Alternative Medicine Finds Path to CCOs

One clinic in Salem is leading the way after gaining a contract with Willamette Valley Community Health

Alternative and complementary providers are making inroads into the coordinated care arena, particularly in Salem community where one particular clinic, JD Health and Wellness, holds a contract with Willamette Valley Community Health. Erick Davis, MSW, CADC III, clinic administrator at JD Health and Wellness, credits the Affordable Care Act and SB 1580 for changing the status quo.

“The law put providers on a level playing field with the commercial health insurers and plans.” He said, “If that law (particularly section 2706a of the ACA) weren’t in place, chiropractors and naturopaths wouldn’t have the opportunity to offer the services they are able to now.”

Vern Saboe, a chiropractic physician and clinical director for JD Health and Wellness, actually spearheaded the effort to make sure Governor Kitzhaber’s healthcare transformation bill (SB 1580) included language indicating that CCOs could “not discriminate in the participation or reimbursement of any healthcare provider based on the provider’s license or certification if the provider is acting within the scope of the provider’s license or certification.”

JD Health and Wellness is the first and only integrated/alternative Patient Centered Primary Care Home contracted with Willamette Valley Community Health.

“What’s significant about that is that it gives the patient (covered) options,” Davis said. “Patients have access to a chiropractor who can use spinal manipulation to treat back pain, while a conventional primary care physician typically only utilizes pharmacological interventions prescribe painkillers. We encourage a healthier lifestyle, nutritional counseling, and exercise to help patients heal. Using a team approach, we can treat the whole person.”

But having the law behind them was just the first step since the healthcare system is designed around the MD/hospital model. The Oregon Health Authority now allows alternative providers who cannot obtain hospital privileges to have a written agreement with their “usual hospital providers” so the primary care home is notified when patients are admitted and discharged.

“We had to wait for the state to support the services alternative providers offer,” Davis said. “Health boards and insurance companies are dominated by MDs. We had to educate the community and insurance companies. There’s not a lot of understanding (in the conventional medical community) about what alternative medicine can offer.”

Since coming on board with WVP Health Authority, JD Health and Wellness has been an asset to the CCO, “both as a community provider with alternative services and a strong patient advocate,” said Dr. Kathryn Lueken, medical director. “The alternative medicine services they deliver have opened up new options for some of our medically fragile patients with chronic conditions and facilitated positive health outcomes. JD Health and Wellness has also shown great willingness to work closely with the peer mentors from the WVP Health Authority Emergency Department Intervention Team, which has resulted in a reduction in inappropriate emergency room visits.”

State and federal laws have allowed alternative providers to connect with the medical community, Davis added.

“The change in the laws allowed the medical community to come together. In the last six months, the best of both worlds (conventional and alternative medicine) have been coming together. Before, we were all in a silo. The ACA pushed us to make those connections. It was a game changer for alternative medicine.”

JD Health and Wellness has also created partnerships with the Mid Valley Pain Clinic, Bridgeway Recovery Services, and the Marion County Health Department.

“We are wanting the community to work together to accept this challenge of making the system better, making sure providers are treated fairly, and ensuring better outcomes,” Davis said.  “You need a team of people with the same vision to make this happen.”

 

FOR MORE INFORMATION:

https://www.thelundreport.org/content/alternative-providers-turn-rule-making-process-inclusion-ccos

https://olis.leg.state.or.us/liz/2012R1/Measures/Text/SB1580/Enrolled

http://www.oregon.gov/oha/pcpch/Documents/ProviderFactSheet.pdf

http://www.oregon.gov/oha/OHPR/Documents/2014%20PCPCH%20Recognition%20Criteria%20TA%20Guide%20FINAL%2010.4.13.pdf

Joanne can be reached at [email protected].

 
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