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Integrative Medicine in Accountable Care: Report from Oregon Naturopathic Physician Bill Walter, ND PDF Print E-mail
Written by John Weeks   
Sunday, 09 December 2012

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.

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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.

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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."

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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."



Last Updated ( Wednesday, 12 December 2012 )
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