Chiropractic 2025:

Chiropractic 2025: Divergent Futures
Scenario 3: Integration & Spine Health Leadership
Imagine:
Henry Walton Jones, a 50-year-old office worker, has been a member of ACME Primary Care (part of the ACME
HMO) for years, though he has been an infrequent visitor. In recent months, however, he has been experiencing
acute low back pain. Concerned, he finally went to see his local ACME primary care team about it. At the
clinic, after completing his intake survey and answering a few more questions, the nurse referred him to Dr.
John Ravenwood for an exam. Dr. Ravenwood is the chiropractor on his primary care team. Henry had noticed
chiropractors’ offices in the community for years but had never visited one. After a comprehensive examination,
Dr. Ravenwood gave him an adjustment and counseled Henry on stretching techniques, exercises to do at his desk,
and dietary changes for weight loss. He also prescribed a series of
additional visits for adjustments. At the end of the visit, Henry asked
Scenario Highlights
■■ Chiropractic enters mainstream
medicine as the spinal health experts
in the health care system, with
“big data” paving the way through
compelling evidence from outcomes
research.
■■ DCs and DPTs no longer compete
with one another for patients. The
two professions partner on integrated
health care teams in screening
and triaging neuromusculosketal
complaints, and educating the public
about prevention of chronic pain.
■■ Many chiropractors join integrated
teams and become critical partners
in addressing back pain and spinal
health.
■■ Other chiropractors find that growing
public acceptance means that they
can sustain their independent or
group practice and in many cases
thrive.
Dr. Ravenwood about his role in ACME Primary Care. Why was there
a chiropractor on his primary care team? Dr. Ravenwood explained that
there has been growing evidence that back- and spine-related conditions
are the primary issues behind at least 5%—and in some settings up to
20%—of primary care demand; and chiropractic care has been shown to
be more effective and less costly than medical or surgical treatments for
most spine-related conditions. To top it off, chiropractic care has higher
patient satisfaction ratings. Taken together, these findings inspired
ACME to add chiropractors to their primary care clinics and to integrate
them into their care teams. Dr. Ravenwood was chosen because he had
several years of successful practice. He had gotten to know the ACME
medical director when they both volunteered at a local free health care
clinic. When ACME was looking to add a chiropractor, the medical
director turned to Dr. Ravenwood. Demand from patients like Henry
has meant that most ACME Primary Care teams now include a full-time
chiropractor or physical therapist.
Scenario Narrative
Over the 12 years to 2025, health care in the United States was reshaped
by a series of policy and delivery system changes that focused on value
and cost-effectiveness. The health insurance exchanges mandated
by the 2010 PPACA proved to be effective, expanding the range of
available insurance options for individuals and families. By 2018, the
U.S. achieved near-universal health care coverage. By 2020, many
employers had backed away from providing health care insurance
benefits. However, most employers did offer support systems and rewards for healthy behaviors that improved work
performance and overall health and subsequently reduced medical care demands.
By the mid-2010s, policymakers, providers, and the public came to fully support the “Triple Aim”—i.e., enhancing
patients’ experience of care, reducing per capita health care costs, and improving population health—as the goal and
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