accrediting body to engage a review process that casting a spotlight on the value of non-pharmacologic approaches such as acupuncture, massage, chiropractic and mind body approaches in pain treatment (Division of Healthcare Improvement 2018). Within a half-decade, the American College of Physicians (Qaseem et al. 2017), and the National Academy of Medicine (Bain et al. 2019) were among the organizations and agencies that had either issued guidelines or guidance documents that stressed the importance of integrating these non-pharmacologic, integrative approaches.