Naturopathy provides a model of prevention-oriented, patient-centered primary care, as described by Ryan Bradley ND in this article, Naturopathy — A Disruptive Innovation in Health Care (1). Naturopathy focusses on whole-person health and self-care, rather than prescription drugs (“A pill for every ill”) and surgical interventions. The Naturopathy model of medical care could disrupt the present medical model that “fuels health care costs”. A major challenge for Naturopathy is developing innovative business models that support the excellent medical model of Naturopathy.
I will review Ryan Bradley’s article and add my thoughts on disruptive innovation using naturopathy in the following sections:
- Sustaining vs. Disruptive Innovation
- Whole-Person Health Model of Care
- Treatment for Depression
- Business Model Innovation with Examples
- Sustaining vs. Disruptive Innovation
Sustaining innovation improves technology in health services for the most profitable patients. Sustaining technological innovations, such as electronic health records, gene-based therapies, and advanced imaging, are perceived as holding great promise. However, in most cases these innovations have increased costs and failed to improve clinical outcomes. (1) In my article, Disruptive Innovation in Healthcare, I discuss the need for disruptive rather than sustaining innovation. (2)
In studying other industries, Clayton Christensen found that disruptive innovation utilizes technology to improve access to more affordable, low profit-margin services. In healthcare, these include primary care and mental health. Christensen suggested that disruptive health innovation would combine new technologies with innovative business models, using membership or subscription payments. Christensen found that established companies in other industries rarely initiated disruptive innovation. He suggested that new disrupting organizations could eventually displace the current leading stakeholders and health care providers. (3)
- Whole-Person Health Model of Care
Our medical system must shift from curing illness (sick care) to promoting better health. Naturopathy transforms clinical practice using a patient-centered approach, including longer patient visits, self-care, avoiding drug or surgical options, and consideration of patient preferences. Less reliance on prescription drugs and reduced referrals to specialists will disrupt the existing business models of hospitals, specialty groups, and pharmacies, by shifting health care to other wellness services. (1)
Naturopathy promotes wellness-based health care delivery, including chiropractic, massage therapy, yoga, acupuncture, health coaches, natural health products, and exercise. Naturopathy also provides guidance for organic natural foods, which is supported by Amazon’s recent purchase of Whole Foods for $14 billion. (1)
- Treatment for Depression
Depression is an opportunity for disruptive innovation. Depression is not well treated by currently available drugs and drastically reduces quality of life. Primary care physicians prescribe the majority of antidepressants using a trial-and-error approach. It is not unusual that someone suffering from depression will have tried several different antidepressants.
We need to address our mental health crisis, particularly among young adults. Most psychiatric disorders show up from the ages 14 to 26 – possibly the most tumultuous decade in a person’s life. The following information about college mental health comes from the book, The Stressed Years of Their Lives. (4) This book was published in 2019, before our COVID pandemic.
- Rates of anxiety and depression have soared in the last decade
- More than half of students reported overwhelming anxiety during the prior school year
- Almost 1/3 of all college students report having felt so depressed that they had trouble functioning in the last 12 months
- More than 80% of college students felt overwhelmed by all they had to do in the past year and 45% have felt things were hopeless
- Yet only about 1/4 of the affected students received counseling for these conditions
Many students do not seek treatment because of the stigma, cost, or lack of access to mental health services. Naturopathy can help with a whole-health approach to treating anxiety and depression. Naturopathy can provide an attractive option for young adults, using natural medicine and minimizing the stigma of mental health.
We need to address the damage done by Facebook and other social media. In January, the Seattle School District filed a lawsuit against Big Tech. They noted that Facebook has been very successful in getting our young people addicted to their site in order to increase advertising revenues. (5) In his book For Profit – A History of Corporations, William Magnuson comments that Facebook has “prioritized its own interests over those of society”. (6)
- Business Model Innovation
I am convinced that our current business model of fee-for-service payments to primary care providers (PCPs) employed by health systems is not sustainable. These PCPs are encouraged to increase patient visits and make more referrals to the profitable specialty and hospital services.
We can develop innovative business models that build on the excellent Naturopathy medical model of care. Naturopathy offers an attractive option for keeping people healthy, reducing the volumes of expensive hospital services, and lowering the total costs of healthcare. Christensen suggested that we will shift from fee-for-service payments to monthly membership, or capitation payments.
I predict that we will implement new Naturopathy business models in two phases: 1) By developing networks of independent Naturopathy groups and 2) Through collaboration of Naturopathy Doctors (NDs) with other care providers. Additional research will demonstrate the benefits of Naturopathy in improving whole-person health. NDs can expand licensure beyond half of our states and improve payment arrangements.
Phase I – Network for Independent Naturopathy Practices
Most Naturopathic Doctors (NDs) work in independent solo or small group practices. These small practices require the active involvement of NDs to attract new customers and manage the business. However, most NDs want to spend their time providing patient services rather than running the business. Therefore, a future network goal will be making the best use of their most valuable resource – ND time.
