Making Our Case for Inclusion in Health Care Reform

On Feb. 14-15, 2012, the National Business Coalition of Health (NBCH) held its annual meeting in San Francisco. It was my pleasure to attend again this year on behalf of the Foundation for Chiropractic Progress. I left the meeting absolutely energized, excited and enthused about the business world's understanding of the role of wellness and well-being and their respective bottom lines. However, I also left the meeting saddened and frustrated that there was so little discussion of the chiropractic role in health, wellness and well-being on the part of the employer community.

There certainly wasn't a negative perception of the chiropractic world expressed by the organizers or the attendees. In fact, the Foundation for Chiropractic Progress was a recognized sponsor of the event and Dr. Jackie Buettner, a well-known San Francisco chiropractor, led one of the session breaks. Dr. Buettner had everyone on their feet and fully engaged as she enthusiastically took them through a quick stretch and movement break. The "clouds" opened for a few minutes, we were in the sunlight, but then the cloud cover moved back in and our moment in the sun was over!

The odd part of all this was that above the "clouds" above the ways people have done things in the past, the alliances that had been forged and strengthened with other providers, and the prejudices of what people thought was important and effective – they were talking our talk! Speaker after speaker told the tale of the costs to their industry of impaired workers; of the "real" costs of illness not being the health care costs, but the productivity losses endured by industry due to illness; and of the need to provide for their workers not only a level of secondary screening, but also a primary level of lifestyle management and healthy living.

It was all I could do to stay in my seat and not run to the microphone, take the rest of their program time and explain how we could help them in ways they haven't even begun to imagine.

The elephant in the room that was eventually addressed was the implications of the various structures and strategies flowing from the implementation of the Patient Protection and Affordable Care Act of 2010 (PPACA). The promise of these strategies, be they accountable care organizations (ACOs) or patient-centered medical homes (PCMH) is a complete revision of the rewards for delivering health care; the arrival of meaningful pay-for-performance concepts in health care in America. There also seemed to be a heightened awareness, with the death of yet another high-profile entertainer (Whitney Houston), of the secondary costs of the "performance" in the current system – things like prescription drug addiction and out-of-control surgical interventions.

In the pre-PPACA days, everyone in health care was paid for the services they provided. Deliver more services, make more money. The "performance" metric was what did you did to the patient; and for the most part, people were paid for what they did to the patient. In the post-PPACA environment, people will be paid for what they do for the patient. The reward factor won't be the amount of services rendered; it will be the change in the patient and the outcome received from the care.

In this approach, the perverse incentives of health care in America throughout history are being turned on their ear! Now payment will be based on keeping people well, keeping them on the job, keeping them as functional as possible, and avoiding expensive and dangerous interventions. All of this stacks up to have the potential to be a golden moment for the chiropractic world.

You might find it hard to imagine that other health care providers will suddenly wake up to the potential and value of chiropractic care and welcome us with open arms. I agree; they won't. The motivation to increase the involvement will not come from providers, it will not come from employers and it will not come from insurance companies; it will come from data analysts. It will come from the people who pour over a seemingly endless flow of health-related data.

More specifically, it will come from the data analyst who starts to ask different questions and looks at the data differently. It will come not from looking at the data and asking, "How much is chiropractic care costing us?" or "How many times did they see the chiropractor?" Rather, it will come from looking at the data and asking, "How much less is the cost for health care when people use chiropractic care?" or "I wonder why people who receive chiropractic care have a higher Well-Being Index?"

As chiropractors, we need to engage the deal. Our experience, history and biases cause us to be very suspicious of any change in the system. For some, it is hard to accept that the "system" itself would ever, could ever or will ever warm up to our approach and our contribution to health and well-being. But what if it could and did?

Now is a moment in time for us to put our case forward, to speak about our century-plus long history of drug avoidance and our emphasis on natural healing, self-healing and well-being. But, it is hard to play in a game that you don't even know is being played. The truth of the matter is that the information gap between the chiropractic world and the emerging world of health care is hard to estimate, let alone measure.

One effort to help orient the chiropractor to the future of health care in America is being hosted by Life University on April 12-14, 2012. The annual Octagon Conference at Life will bring together political figures, policy experts, futurists and practitioners to lay out the forms, structures, opportunities and threats the evolving system may hold for us as chiropractors.

You may think this is a potential-filled moment. You may think these are changes that will be harmful to our future as chiropractors. Either way, knowing about the future is far better than sticking your head in the sand and taking what comes your way.

For more information about the Octagon 2012, including registration information and program details, visit www.lifeoctagon.org.