Author Believes Complementary and Alternative Medicine Belong in CCOs

OPINION – March 7, 2012 -- Oregon is on the cusp of major reforms to its health care system. One of the key changes citizens can expect is the introduction of Coordinated Care Organizations (CCOs), initially for Oregon Health Plan members. 

CCOs are designed to remove barriers and increase quality for patients seeking health care services by coordinating services at a local level. Ideally, Coordinated care organizations will create an environment where all providers involved in an individual’s care have access to all the information necessary to ensure that services are not duplicated and complement, rather than take away from, the patient’s overall health and wellness. This is expected to lead to significant cost savings and increased patient satisfaction and health.

In October of 2011, the state of Oregon conducted several well-attended community meetings. The goal of these gatherings was to understand the needs and expectations of Oregon’s healthcare consumers and providers in light of upcoming reforms. 

Interestingly, the most common theme to emerge was the need to provide care to the whole person, not just their particular disease or illness. To achieve this goal, it was thought essential to include a whole host of services and providers, including those provided by Complementary and Alternative Medicine (CAM) providers.

CAM providers (chiropractors, naturopathic physicians, acupuncturists and licensed massage therapists) have a proven approach focused on overall health and wellness, while also treating an individual’s specific health care needs. Through training and experience, CAM providers recognize that a patient’s medical concerns may have deeper, underlying causes that would be overlooked through simple treatment of symptoms. By focusing on prevention and overall health, it is understood that more positive outcomes can be achieved. In addition, studies have routinely shown that Complementary and Alternative Medicine costs less and often results in greater patient satisfaction.

In Oregon, and the United States as a whole, use of CAM services is growing. Hospital systems and medical professionals are among the adopters. At the same time, more and more healthcare consumers are relying on their chiropractors and naturopathic physicians for primary care services.

In leading the nation in healthcare reform, Oregon has the unique opportunity to recognize the value of CAM and to foster these innovative and successful relationships. Doing so will undoubtedly produce much needed cost savings and, more importantly, healthier citizens.

Jamie Sewell is director of sales and marketing at The CHP Group.

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I know of three women who have used CAM to appear flawlessly healthy, even with MS diagnoses. A recent Grand Rounds posting from OHSU underscored the importance of proper nutrition in dealing with challenges of chronic-health conditions. Conventional medicine is well advised to play well with others, as consumers in substantial numbers will otherwise avoid conventional-health options unless they are knocked out and unable to resist, at which time the options may not be so good for anybody. Clients will choose close and friendly neighborhood care and rely on that care to vet other choices. This is already here. I applaud this posting, and I hope the big players will consider this information carefully.

Unfortunately too many CAM providers are recommending to parents that they avoid childhood vaccinations against serious preventable diseases. Others are offering unproven remedies (such as Chiropractic adjustments for children with learning and behavior problems) that delay access to effective care. Some CAM providers are a true asset to our healthcare society and offer real holistic advantages when added to traditional healthcare, but there is too much variability and expense. The question is not whether these services are available, they are, but who should be responsible for them. To add the cost of acupuncture, massage therapy, nutritional counseling, naturopathic care, etc. to the CCO's list of required covered services would amount to requiring the taxpayers of Oregon to pay for suplimental unproven care. We have enough on our plates trying to get basic healthcare services to EVERYONE in our society. Individuals who value them can be responsible for their CAM services.

Hello, Thank you so very much for your efforts in moving Oregon forward on our approach and adoption of holistic and preventative healthcare. It is a healthcare model that is vital to the mission and our goal to provide economic relief to our troubled system in the midst of a very real healthcare crisis. I regret that you didn't mention Health and Nutrition Coaches and Counselors in your list of important CAM additions that are needed to help foster successful outcomes for our Oregon's new healthcare model. I am a certified health and nutrition coach that hopes to find a place in the system. I have complete faith in our ability to heal ourselves through good nutrition and dietary changes. If Oregon was to adopt a more focused approach to dietary healing, I could assure a huge cost reduction in our healthcare and significantly better outcomes for patients and doctors alike. Thank you!!

