![]() Few researchers address practitioner experience in their publications on IGMVs, although qualitative research has indicated high levels of practitioner satisfaction with GMVs more broadly. 32 IGMVs, then, may be a key organizational reform. Practitioner experience is closely connected with patient health recent research shows that clinician burnout is associated with unsafe care and lower patient satisfaction, 31 and that changes in working conditions can reduce clinician burnout. 16 The authors recommend that the Quadruple Aim be used as a framework to guide the future of both group-delivered services and research, to measure the potential impact of these programs on advancing health equity. 16, 17 Researchers suggest that GMVs can meet the goals of the Quadruple Aim by (1) improving patient experience through extended time with the clinician, peer support, and engagement in care (2) improving population health through better patient health outcomes (3) lowering health care costs, as demonstrated in studies of GMV cost-effectiveness and (4) improving practitioner experience, described in qualitative research with GMV practitioners. ![]() 15 The Quadruple Aim has been used to frame reforms on a wide range of health care issues, including efforts to address the current opioid crisis and improve prenatal care. 14 The fourth aim added practitioner satisfaction, and was first noted in the literature by Spinelli as the “phantom limb” needing attention as rates of burnout increased among clinicians. The Quadruple Aim was developed as an expansion from the Institute for Health Improvement's Triple Aim Framework, which focused on cost-effectiveness, patient experience, and population health outcomes. Having identified a need for a framework to support IGMV implementation and research, the authors propose the Quadruple Aim Framework as described by Bodenheimer and Sinsky. 12Īlthough IGMV programs and GMVs more broadly vary in structure, duration, frequency, and staffing, researchers and practitioners have identified benefits to patients, health care staff, and organizations that are present across IGMV models. 7–10 IGMVs add CIH to existing GMV models, 11 in response to CIH's inaccessibility to many people due to limited insurance coverage and high out-of-pocket costs. 5, 6 Although billable medical care in GMVs does not differ substantially from standard individual care, the presence of peers appears to provide additional benefits. 4 GMVs combine medical care, health education, and peer support to treat a wide variety of health conditions. health care: rising prevalence of chronic health conditions, with notable disparities by race/ethnicity and socioeconomic status 1, 2 extremely high health care costs compared with other industrialized countries, 3 and high rates of clinician burnout. Group medical visits (GMVs) emerged at the intersection of several concerns in U.S. As explored in the recent JACM special issue on group-delivered services, IGMVs create an opportunity to expand access to CIH. Integrative group medical visits (IGMVs) are a compelling health service delivery innovation for complementary and integrative health care (CIH). In so doing, they provide evidence on how the movements for integrative health and that for realizing the Quadruple Aim are in multiple respects parallel play toward transformation of the volume-based industry. In the Commentary, the authors affirm the multiple ways that group-delivered services move the dial positively on this quartet of values. The “Quadruple Aim” has become a go-to method for capturing this mission. It looks at these group values through the lens of another movement: to shift the US medical industry from a focus on production of services and “volume” toward what is called “value-based medicine”. ![]() ![]() A submission for that issue provoked this Invited Commentary. We engaged the project out of clarity that there is a strong concordance between the values in the movement for integrative health and medicine and those imbued in and experienced through the group delivered service models while yet there remains a pervasive under-utilization. Editor's Note: In July 2019, we proudly published the JACM Special Focus Issue on Innovation in Group-Delivered Services, with Paula Gardiner, MD, MPH and Maria Chao, DrPH, MHA as Guest Editors. ![]()
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