Chiropractic 2025:

Chiropractic 2025: Divergent Futures
institutions in complementary and alternative medicine, gave the field a surprising sense of shared identity. This
identity was not inconsistent with or disruptive of the spine-health lead provider identity that was growing in the
core of the profession.
In parallel to the advances in chiropractic research, major parts of the PPACA were implemented by 2016, including
the move to ACOs, the use of health insurance exchanges, and mandates for coverage. Support for the PPACA and
its execution, however, varied by state and costs continued to rise. This led to a Medicare reform enacted in 2017,
capping annual national spending and accelerating the movement to ACOs and capitated care. Private insurers
and the health exchanges followed suit, putting a nationwide squeeze on any health care services that could not
show a high rate of health return on dollars spent. Yet full coverage health insurance remained expensive for most
individuals and families. By 2018, large numbers of people were opting for high-deductible catastrophic health care
plans and paying out-of-pocket for doctor bills and other expenses. By 2020, 40% of the population were enrolled
in integrated health care systems (ACOs and managed care), and another 40% were relying largely on self-care in
conjunction with their consumer-directed health plans (CDHPs).
Over the years leading to 2025, integrated care plans and most of the better CDHPs provided their members with
up-to-date digital health coaches that for millions of Americans became trusted partners and knowledge navigators
in care, health, wellbeing, and prevention. Digital health coaches incorporated the person’s electronic medical
records, genetic profile, personal biomonitoring data, as well as the individual’s health conditions, budget, location,
and preferences for type of health care practice into the digital coach’s analysis and recommendations for providers,
health promotion activities, nutrition, and other products. Health wisdom expanded as people “crowdsourced” their
health care experience through social networks. They compared their care with providers and protocols with those of
others. These comparisons led some consumers to switch providers.
Patients could also link their profiles to their social health networks and accrue “points” for achieving their self-care
goals. These points could be used to get special deals on visits to providers that included a network of chiropractors,
osteopaths, acupuncturists, naturopathic physicians, and physical therapists who made agreements with the social
health networks. MyHealthAlternatives in particular provided a social health network and the first-ever digital health
coach specializing in alternative care. Members were able to use their personal biomonitoring tools to easily collect
specific biomarker data that allowed research on chiropractic’s more subtle effects on their energy and healing. In
fact, the growing use of MyHealthAlternatives and its research helped increase the range and integration of CAM
disciplines and approaches among ACOs and for self-care patients.
Transparency in local markets based on EHRs and people sharing their outcomes in treatment allowed local and
national groups like Angie’s List, Jill’s List, and PatientsLikeMe to become more sophisticated in their scorekeeping
and outcome measuring, with many listing prices for providers as well. By the early 2020s, outcomes research,
including provider-based whole practice outcomes research, had become an imperative for individual chiropractors
to join an ACO or PCMH, or compete locally with other chiropractors and other health care providers. Thus,
the majority of the chiropractic community adopted electronic health record (EHR) systems in their offices
and took part in registry development and outcomes research spawned by chiropractic colleges, the Integrative
Chiropractic Outcomes Network, and other chiropractic organizations. They linked with funders and research
organizations like the Patient-Centered Outcomes Research Institute (PCORI), the Cochrane Collaboration, and
PatientsLikeMe, and drew on data from ACOs and digital health coaches. The findings reinforced earlier studies
that had shown chiropractic care to be clinically effective for low back pain, neck pain, and spine issues. Ongoing
research identified other conditions where chiropractic care was effective and protocols and digital health coach
recommendations reflected this. Chiropractors as a whole also continued to have high patient satisfaction rates and
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