The goal of CCO's is to improve quality, patient experience and decrease costs. Since "alternative medicine" is largely unproven to be effective, and therefore decrease overall costs, I can't imaging including it in CCO's. True, if someone avoids seeing a physician costs will decrease in the short term. To the degree a treatment can credibly show it works, I will support it. The oft cited phrase that MD's and DO's "only treat symptoms" is completely wrong. We understand better than any profession what leads to cancer, heart disease, lung disease etc. Medicine is based on basic and clinical science, which assumes there are explanations for what is observed. It is not soley a philosophy like naturopathy. Chiropractic care can not treat a multitude of disease, for example asthma. To say that manipulation can affect the nerves and somehow reduce bronchial inflammation is without scientific basis. I have never read that manipulation can be used to treat an acute asthma attack. On occasion, I have read reports from chiropractors and naturopaths. The diagnoses are vague or incorrect. They generally diagnose allergies, gluten intolerance, heavy metal toxicity, depression, stress, and lack of exercise. Treatment often includes diet, exercise, supplements and stress reduction. This shows a very basic level of understanding yet in the alternative world seems to define the "true underlying cause." For example, a chiropractor ordered a massive battery of tests after the patient came to the chiropractor with a known elevation in liver enzymes. The chiropractor diagnosis was "hepatitis" and prescribed several supplements and recommended they follow up with a physician. Hepatitis is not a useful diagnosis, if it can be considered a diagnosis at all. What if the patient was a heavy drinker, had iron overload, an autoimmune disorder, acetaminophen toxicity, or a hepatic virus? Of all the testing ordered, only some of it pertained to the likely possibilities, but not all. The patient was given a pseudo-diagnosis and pseudo-treatment. This can not be allowed into a CCO. I have heard the arguments. Doctor's get paid by pharmaceutical companies to prescribe medications, only treat symptoms, somehow haven't been educated properly or just don't know what "alternative" providers know because we are being kept in the dark because the treatment is so effective it will financially devastate some company. These claims are clearly incorrect, misleading and unethical. We don't focus on unproven, unfounded, or unlikely claims. Chelation therapy when it was originally studied, killed several subjects, hence it was dropped. If one has atherosclerosis, how is chelating calcium going to get rid of deposits? Calcification is a relatively late occurrence in the pathogenesis of athersclerosis, so what good is leaching calcium from the skeleton going to do? Enemas for fecal impaction takes advantage of patients lack of knowledge of gastrointestinal physiology. If intestinal parasites are so common, how do gastroenterologists keep missing this? They even send biopsies for pathology review under a microscope, yet a naturopath finds candida (which is just a colonization) and diagnosis a yeast infection. Micronutrient IV infusions are unnecessary and result in expensive urine production. Not getting vaccinated requires the suspension of understanding of the millions of lives saved and how infection occurs. Then there is pH balance - one camp espouses acidification and the other alkalinazation. They are both convinced they are correct, doctors incorrect, yet are in direct conflict with each other. It is very well documented that a pH of 7.4 is the ideal. Pushing the balance either way, especially up, can be deadly. Fortunately buffering mechanisms can overcome supposed treatments. CAM services are growing because the public is willing to pay for it, not because it has been shown to be effective. Supplements are a multibillion dollar industry, yet is perceived to be exempt from false claims in contrast to pharmaceutical companies (which are no doubt biased). Patients rely purely on personal experience and Google to convince themselves what works. Personal experience alone, can be very misleading. Information from the web has to be interpreted. Physicians rely on personal experience in the context of a solid scientific education.

Some of these comments are obviously being made by people who are ignorant about the research evidence for certain CAM professions. I've learned there is a tremendous amount of evidence in the research literature that chiropractic care is safer, more effective, and cheaper than current treatment options for musculoskeletal complaints within the Oregon Health Plan. Who knew? I think many CAM professions need to do a better job of standardizing their treatment protocols. There are definitely some practitioners out there doing some strange things, but for the most part I think CAM would be very helpful at making Oregon healthcare better.