Insurance Coverage: Should NDs Really Be Fighting for It?

James Maskell

Having worked with naturopathic doctors for over a decade, written a practice development column on this site for 2 years, and taught in the University of Bridgeport’s ND program and at the AANP annual conference, one of the biggest things I hear NDs fighting for is inclusion into insurance plans.

It seems logical… most medicine is delivered on insurance, and reimbursement for naturopathic doctors can be spotty at best, and differ state-to-state and plan-to-plan.

But what if medicine was changing? What if NDs could just adopt emerging models that didn’t rely on insurance, and lead the whole of medicine toward a system for chronic disease that actually works?

Some Important Questions

Here are 5 big questions to consider on the topic…

1. What is insurance really for?

In all other types of insurance, we understand what insurance is supposed to do and what it is not supposed to do. Home insurance and car insurance both protect us in case of an emergency. But we wouldn’t forsake putting oil in the car because our car insurance doesn’t pay for it, right? Investing in health creation is something the American consumer is good at already, to the tune of hundreds of billions of dollars of out-of-pocket medical expenses for integrative providers, supplements, and modalities that naturopathic doctors already use.

2. Are you already covered?

Section 2706 of the Affordable Care Act dealt with discrimination against providers, and the language in the bill – inserted through the great work of the Integrative Health Policy Consortium (IHPC) – insists that no provider be discriminated against because of their degree type. So, if a patient has pain, they should be able to choose a pain management doctor using opioids, or an ND using acupuncture.

The problem, of course, is that that insurance companies are out of compliance with this law. Surprise surprise. So, if the goal is to “get covered,” what happens when the payers don’t pay, even if the law requires it? This is why the IHPC has launched www.CoverMyCare.org – a place where physicians can report discrimination and work together to get the law to be enforced.

3. What is Direct Primary Care?

If fee-for-service was designed for the pill-for-an-ill model of acute care, then Direct Primary Care (DPC) is arriving to showcase a medical relationship designed for chronic disease prevention, reversal, and health creation. DPC practices have members, not patients, and create various membership plans depending on location, price, overhead, and business model. The fee-for-service structure is replaced by a flat monthly fee.

Even in allopathic circles this model is taking off, with physicians happy to create a predictable income stream and know exactly whom they are responsible for. DPC is gaining huge traction in corporate wellness as medium-sized corporations get kicked off insurance plans and drive toward self-insurance. Having prevention-orientated physicians “in-house” leaves the physician with an independent and low-overhead (or, in some cases no-overhead!) practice.

So, whom do your current patients work for? Might be good to find out.

4. Is it worth it?

One of the major reasons that physicians are leaving the insurance system is that reimbursements are so low, anyway, and are only heading in 1 direction, especially for consultation-based care. Are you ready to leave your rate to the whims of insurers? Furthermore, the Association for American Physicians and Surgeons (AAPS) feels that insurance interferes with the physician-patient relationship, which is at the core of naturopathic medicine; being independent allows you to focus on the needs of the patient, first and foremost.

5. What will be the Uber of medicine?

Having just spent a weekend at Summit at Sea with some of the most disruptive innovators on the planet, the real question appears to be… When will medicine become “Ubered,” and which “operating system” will win?

In my opinion, the biggest thing naturopathic medicine has going for it is that it is the future of not only primary care but also chronic disease care. Emerging studies from the Canadian College of Naturopathic Medicine show huge cost savings by using providers with our “operating system.”

Newsflash: No one else knows how to do this.

Let’s Be the Disruption

Every developed country is looking for answers for chronic disease and, for whatever reason, haven’t yet stumbled on the functional medicine or naturopathic operating systems.

As a perfect example of this, you have United Healthcare recently considering quitting Obamacare,1 citing “unsustainable conditions,” but at the same time telling Dr Mark Hyman2 that they “love Functional Medicine” and want to work out how to scale it.

Are you ready to hand your trump card to third parties who have chosen to operate as adversaries for half a century?

What if we didn’t try to become part of the system? What if we forged our own system?

For your local community… the choice is yours.


Maskell_headshotJames Maskell is the creator of Functional Forum, the world’s largest integrative medicine conference. He lectures internationally, and has been featured on TEDMED, Huffpost Live, TEDx and more. He is also a contributor to Huffington Post, KevinMD, thedoctorblog and MindBodyGreen. James serves on the faculty of George Washington University’s Metabolic Medicine Institute. 


 

References:

  1. Tyler T. UnitedHealthcare Considers Quitting Obamacare, Cites Unsustainable Conditions. November 19, 2015. HNGN Web site. http://tinyurl.com/jc8e4a2. Accessed December 1, 2015.
  2. Facebook post. October 9, 2015. Available at: https://www.facebook.com/drmarkhyman/posts/1143551885675559:0?hc_location=ufi. Accessed December 1, 2015.

 

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Showing 3 comments
  • Christie Fleetwood, ND, RPh
    Reply

    Thank you, James! I’m in the process of writing my business plan using this very model. I’ll be sharing this article with my students at Bastyr Univeristy.
    Christie Fleetwood, ND, RPh

    • Blake Myers
      Reply

      Siskiyou Vital Medicine is doing a DPC model in Medford, Oregon. It’s the future. We’ll be teaching about it at Bastyr at the end of February Christie!

  • Blake Myers, ND
    Reply

    Thanks for posting this James. We will be following up with a more in depth article soon!

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