Coming out of the opioid epidemic, government bodies are leading the push toward interdisciplinary and collaborative medicine models of care
INTERPROFESSIONAL COLLABORATION AND COLLABORATIVE MEDICINE PRESENTS A UNIQUE OPPORTUNITY FOR THE CHIROPRACTIC PROFESSION. A recent Gallup-Palmer Study shows that 78% of Americans prefer to try other ways to address their physical pain before they take pain medication prescribed by a doctor.
On a parallel track, regulatory bodies, policy makers and other national organizations have been increasing pressure on medical professionals to explore conservative alternatives to opioids for the management of acute and chronic pain. Doctors of chiropractic are at the crossroads of the needs and wants of both patients and health care professionals.
Breaking down the walls
Effective collaboration requires effective communication. This means that as health care professionals we must learn to understand each other’s education, scope of practice and areas of expertise. We must learn each other’s language, competencies and norms to most efficiently use our unique resources and knowledge. Historically, health care professionals were educated in isolation without knowledge of the educational requirements and scopes of practice of other disciplines.
It is advantageous to have health care professionals begin working together before they start working in the field. Universities and training programs can expand interdisciplinary educational opportunities and programs to help foster collaboration among students before they enter the health workforce. Chiropractic and medical students can be prepared to be members of interdisciplinary health care teams by learning to focus on each patient as an individual, rather than a treatment or diagnosis.
The future of interprofessional collaboration
The benefits of interprofessional collaboration — for doctors of chiropractic, medical doctors, other health care professionals and patients — includes improved patient outcomes, fewer preventable errors, reduced health care costs and improved relationships with other disciplines. Enhanced communication among disciplines also leads to increased efficiencies by minimizing duplicated efforts, reducing errors and increasing knowledge. Building relationships with professionals in other disciplines leads to better understanding.
Are you ready to embark on an interprofessional collaborative medicine journey? Before doing so, ask yourself these questions:
- How can I collaborate interprofessionally?
- What opportunities exist for me to collaborate?
- What disciplines outside of chiropractic could I collaborate with?
The changing landscape
Whether or not you identify with a certain political party or philosophy, we can all agree that change is required to sustainably deliver health care to our aging population. The landscape of health care delivery has changed considerably and is being reshaped by reform and innovation.
Both the federal government and other third-party payers are incentivizing health care professionals to focus on improving quality and patient outcomes. Reimbursement has now become inseparably tied to cost savings, quality measures, service and efficiency. The patient is now firmly at the center of health care, and value-based care has replaced volume-based care as we have shifted toward a pay-for-performance reimbursement structure.
Interdisciplinary models of care
Health care providers are now encouraged to collaborate in interprofessional care teams designed to better coordinate care and identify and treat conditions more effectively and affordably. These models of interdisciplinary professional care include:
- Multidisciplinary Group Practices (MDPs)
- Accountable Care Organizations (ACOs)
- Patient-Centered Medical Homes (PCMHs)
These models of interdisciplinary care foster mutual respect and collaboration between professions and improve health outcomes. This stands in stark contrast to the outdated health care delivery model of working in silos.
The collaborative medicine care models, MDPs, ACOs and PCMHs all place the patient at the center of care. Health care professionals work together to provide services, education and coaching while applying best practices and guidelines. Team members regularly interact and communicate to review cases and gather input from the entire team. The evolution of the electronic medical record (EMR) has fostered transparency, communication and the further breaking down of silos between professionals as they are able to consult with and work with a unified medical record.
Multidisciplinary Group Practices (MDPs)
The multidisciplinary practice model is a group practice that provides chiropractic, medical, physical medicine and other health care services. The model has increased in popularity over the last few years. In a recent survey performed by Chiropractic Economics, 28.7% of chiropractors responded that they practice in a multidisciplinary setting.
The multidisciplinary practice is on the cutting edge of health care reform because it fosters interprofessional collaboration. There is a clear scope of practice difference between allopathic and chiropractic health care, and MDPs provide patients the best of both disciplines. Multidisciplinary practices provide a consolidation of location along with a diversification of services delivered at that location. This highly coordinated, cost-effective manner of delivering patient care is a major paradigm of the practice of health care today.
The Corporate Practice of Medicine Doctrine and individual professional scopes of practice vary by state. If you are interested in establishing an MDP, be sure to obtain advice from a knowledgeable consultant and legal counsel from a health care attorney familiar with the laws and regulations of your state.
Accountable Care Organizations (ACOs)
Accountable Care Organizations are groups of health care professionals that provide coordinated care for Medicare patients. They are designed to make Medicare more efficient by reducing medical errors and unnecessary services through interprofessional collaborative medicine.
When Medicare saves funding from these programs, a portion of the savings is passed on as an incentive for ACO providers in a Shared Savings Program. Medical professionals are not required to participate in an ACO, although Medicare encourages participation and offers incentives to do so. The quality and cost-effectiveness of chiropractic services makes the participation of chiropractors in ACOs a highly-attractive addition to the interprofessional health care team. Chiropractors may not register individually as ACOs, but are eligible to work with other providers such as MDs or DOs who may form an ACO as a group. If you are thinking of partnering with an ACO as a contracted provider, be sure to review the contract carefully.
Patient-Centered Medical Homes (PCMH)
The medical home, also known as the Patient-Centered Medical Home, is a team-based health care delivery model, led by a physician, that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes.
The PCMH has been proposed as a model for transforming primary care and improving efficiency and effectiveness in the health care system. Chiropractors have the opportunity to play a fundamental role within the PCMH model. By integrating chiropractic care, interprofessional teams are able to most effectively care for patients, and therefore meet the criteria and goals of the PCMH — improved overall health outcomes, affordable health care, better access and increased patient satisfaction.
The cornerstone of success
Collaboration is the cornerstone of success in any team. Interprofessional collaboration is one of the trademarks of highly-successful health care innovations. When doctors of chiropractic and medical doctors collaborate as equals with other health care providers, patient outcomes and quality of care improve. Collaboration improves the quality and safety of patient care as well.
How many times have you heard the expression, “two heads are better than one?” Through interprofessional collaborative medicine, the collective skills and experience of the team members support each other and result in a higher quality of service than each would produce working alone.
The result of the increased diversity in practice models means that chiropractic patients have more options than ever before in how and where they access chiropractic care. This presents a significant opportunity for chiropractors who are willing to step out of their traditional comfort zone and collaborate with other health care disciplines. The chiropractic profession has the potential to forge new collaborative medicine synergies amongst other health care professionals, researchers and policy makers — all to the benefit of our patients.
MARK SANNA, DC, ACRB Level II, FICC, is a member of the Chiropractic Summit and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching and can be reached at mybreakthrough.com or 800-723-8423.