Chiropractic Within the PCMH

Author: Sarah Pothoff, DC/Wednesday, March 02, 2016/Categories: March 2016

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By Sarah Potthoff

THE MISSION OF THE MILLENNIAL THINK TANK (MTT) is to influence and inspire the future of the chiropractic profession and overall health care system. MTT has begun investigating several avenues; one is to examine the changing health care environment, with a focus on patient-centered medical homes (PCMHs). To best use the talents of new grads in the field of PCMHs, MTT is working to first understand what the future of health care looks like and our role in it. It is no surprise that many of MTT’s goals have an emphasis on integrating the chiropractic profession into the changing health care system. Here are three specific MTT goals, which focus on the inclusion of chiropractic in the current and future health care system:

1) Understand the role of chiropractic as specialists within the larger, integrative health care environment.

2) Influence and strategically plan for the expanded role of chiropractors within primary care settings [such as accountable care organizations (ACOs) and PCMHs].

3) Innovate new opportunities for early career practitioners, especially within multidisciplinary practice environments, research and policy.

In the last five years, the chiropractic profession has showed particular interest in PCMHs. This aligns with the 2015 Institute for Alternative Futures (IAF) report entitled “Chiropractic 2025: Divergent Futures.” The report presents the results of exercises that attempt to identify the future direction of the chiropractic profession in relation to our nation’s future health care delivery system. The No. 1 suggestion of the IAF report is to, “Integrate chiropractic into health care systems, particularly into ACOs and PCMHs.”

Understanding ACOs and PCMHs


ACOs and PCMHs were designed to achieve what is called the triple aim: better patient care experience, improved population health and lower costs.

ACOs are made up of providers that are jointly held accountable for achieving quality improvements and reductions in medical expenses/spending.

A PCMH is a redesign of primary care with a team-based approach using health information technology and quality improvement tools to coordinate care.

How do they differ? There are two components that separate PCMHs from ACOs. First, forming an ACO involves contracting with practices that have aligned themselves with the PCMH or health care home guidelines, which focus on communication and collaboration of patient care. These aligned practices create a medical neighborhood and can include specialists and hospitals, which are an integral part in the ACO model.

The second difference is in the financial structure. With an ACO, there can be more liability with shared savings contracts.

Understanding the ACO and PCMH models is only the beginning for doctors of chiropractic (DCs) pursuing these opportunities. There are many questions DCs should ask, including:

• Who is organizing and implementing these delivery systems, and how do they work?

• Is the DC’s role a primary care or specialty role, or something in between?

• What are the benefits and challenges for chiropractic inclusion?

MTT will serve as a vehicle for new graduates to approach and answer these questions.

PCMH and Integration

Chiropractic has emerged in a few integrative health care facilities already. These new beginnings have provided a beacon for chiropractic’s role within PCMHs and afford insight for innovations in future PCMHs. From almost three years of providing chiropractic care in a PCMH, I can confidently say the outcome truly achieves the triple aim of “win-win-win.” Integrating chiropractic services has enhanced my organization’s ability to obtain not only better outcomes but also to achieve greater patient satisfaction and cost savings.

I encourage all chiropractic physicians to begin a dialogue addressing the above questions.

For more on MTT, see “The Birth of the MTT,” Jan./Feb. 2016 ACA News, Page 39. Contact MTT at acamillennialthinktank@gmail.com.

Sarah Potthoff, DC, is a graduate of Cleveland Chiropractic College in Kansas City, Kan. She currently works at Casey Health Institute, a non-profit, primary care patient-centered medical home (PCMH) in Gaithersburg, Md. She is an active ACA member. Her clinical background includes interning at Walter Reed National Military Medical Center in Bethesda, Md., practicing and volunteering for World Spine Care at the Mahalapye District Hospital in Botswana, Africa, and private practice in Des Moines, Iowa. 
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