Opening the Door to the Medical Home?

While doctors of chiropractic are not currently recognized as primary care providers in the patient-centered medical home model, they are eligible to participate and may have a valuable role to play as a member of the patient's multidisciplinary team. To what extent DCs can play a role is the unanswered question, which is why the Foundation for Chiropractic Progress has partnered with URAC, a nonprofit health care accreditation and education organization – and one of the few that currently offers an accreditation program for medical homes. According to an October press release from the foundation announcing the partnership, the organizations are launching a special pilot project "to determine how chiropractic care models can best achieve the principles of the patient-centered health care home."

"Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary and lifestyle counseling," said Alan P. Spielman, URAC president and CEO. "The ultimate goal of URAC's PCHCH program is to coordinate all aspects of a patient's care, so it is important to evaluate how chiropractic health care can best support that goal."

In line with generally offered definitions, URAC defines the patient-centered health care home as "a quality-driven, interdisciplinary clinician-led team approach to delivering and coordinating care that puts patients, family members and personal caregivers at the center of all decisions concerning the patient's health and wellness. A PCHCH provides comprehensive and individualized access to physical health, behavior health, and supportive community and social services, ensuring patients receive the right care in the right setting at the right time."A major component of the pilot project involves evaluating select URAC PCHCH standards that are consistent with state-specific chiropractic scope of practice.

The premise is simple enough: If chiropractors can meet URAC PCHCH standards, then chiropractors / chiropractic practices can be accredited by the organization. Being recognized as a patient-centered health care home clinician would likely open doors to participation in medical home models because primary care providers (in the medical home sense; medical doctors, osteopathic physicians, nurse practitioners and physician assistants) would be more likely to recruit PCHCH-accredited practitioners to their multidisciplinary team.

URAC Senior Vice President and Chief Accrediting Officer, Christine Leyden, provided further insight into the pilot project in an interview with Dynamic Chiropractic in mid-October, only days after the announcement:

Could you please describe the pilot project for us in a little more detail? This is a special patient-centered health care home pilot project in partnership with the Foundation for Chiropractic Progress. The intent of the pilot project is to examine whether or not chiropractors within their practice, how they support the patient-centered health care home model; how they help assist with care coordination for patients, wellness activities, etc., so patients can navigate the health care system.

How do you see the results of the pilot project being used? The results of the pilot project for the URAC component is to determine whether or not URAC's existing patient-centered health care home standards can be applied to specialty practitioners such as chiropractors; or if they cannot, should URAC look at creating a new program in support of chiropractors as part of specialty practice.

So, based on the results, one of two things will happen: either you'll see that chiropractors can be accredited as part of the interdisciplinary team, or there has to be some kind of a new designation for them? Yes, that's correct. We test to see how organizations can meet the standards. It's our normal process when we look at our standards. So, we try not to prejudge and we're excited to see what the results will be.

According to URAC, recruiting of applicants for the pilot project began in September, with site visits to all applicants scheduled for October-November. Results will be reviewed in December, adjustments made if necessary, and if all goes well, the first wave of accreditations announced in January 2013. A project report will be released in March 2013.

"As a widely used evidence-based, valued health care discipline, chiropractic should be included within the emerging patient centered health care home model," said Gerard Clum, DC, foundation spokesperson. "This pilot project will provide an opportunity for the chiropractic profession to articulate its role and validate its significance in advancing major model principles – such as improved costs, clinical efficiency and overall patient outcomes."

For background information on the patient-centered medical home, including the foundation's white paper on the chiropractic opportunity within the medical home model, read "The Medical Home: Health Personalized" in the Aug. 26, 2011 issue. To learn more about URAC, click here.