Incorporating Integrative Health Providers in Health Systems

• Minimize leakage, optimize referrals: Including CIH providers within a health system, whether as direct employees or contracted extenders, expands the breadth of services offered and increases the likelihood of referrals to specialists within the network. The system retains patients and revenue by offering a more comprehensive line of services.
• Decrease total costs of care: Implementing services from licensed acupuncturists, massage therapists, and chiropractic physicians reduces total costs of care, and would better position health systems in alternative payment models with private and public insurers. 5, 15, 16, 17
• Effective pain management: Hospitals incorporating massage therapy and acupuncture have reported improved pain management and decreased anxiety in post-operative, cancer, and emergency department patients. 18, 19, 20
• Decrease opioid prescribing and utilization: Early intervention from a chiropractor reduces odds of short-term and longterm opioid use.21 Veterans and Medicare beneficiaries with access to chiropractic care have reported reduced rates of opioid prescription and opioid use. 22, 23, 24
• Right provider for the right service: Utilizing CIH providers to deliver care at the top of their license increases access and decreases wait times for patients, helps triage care, especially in emergency and acute care settings, and allows specialists to focus on the management of complex health complaints. 25
• Decrease low-value services: Early back pain treatment with chiropractic, acupuncture or physical therapy decreases utilization of low-value imaging, spinal injections, opioid medication, surgery, and the premature escalation of care. 25, 26, 27
• Care coordination: Health professionals working in the same system can mitigate care fragmentation that creates inefficiencies and accounts for waste within the system. Including CIH providers within a system facilitates communication across providers through shared electronic health records and proximity for care consultation, with the potential to improve clinical outcomes and increase patient satisfaction.
• Whole person health: CIH providers are trained with a holistic health orientation, focused on both disease management and health creation. 28

• Financial disincentives: Contradictory financial incentives encourage the use of expensive diagnostic tests and treatment procedures that may be of low therapeutic value, 29 while insurance coverage gaps, high co-pays, and artificial restrictions on visits discourage patients from using CIH interventions. 10, 30, 31
• Apprehension: Health system administrators and physicians may be unfamiliar with the training and scope of practice of CIH providers, creating reluctance to refer patients who might otherwise benefit from non-pharmacologic therapies.
• Infrastructure: Limitations on clinical space and restrictive policies within health systems, including credentialing, impair CIH providers’ ability to practice at the top of their license.

Along with conventional medical providers, CIH providers serve in the Department of Defense and VA System. 33, 34 Chiropractic physicians and acupuncturists are also serving patients in Federally Qualified Community Health Centers (FQHC) here in Minnesota and across the United States, including Minnesota Community Care, Open Cities Health Center in St. Paul and Northpoint Health and Wellness Center in Minneapolis.

A new initiative in the Twin Cities, the Fairview Community Health and Wellness Hub, features a chiropractic physician as the medical director overseeing all outpatient primary care services. The model that is emerging in this facility will address health disparities, the impact that social risk factors have on health, and a new focus on well-care.

While these select examples of professional workforce changes are forward-thinking, evidenced-based and in the best interest of patients, availability does not meet current needs. Nationally, access to CIH services remain limited or unavailable in many other health systems.