Chiropractic 2025:

Chiropractic 2025: Divergent Futures
focus of health care providers. The Patient-Centered Medical Home (PCMH) became the default delivery form and
standard of quality for primary care. Care emphasized coordination, patient focus, and the anticipation of patient
needs. Care also shifted from largely solo and small group physicians to primary care teams that were part of larger
integrated systems operating with capitated payment and other forms of risk sharing. Payers rewarded providers for
prevention and personalization, and for achieving optimal health outcomes while reducing costs.
In the years leading up to 2020, “big data” applications combined advanced analytics with individual patient data,
community health records, and aggregated population health metrics to facilitate health improvement at the level of
the individual. Providers increasingly used predictive models and simulations that assessed risks and potential health
gains for each beneficiary in an insurance plan. These simulations were informed by whole genome sequencing, the
cost of which had dropped below $100 by 2020, and clouds of data from inexpensive biomonitoring devices and
microfluidic devices, which enabled nearly continuous testing of blood for circulating proteins. Analysis of this data
led to an explosion in the understanding of genotype/phenotype relationships and of epigenetic factors, allowing the
generation of personalized approaches to prevent chronic disease or at least to slow its progression. The recognition
that the so-called “silent” regions of DNA were in fact part of the complex control mechanisms during human
development eventually led to earlier interventions that prevented the need for acute treatments.
In this context, outcomes research became the most important factor in the decade leading to 2025 in policies and
plans for determining coverage and for deciding which providers would take leading roles on the PCMH teams.
Most chiropractic colleges expanded their research capabilities to support, develop, and demonstrate evidenceinformed
practice, including working with practitioners and insurance networks in developing patient registries and
outcomes data. Research from the chiropractic community outside the U.S. also contributed to the growing evidence
of chiropractic’s therapeutic and cost effectiveness. Major insurance companies analyzed their data on millions of
patients and reconfirmed that for back and spine problems, going directly to a chiropractor (rather than an MD)
produced better outcomes and higher patient satisfaction at lower costs. Then in the early 2020s, the field cheered
when news broke of research confirming previous studies that had found that spinal manipulation did indeed affect
gene expression (via chaperone molecules that assist protein folding, which can be sensitive to stress).
Chiropractors had the pieces to successfully define their profession in a way that supported their participation
in the value-based delivery system: new research confirming the value of chiropractic care, rising demand for
care, a growing shortage of primary care providers, and the high incidence of spine-related conditions. Much of
the chiropractic field and its major organizations united behind the chiropractor’s role as spinal health expert in
the health care system. Thousands of chiropractors reached out to organized health care to develop professional
relationships with medical directors, health care administrators, and clinic managers. DCs also sought the support of
loyal chiropractic patients to demand that provider systems and PCMH teams include chiropractors.
As the nation rapidly reorganized health care delivery, chiropractors joined integrated care teams where they came
to “own” spinal health for most plans. By 2020, primary care teams usually included an MD, NP, PA, DC, DPT, a
behavioral health provider, a medical assistant, and a community health worker. By 2025, a considerable 21,000
DCs, or 31% of the field, were practicing in integrated care systems, particularly in their PCMH teams. This includes
750 chiropractors practicing in VHA hospitals and DoD facilities in 2025.
DCs’ success in integrated systems related to pathways that identified the chiropractor as the appropriate provider
for most neuromusculosketal issues. As it had become cost-prohibitive to send all routine cases to physicians,
ACOs and other large providers developed care pathways for major conditions, including diabetes, cardio issues,
musculoskeletal issues (in particular low back pain), and obesity. These pathways specified the appropriate provider,
the right treatments, and their sequence.
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