Rich Snyder, chief medical officer for Independence Blue Cross (IBC) dreams of transforming primary care providers into full-service patient-centered medical homes (PCMH), according to an interview written by Dina Overland and published April 30, 2012 in FierceHealthPayer. According to Snyder, IBC, a nonprofit community-based insurer in Philadelphia, is undertaking a "multi-year transformation to achieve the dream we've set for delivering primary care."
The PCMH model, which is to Medicaid approximately what the Accountable Care Organization (ACO) model is to Medicare, is moving into the mainstream in several states. The concept is that a primary care physician will oversee and coordinate patient care, calling in resources such as home nursing, rehabilitation, physical therapy, nutritional counseling, and services from other medical team members, as required. Passing all care under one manager is hoped to cut waste, reduce redundant services, and avoid duplicated prescriptions and drug interactions.
It sounds sensible. However, the question we at ChiroCode Institute ask, and have asked since the medical home concept was first floated years ago, "How do we make sure that Chiropractors are fairly represented in the medical teams?" If the teams are controlled by experienced doctors of medicine, can our industry expect a decent flow of referrals? It is an important question.
The Medicaid market is huge and is likely to grow as employers continue to shed health care benefits as part of employment. IBC, has so far helped almost 200 primary care practices to become PCMHs, three times the number since the start of 2011, and has seen the model take off in the last 15 months. More than 1,000 of IBC's in-network doctors now are said to be practicing within the PCMH model. Snyder added that technology, including electronic health records, is a key ingredient enabling three PCMH advantages, which he said in the article, include:
- Maximal access to care
- Optimal coordination of care, and
- Self-management skills training for patients.
And that returns to the question—how will Chiropractors fare under this PCMH system?
In a ChiroCode Hot Topics article published in November, 2011, ChiroCode Institute surveyed the majority of the providers associated with the “Pioneer Accountable Care Organizations.” We found few Chiropractors listed, except in one western state, New Mexico. The commentary in the June, 2011 issue also dealt with this matter, as did a story published in September 2011.
And of course, we are speaking in this PCMH story of a Blue Cross entity. In Arizona, this carrier has created havoc among Chiropractors by letting a third-party network, American Specialty Health, provide Chiropractic services on its behalf. The resulting reduction in fees was disastrous to many practices.
An interview with the president of one of the two state Chiropractic associations operating in Arizona was featured in Chiropractic Hot Topics in April and May, 2011. From that interview, one might gather that it is not certain, even if Chiropractors are included on the medical care teams associated with a particular PCMH, that claims will be paid at a sustainable rate.
In the end, the future of Chiropractic under PCMHs may be tied to the fate of the Patient Protection and Affordable Care Acts (PPACA), which currently await a decision about their constitutionality, expected in June. Some states that were predominantly approving of health care reform acted quickly to set up the legislative framework to connect to the federal initiatives regarding Medicaid. States opposed sued the Federal government, joining with the state of Florida in one of the suits and appellate court cases which was recently heard at the Supreme Court level. The states that have drafted legislation that defines which kinds of doctors can act as primary care providers, and which may presumably serve via the medical teams. In some cases, Chiropractic, although specifically mentioned in the Social Security Act which applies for Medicare, is not part of the list for Medicaid.