Writing a short article on integrative health care recently gave me a chance to reflect on what’s taken place in the field over the last two decades. The system is evolving, slowly in some places and quickly in others. In 1997 a team at Northwestern College of Chiropractic developed a set of seed algorithms for integrative care teams. Based on the experience of opening the Natural Care Center at Woodwinds Hospital (now closed), I wrote a somewhat tongue-in-cheek take on working with hospitals and ‘health’ care systems. At that time, medical staff were commonly entrenched in opposition to integrative services. That dynamic has changed a lot, but it still may serve as a guide to the relationship dependencies required today. Continue reading
In December of 2000, I wrote this article for the Journal of the American Chiropractic Association. I can’t remember if it got published or not. It’s interesting to reflect on the observations in the piece. Not sure much has changed for the chiropractic profession.
Navigating the Issues of Integrated Health Care
By Stephen Bolles, DC
In the last decade and a half, doctors of chiropractic have borne witness to a changing health care market that has moved at a dizzying pace. Pressured by a variety of forces, health care delivery has fundamentally changed for virtually every person in the United States. Whether on the cutting edge or the bleeding edge, chiropractic physicians have had a front row seat to the rapidly changing landscape before them. The process has already placed tremendous pressure on our profession, and we are well advised to watch the forces of change at work. Continue reading
As a preacher’s son, parables and examples in Scripture are never far away in my consciousness. Even though a good deal of what passes for theology makes my teeth hurt these days, there is poetry in the Bible.
Seeing some of the information being distributed by those who would expand the profession’s scope of practice to include the ability to prescribe drugs, I’m reminded of one verse in particular: ‘For how is a man benefited if he should gain the whole world and he should lose his soul?’ (Mark 8:36). Gender-slanted language aside but in the context of today’s professional struggles, it might also read, ‘How will the profession retain its soul if it becomes more like medicine?’
It’s a hard question to answer when the profession itself hasn’t had the conversation about what its own ‘soul’ is. If soul is ‘…moral or emotional nature or sense of identity’ and describes what is enduring about that nature, how would we describe chiropractic’s soul? Continue reading
Shifting roles, relationships, marketplace positions and economics have every aspect of health care under strain. A leading observer, leader and chronicler of integrative health care for decades named John Weeks recently wrote a perceptive piece on his analysis of the opportunities for doctors of naturopathic medicine (NDs) in this challenging landscape. Can we learn something from his analysis that might affect chiropractic? I believe so. Continue reading
A recent personal health crisis brought a practical example of the role of chiropractic into sharp focus. As passions heat up over the contentious issue of scope expansion and prescription privileges, and with no real information about what health care consumer/patients actually want, anyone who has an opinion about the issue is making a lot of value-based assumptions. With that in mind, and with the historic and inclusive ACC Paradigm of Chiropractic as a starting point, here’s one man’s story and some potential insights for the profession. Continue reading
Three articles from different sources highlight just how different providers’ needs are for marketing in today’s emerging retailized health care marketplace.
Why is this important for doctors of chiropractic? Because as the health care marketplace increasingly functions like a retail marketplace, providers and systems will have an opportunity–if not a need–to have a more direct relationship with their patient/customers. And the basis and content of that relationship is significantly different than ever before. Continue reading
At the point of completing his first year in place as president of Northwestern Health Sciences University, Dr. Christopher Cassirer offers a kind of report of findings and environmental assessment on the profession in July/August issue of the Minnesota Chiropractic Association’s MCA Journal. He lists a number of observations and proposes what I’ll call ‘design principles’ for solutions to the challenges the profession is facing. He notes that:
- The US health care system delivers very poor outcomes for the enormous sums of money spent.
- Novel delivery system processes (accountable care organizations, etc.) are going to be used as payment vehicles for many efforts.
- Scope of practice competition requires an ongoing legislative effort, while at the same time demands for more data supporting and detailing chiropractic clinical contributions will only increase.
He notes pointed concerns, as well, calling out intraprofessional squabbling on differences that perhaps consigns us to a ‘Nero fiddling while Rome burns’ position as health care reform goes forward.
Does he offer a blueprint for solving some of the profession’s concerns and issues? Continue reading
A recent news tidbit referred to new training being undertaken by California dental hygienists seeking to provide temporary fillings without dental supervision. As a regulated profession, this is a scope of practice (legislative) issue. As an effort to expand the role being played by a profession in the health care system, it’s one among a very crowded field.
Doctors of medicine have had essentially open-ended scope of practice laws for close to a century, largely consistent from state to state. They have established a degree of cultural authority against which others’ practices, laws and education are measured; all regulated professions outside medicine have a kind of templated required prohibition, typically something like [the profession in question] ‘is not the practice of medicine.’ For decades, other professions have sought to establish and expand scope of practice legislation to legitimize their professions, confer as much autonomy as possible within the bounds of their education, and to wedge open a new or larger role in the US health care system. Doctors of chiropractic have sought and achieved this as well in a number of places–and some are seeking further expansion to include prescription rights. Are all these efforts helpful? Important? Do the professions get what they want? Continue reading
‘Patient engagement’ has been used as a general term to describe what patients do for their own health. What’s required for engagement? Motivation, either imposed on us (precipitating events like heart attacks can get people’s attention and motivate them to refine lifestyle habits–but not everyone, and not always), driven by personal values, or–for some–rewards.
Other factors matter as well. Health literacy–understanding basics like terms and body systems concepts is often necessary. Technology access and competence matter more and more: much of health care, information, and soon access too and purchasing of health services requires access to the Internet. Ethnicity, race and culture matter: ingrained cultural norms, differences in values, relationship approaches, language, information and activities between caregiver and patient can affect participation, engagement and outcomes. And perhaps the most profound driver of engagement is the tribal cohort factor: peer group activities shape and motivate what its members do.
Some things in health care can be done to a person, but most efforts in recovering and maintaining health and optimal function mean the person has to do something. The provider’s role is one of facilitation and limited intervention. So engagement (motivation) matters: the more I do on my own, the less I need others’ services–so the less I cost the system. “Patient engagement 1.0” has been defined and largely managed by system-side resources. But with the new, consumer-focused retail health care marketplace, the locus of power and control is shifting–and the basis for engagement is changing. We’re likely to see it substantially revised: “Patient Engagement 2.0.” What is it, and what can we do to be prepared? Continue reading
The idea of ‘integrative health care’ has captivated people for several decades, and many examples have come and gone. Some medical delivery systems have incorporated some providers into care delivery; most have not. Some business models have survived; many have not. One of the more important local (Minnesota) sets of accomplishments in integrative health care occurred from 1998-2000, when some novel clinic models were established. As a product of the leadership of Dr. John Allenburg, president of NWCC and its successor host institution Northwestern Health Sciences University, there were five notable experiments, all distinctive and unique–especially for the time.
Dr. Allenburg had held that there were three types of models that reflected real-world needs and thus should inform the school’s efforts. One was a multidisciplinary provider team, housed in a single clinic; another was a virtual team, housed at different locations but functioning together with electronic facilitation; and another was that of an independent solo practitioner, able to craft interdisciplinary referral relationships as their circumstances, values and patient needs dictated. Based on this strategic vision, NW created five experimental clinics. With the news that NWHSU sold the Natural Care Center at Woodwinds in Woodbury MN on 6/29/15, the last chapter in this effort is over. Whatever integrative efforts occur will come from on-campus or other new opportunities. Is this a net gain, neutral, or a net loss? As Dr. John has said many times, “Where you stand depends on where you sit.” Continue reading