Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain

Emery R. Eaves, Clarissa W. Hsu, Lynn L. Debar, Catherine Livingston, Laura E. Ocker, Sarah J. McDonald, Laurel Dillon-Sumner, Cheryl Ritenbaugh

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.

Original languageEnglish (US)
Pages (from-to)S61-S68
JournalJournal of Alternative and Complementary Medicine
Volume25
Issue numberS1
DOIs
StatePublished - Mar 1 2019

Fingerprint

Neck Pain
Back Pain
Delivery of Health Care
Medicaid
Health
Organizations
Guidelines
Pain Management
Therapeutics
Insurance
Observational Studies
Interviews
Research

Keywords

  • chronic pain
  • complementary and alternative medicine
  • complementary and integrative health care
  • opioid response
  • Whole systems research

ASJC Scopus subject areas

  • Complementary and alternative medicine

Cite this

Whole Systems Within Whole Systems : The Oregon Health Plan's Expansion of Services for Back and Neck Pain. / Eaves, Emery R.; Hsu, Clarissa W.; Debar, Lynn L.; Livingston, Catherine; Ocker, Laura E.; McDonald, Sarah J.; Dillon-Sumner, Laurel; Ritenbaugh, Cheryl.

In: Journal of Alternative and Complementary Medicine, Vol. 25, No. S1, 01.03.2019, p. S61-S68.

Research output: Contribution to journalArticle

Eaves, Emery R. ; Hsu, Clarissa W. ; Debar, Lynn L. ; Livingston, Catherine ; Ocker, Laura E. ; McDonald, Sarah J. ; Dillon-Sumner, Laurel ; Ritenbaugh, Cheryl. / Whole Systems Within Whole Systems : The Oregon Health Plan's Expansion of Services for Back and Neck Pain. In: Journal of Alternative and Complementary Medicine. 2019 ; Vol. 25, No. S1. pp. S61-S68.
@article{4d35a87d64894a4aaa6bb000c1bce207,
title = "Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain",
abstract = "Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.",
keywords = "chronic pain, complementary and alternative medicine, complementary and integrative health care, opioid response, Whole systems research",
author = "Eaves, {Emery R.} and Hsu, {Clarissa W.} and Debar, {Lynn L.} and Catherine Livingston and Ocker, {Laura E.} and McDonald, {Sarah J.} and Laurel Dillon-Sumner and Cheryl Ritenbaugh",
year = "2019",
month = "3",
day = "1",
doi = "10.1089/acm.2018.0431",
language = "English (US)",
volume = "25",
pages = "S61--S68",
journal = "Journal of Alternative and Complementary Medicine",
issn = "1075-5535",
publisher = "Mary Ann Liebert Inc.",
number = "S1",

}

TY - JOUR

T1 - Whole Systems Within Whole Systems

T2 - The Oregon Health Plan's Expansion of Services for Back and Neck Pain

AU - Eaves, Emery R.

AU - Hsu, Clarissa W.

AU - Debar, Lynn L.

AU - Livingston, Catherine

AU - Ocker, Laura E.

AU - McDonald, Sarah J.

AU - Dillon-Sumner, Laurel

AU - Ritenbaugh, Cheryl

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.

AB - Objectives: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. Design: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. Methods: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. Results: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. Conclusions: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.

KW - chronic pain

KW - complementary and alternative medicine

KW - complementary and integrative health care

KW - opioid response

KW - Whole systems research

UR - http://www.scopus.com/inward/record.url?scp=85062963404&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062963404&partnerID=8YFLogxK

U2 - 10.1089/acm.2018.0431

DO - 10.1089/acm.2018.0431

M3 - Article

C2 - 30870022

AN - SCOPUS:85062963404

VL - 25

SP - S61-S68

JO - Journal of Alternative and Complementary Medicine

JF - Journal of Alternative and Complementary Medicine

SN - 1075-5535

IS - S1

ER -