Integrative Medicine in an Accountable Care Organization: Report from Oregon Naturopathic Physician Bill Walter, ND

Bill Walter, ND: forging relationships in a CCO

Bill Walter, ND of 

Golden Apple Healthcare has been on a quiet campaign for months to create a place for naturopathic doctors and other complementary and alternative healthcare services in the emerging payment and delivery model. Walter's home base is Lane County, Oregon, which surrounds the liberal university town of Eugene and its working class sister city of Springfield.

Oregon is using the term Coordinated Care Organizations (CCO) rather than Accountable Care Org (the norm in most of the US). Walter's participation in care delivery as a naturopathic physician has been supported by a handful of clinic medical leaders. The profession's deep roots in the community, where naturopathic doctors have been licensed for nearly a century, help. Walter reports that there has been broad support from the naturopathic community for his efforts. One supportive medical doctor, chief of a unit at a local health system, is a member of the Lane County Coordinated Care Organization's clinical advisory panel (CAP) which will be making determinations about which services to cover.

Where ACOs are Coordinated Care Organizations (CCOs)

Walter shared that he has also been integrated into two of the CCO's committees that were established to explore "transformation" in care delivery. One related to behavioral health and primary care integration, and the other to chronic pain/opiate reform. The latter committee also includes another naturopathic doctor, Miriam Mazure-Mitchell ND, MS. Mitchell also sits on the board of the Pain Society of Oregon. Walter notes that though these committee seats are held by naturopathic doctors, the CCO has not yet credentialed NDs as providers. The issue is on the CAP's agenda. The CCO is also interested in exploring payment for evidence-based natural therapies (supplements, herbs, etc), and is interested in the NDs helping make determinations about which therapies have enough clinical-trial support that they might justify being added to the formulary available for all of the CCOs primary care providers.

Walter shares that the dialogues with Oregon's CCOs have also led to the credentialing of a naturopathic doctor who is also licensed as a midwife, into a separate CCO in rural Eastern Oregon. The Oregon Association of Naturopathic Physicians, led by executive director Laura Farr, has developed a network of naturopathic doctors who are in dialogue with different CCOs, and, per Walter, the OANP is finding that many "are making nods that they'll start credentialing NDs in 'some' capacity."  These sources suggest that "some chiropractors and licensed acupuncturists are also likely to be credentialed." He adds: "Direct-entry midwives and massage therapists don't seem to have gained much traction, but I'm not tracking them too closely right now."

State association credited with strong support

Comment