An overall network goal is to keep people healthy and reduce utilization of expensive specialty and hospital services. To support this goal, payment systems will shift from fee-for-service to monthly membership or capitation arrangements. Independent ND groups have different financial incentives than established hospital systems that depend on high utilization of their most profitable services to cover facility overhead
The ND network can establish a management services organization (MSO) that provides administrative and marketing services. The MSO can improve the effectiveness and efficiency of these practices with greater economies of scale in group purchasing and insurance contracting. The MSO can also help with quality improvement by collecting and comparing data on quality measures. However, as Einstein has commented, “Everything that can be counted does not necessarily count, and everything that counts cannot necessarily be counted”. We need research into how Naturopathy improves whole person health by addressing the root cause of illness, rather than the symptoms.
Disruptive innovation will combine innovative business models with new technologies. The MSO can greatly assist in the evaluation and purchasing of new health technology, including electronic medical records (EMR’s), billing systems, mHealth apps, and digital therapeutics. We can use health tech to improve efficiency and effectiveness of NDs, while improving quality of services and reducing ND burnout. We can also learn from our experience with EMR’s, which were largely designed to improve billing and have greatly contributed to provider burnout.
Phase II – Collaboration of NDs with Other Care Providers
To disruptively innovate in primary care, NDs will need to collaborate with providers sharing the same goals. There are 6,000 NDs and approximately 500,000 PCPs (including primary care doctors, NPs and PAs). NDs will decide if they will use natural medicine in conjunction with conventional PCP care or as an option to PCP treatment. NDs can offer an attractive option to consumers wanting to use natural medicine in improving whole-person health. NDs can choose to collaborate with chiropractors, massage therapists, acupuncturists or psychologists.
Several organizations share the goals of keeping people healthy and reducing the utilization of expensive healthcare services. Examples include self-insured employers, college student health services, community health centers, health maintenance organizations (HMO’s), and Medicare Advantage full-risk plans.
NDs can provide services for niche markets, by addressing a real need in the market and providing services that will “catch on”. Naturopathy can use a whole-person model for addressing our college mental health crisis, providing an option to conventional mental health care. College should be a time of learning and personal growth rather than anxiety and depression. Naturopathy colleges could become leaders in improving whole-person student health services.
Examples of Innovative ND Business Models
Ideal Human is a husband-and-wife team in Sussex, Wisconsin. Lindsay Moreau is a Naturopathic Doctor and Stephen Moreau is a Chiropractor. Dr. Lindsay recently collaborated with her husband in caring for a patient with a herniated disc. She was able to make some dietary recommendations to enhance the healing process. Dr. Lindsay shared that many NDs work with chiropractors.
They opened their clinic at a challenging time – at the beginning of the COVID pandemic, in February 2020. Although Dr. Stephen’s chiropractic practice initially grew faster, Dr. Lindsay has been attracting new patients every month. Dr. Lindsay told me that younger patients are particularly attracted to naturopathy using a whole person approach to improving health.
Dr. Lindsay commented that Wisconsin is 5–10 years behind the West Coast in using naturopathy services. Although Wisconsin passed legislation for ND licensure, it will take several years to fully implement. Because two-thirds of licensed NDs practice on the West Coast, they will have greater opportunities for collaboration with other care providers. Washington and Oregon have licensed NDs for over 60 years.
Dr. Lindsay wants to have prescription privileges, mainly so she can de-prescribe rather than prescribe medications. She provides services that PCPs don’t offer, partly because of their limited time with patients. Her whole-person approach using natural medicine can better address exercise, nutrition, sleep, and stress management in improving health.
Another example of an innovative ND business model is HealthPoint, located in the Greater Seattle area. HealthPoint is an innovative network of Community Health Centers and was founded in 1971. It provides an excellent example of how NDs collaborate with other care providers. Their network operates in 19 locations, including school health programs. They have over 200 health professionals, including 15 Natural Medicine providers. Cindy Breed ND published an article, “Treatment of Depression and Anxiety by Naturopathic Physicians”. “In the United States, the majority of care for mental-health morbidities is received from primary care providers (PCPs) rather than from mental health specialists.” (7)
Summary
Clayton Christiansen has written that, “Healthcare screams for innovation”. There are great opportunities for improvement in healthcare delivery to achieve the Quadruple Aim – Improving health and patient experience at a lower cost, while also improving provider well-being. Naturopathy can become a more widely accepted model of primary care with a focus on whole-person health, self-care behaviors, and natural treatments.
NDs on the West Coast will lead the way in improving whole person health with innovative business models.
References
- Bradley, R.; Naturopathy as a Model of Prevention-Oriented, Patient-Centered Primary Care: A Disruptive Innovation in Health Care; MDPI, Medicina, 2019
- Korus, B.; Disruptive Innovation in Healthcare, June 2020
- Christensen, C.; The Innovator’s Prescription (A Disruptive Solution for Health Care); McGraw-Hill Education, 2017
- Hibbs, J.; The Stressed Years of Their Lives (Helping Your Kid Survive and Thrive During Their College Years); St. Martin’s Press, April 2019
- Yang, M.; 3 Reasons why Seattle Schools are suing Big Tech over a youth mental health crisis; NPR, January 11, 2023
- Magnuson, W.; For Profit – A History of Corporations; Basic Books, November 2022
- Breed, C.; Treatment of Depression and Anxiety for Naturopathic Physicians: An Observational Study of Naturopathic Medicine Within an Integrated Multidisciplinary Community Health Center; Journal of Alternative and Complementary Medicine, 2017