Embed Size (px)
Citation preview
Piloting Patient Centered
Medical Homes in Vermont:
Naturopathic Style
Lorilee Schoenbeck ND
Mountain View Natural Medicine
IHS NYC 2019
Overview
◼Patient Centered Medical Homes-◼Health Care Reform Elevates Primary Care
◼Naturopathic primary care◼ Piloting naturopathic PCMHs in VT-
Mountain View Natural Medicine◼ What have we learned so far?
The Affordable Care Act
◼460 Mentions of “public health”◼239 mentions of “prevention”◼93 mentions of “wellness”◼42 mentions of “health promotion”
◼Also: “complementary and alternative medicine”
◼“integrative health center”◼“patient-centered care”
Provisions Affecting N.D.s in the Affordable Care Act
◼ Section 4001 – ‘Integrated health” and “integrative practitioners” included in National Prevention, Health Promotion and Public Health Council
◼ Section 3502 – PCMH may include chiropractors and licensed complementary and alternative medicine practitioners
◼ Section 6301 – Integrated practitioners have seat on Patient Centered Outcomes Research Institute (PCORI)
◼ Section 5101 – National Healthcare Workforce Commission required to include integrative health practitioners
◼ Section 2706 – Non-discrimination against provider types
“Patient-Centered” “Primary Care”
Medical Homes◼ Patient-Centered
◼ Payment Reform ◼enhanced payments for managing pt’s
primary care
◼ Enhanced Access to Care◼No waiting; culturally-appropriate;
access to personal physician
◼ Prevention, Education, Healthy Living ◼ Coordinated Team-based Care◼ Quality Improvement
Naturopathic Education
Standardized 4-5 year medical colleges, accreditation recognized by US DOE.
◼4,457 hours (includes 1,264 hours clinical training)
◼Standard Pre-med requirements
◼Basic Science (yr 2) and Clinical Board Examination
◼Primary care/general medicine based
◼Residencies in development
◼State Licensure
◼Continuing medical education
Naturopathic Scope of Practice
Diagnose, prevent, and treat disease;
• Perform full physical exams
• Provide Diagnostic Labs & Imaging, including ordering x-rays, electrocardiograms, ultrasound, CT, MRIs, and laboratory tests;
• Draw blood and perform CLIA-waived lab tests in-office;
• Refer to specialists
• Perform minor office procedures
• Rx medications, including IV administration
Core Naturopathic Principles◼ I. Emphasize prevention and self-care as a
cornerstone of health;
◼ II. Patient-centered care, addressing the determinants of health in treatment plans;
◼ III. Prioritize a “therapeutic order” that begins with minimal intervention and proceeds to higher intervention;
◼ IV. Focus on the underlying cause, not onsymptomatic treatment;
◼ V. Patient education. Docere = Teacher
Tailoring the Medical Home
◼ Community Health Team = whomever you want◼ For example:
◼ Free to your pts. Salaries paid by insurers. ◼ $$ available is determined by your pt population size.
Patient
& Doc
Social
worker
Nutritionist
Health
coach
L.Ac, DC,
RN…
Reiki /
hypnotherapy
Panel
Manager
Mountain View Natural Medicine
Patient experience assessment
Patient experience assessment
Expected Cost Reductions
The majority of patient visits to naturopathic physicians are in lieu of, not in addition to conventional medical care.
Cherkin DC, et al. Characteristics of visits to licensed acupuncturists,
chiropractors, massage therapists, and naturopathic physicians. J Am Board FamPract. Nov-Dec 2002;15(6):463-472.
In Washington state, per visit expenditures to
integrative medicine providers, including NDs,
cost only 52% as much as for conventional
outpatient care. Lafferty WE, et al. Insurance coverage and subsequent utilization of
complementary and alternative medicine providers. Am J Manag Care 2006; 12(7):
397-404.
MVNM State average
What else is our PCMH spending $ on?
Besides referrals to nutritionist, physical therapy, mental health…
Cervical cancer screening:
76% of eligible pts screened (State ave: 64%)
Breast cancer screening:
80% of elig. Pts. screened (State ave: 72%)
Diabetic eye exams:
67% of elig. Pts (state ave 58%)
→are we seeing short term increased costs of prevention???
Evidence of increased prevention usage for ND patients
NDs significantly improve preventive services
among a significant population of “reluctant”
health consumers.
Patients of integrative medicine providers were more likely
to have regular:
-Pap smears
-Cholesterol screening
-Influenza immunization
-Breast exams
Druss BG, Rosenheck RA. - JAMA. 1999;282(7):651
What have we learned?
◼ ND-led PCMHs exist
◼ ND training based on many core PCMH principles: Pt-centered care, prevention.
◼Mountain View Natural Medicine (N-1) ◼ Patient experience rates high
◼ Annual health costs => state average
◼ Screening and preventive services rates => ave.
