background resources in PDF |
|
some CAM/IM publication links |
|
|
Integrative Medicine in Accountable Care: Report from Oregon Naturopathic Physician Bill Walter, ND |
|
|
|
Written by John Weeks
|
Integrative Medicine in an Accountable Care Organization: Report from Oregon Naturopathic Physician Bill Walter, ND
Note: This report follows some months of email exchanges with Bill Walter, ND, relative to his work to assist local health officials in exploring the value of integrative services, and in particular, naturopathic doctors, in Oregon's Coordinated Care Organizations.
Late breaking: Walter shared on December 12, 2012 that he has confirmation that Trillium Community Health Plans, Oregon's Community Health Plan and his county's Medicaid provider, will be credentialing naturopathic doctors starting in 2012. he adds that he has confirmation that they will also be working with licensed acupuncturists and chiropractors in some capacity.
______________________________
 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 has been integrated into two CCO
committees established to
explore "transformation"
in care delivery - one for behavioral health
and
the other for chronic pain/opiate reform.
|
|
Walter's connection to the CCO process has put him in frequent dialogue with the county's chief public health officer. Walters says the officer "is keen to see how naturopathic
doctors may be utilized in campaigns related to immunization, tobacco
cessation, and obesity." Walter states that a key to recognition of the
naturopathic doctors as primary care providers in the CCOs will be that they
have Drug Enforcement Administration (DEA) numbers and support immunization objectives. "Immunization is becoming
a key litmus test for CCO participation," says Walter. Immunization and
prescriptive authority are each in Oregon's naturopathic scope.
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
: Over the last few months, Walter has shared with me, not for
publication until now, his stepwise engagement with Lane County's CCOs and the web that
he has spun off this truly commendable work. From the list of committees and
meetings he continues to follow, the fellow clearly needs to be cloned. Only
not just in Lane County, and not only for naturopathic doctors, but for each of
the disciplines in counties and regions across the United States faced encountering the new payment and delivery.
Walter concluded
a recent missive on this optimistic note about his own profession, in his home
county: "We're getting rumblings that the hospital some major specialty groups
are interested in creating wellness centers and ND partnerships. Gastro and
cardiology are now starting to refer to NDs. If we pull this off right, we'll
have NDs peppered throughout the [conventional] healthcare landscape in Lane
County in the next 5-10 years. Maybe overly optimistic, but there's alot of
buzz for what we're doing." I am reminded of two phrases from my dabbling
in the I Ching in my early 20s: "It furthers one to cross the great
water" (perhaps the Integrator slogan) and the blunt charge, worthy
of Polonius' maxims: "Perseverance furthers."
|
|
|