Unraveling Health Care Reform and Identifying Our Opportunities

Some of our nation's top thinkers in politics, business, law, health policy and health care gathered recently on Life University's campus and challenged chiropractic to exert greater influence on evolving health care reform and implementation of the Patient Protection and Affordable Care Act (PPACA). The 4th Annual LIFE Octagon Conference launched a significant effort to guide the profession in better understanding and impacting how PPACA is realized.

With our nation finally striving to craft a health care strategy that reflects – far more than ever before – a chiropractic view, we have a huge opportunity to facilitate a health care revolution by ensuring greater representation of our vitalistic philosophy within the legislation and its associated regulations. How we respond to the call will impact our lives as health care providers, the lives of our patients and even our personal abilities to access the services we value most.

Understanding the Health Care Act and Its Implications

Many people think they understand what health care reform means, but don't realize that so much of what we've "learned" has been skewed by various interest groups. The Octagon conference provided a more complete, thorough and unbiased understanding of the elements of reform.

Learning From the Experts: Key Messages From the OctagonConference Relative to Health Care • Dee Edington,PhD, professor of movement science and director of the University ofMichigan's Health Management Research Center, spoke to the failure of health"risk" management and the need for a paradigm promoting genuine wellness. • Andrew Webber,president of the National Business Coalition on Health, spokeenthusiastically about the value chiropractic and other nonmedicalprofessions bring to helping employers control costs and enjoy betteroutcomes and productivity. • The HonorableMs. Deborah Senn, known during her term in office in Washington state as "thenation's best insurance commissioner," spoke to the dramatic improvement inpopulation health that chiropractic and other nonmedical professions have hadin the state marketplace. • Clement Bezold,PhD, founder and chairman of the board, Institute for Alternative Futures,spoke on the institute's recent work force modeling, Primary Care 2025, thatshows the potentially critical contributions of nonmedical providers toeffective front-line roles in a more sustainable health care system.

For example, many of the distinguished speakers (see sidebar for partial list of speakers) emphasized that change is a definite, no matter who is in the White House or Congress next year, or how the Supreme Court interprets the constitutionality of national health care efforts. The whole thing has simply become unsustainable. Just 20 years ago, U.S. expenditures on health care reflected "only" 10 percent of the gross domestic product. Today, that figure is already over 18 percent and is projected to hit 25 percent by 2020.

The Really Good News

Although change is hard and practitioners are wary of further restrictions on reimbursement and practice autonomy, one of the most exciting aspects of health care reform is that it's moving in our direction. Even if the impetus is cost-containment, the thinking of health policy leaders is still moving away from a high-tech, disease treatment model to a prevention and lifestyle approach.

They call it "Triple Aim" because the most sought-after health care approaches hit all three marks: greater health among the general population, greater patient satisfaction and lower costs. That sounds an awful lot like everyday chiropractic to me.

New Ways of Being Paid

Following the money is one of the most reliable ways of seeing what a society values, and a key component of health care reform is reshaping the payment system. Although we're likely to retain some form of fee-for-service, there will be a much greater emphasis on payments linked to outcomes and patient satisfaction.

Insurers will start to reward patients for healthier choices. Take diabetes, for example. Under health care reform and a concept called "values-based design," insurers are likely to cover a greater share of the cost for preventive health services, such as insulin testing strips, syringes and diabetes education. They would cover a smaller percentage of the costs involved with advanced complications from an unmanaged disease.

If we look at the neuromusculoskeletal aspects of chiropractic care, a values-based design might involve much lower co-pays for a visit to the chiropractor and higher co-pays for a more costly and typically more invasive visit to an orthopedist.

Darren White, DC, the founder and CEO of a worksite wellness company, shared how his organization has achieved a return on investment of 5:1 for its healthy work-force programs, which follow a vitalistic health and optimal performance model. One Fortune 100 company that invested $320,000 with the company last year for lifestyle interventions for its employees has saved $2.8 million in health care costs.

Keeping the Well ... Well

Many of the Octagon speakers referenced the fact that, even under the best circumstances, all of our national investment in health care only increases life expectancy by 10 percent. The real meat of the thing is in prevention, and that means a massive shift in resources to behavioral and wellness changes such as improved diet, exercise and smoking cessation.

Kaiser Permanente, one of the largest managed care companies in the United States, sees the population in roughly three groups – people who are generally healthy, people who want to be healthy, and people who are unlikely to be healthy. The key to cost-containment is keeping the healthy people well because they don't consume a lot of resources. The next priority is to move as many "wannabes" as possible up into that healthy category by supporting them in making key lifestyle changes.

Think about it. Of course, the sick will still receive needed care, but if we focus more on keeping well people well, and how to get the marginal folks up into wellness, our nation will dramatically change how it invests its health care dollars. The motivation might be dollars and cents, but the impact will show up in increased investment in services that truly promote health. Again, sounds like everyday chiropractic to me.

What Should DCs Do?

There are clear-cut ways doctors of chiropractic can shape the health care debate and what our profession is likely to look like over the next decade or so. Here are a few:

• Give up the fantasy that change won't come. Health care reform is already on its way.
• Learn about the evolving system. Pay attention to what politicians are saying about health care reform and read proposed regulations related to its implementation.
• Embrace the fact that this is the kind of change we've been asking for. We wanted a more wellness-oriented system focused on prevention, and it looks like that's exactly what we're going to get.
• Think about ways to increase quality of care, increase patient satisfaction and decrease costs, and then articulate them to politicians. Chiropractors are perfectly situated to provide these benefits.

Chiropractors who focus primarily on caring for patients with neuromusculoskeletal concerns and vitalistic wellness practitioners both fit in this model. Those providing services for back and neck pain already have a wealth of data to draw on that shows how much more effective and cost-efficient chiropractic care is for these patients than more invasive procedures. We've already seen a lot of this data come out of chiropractic's involvement with the Department of Defense and the Veterans Administration.

Wellness practitioners, this is the golden moment we've been working for our entire careers. We know our vitalistic philosophy is perfectly suited to helping people maintain and reach more of their inborn potential for true health. We have to articulate that to policy-makers clearly and forcefully. This is no time to shy away from boldly stating how you help people get better and stay better. For once, we're talking about the exact concepts health-policy decision-makers want to hear about.

Several outstanding policy papers from the Foundation for Chiropractic Progress will help orient you to these realities. Educate yourself about what's going on and then get over any inferiority complex, if you still have one, created by years of being treated as second-class health care citizens.

Our time is now. National health care decision-makers may not have wanted our input in the past, but economics has made them much more responsive to our point of view. Let's make sure we share it.