This webinar discussed the value of chiropractic treatment as a primary care intervention. Our panelists discussed the role of chiropractic specialists in the primary care team and reviewed the integration of chiropractic services. Panelists: • Margaret Flinter, PhD, APRN, FAAN, Senior Vice President and Clinical Director, Community Health Center, Inc. • Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc. • James J. Lehman, DC, MBA, DIANM, Director of Health Sciences Postgraduate Education, University of Bridgeport, Chiropractic Orthopedist, Community Health Center, Inc. • Lesly Valbrun, DC, MPH, MBA(c), Chiropractic Resident, University of Bridgeport, Community Health Center, Inc.

1. Chiropractic Specialists as part of
Health Center Teams
Thursday, May 26, 2022
1:00-2:00pm Eastern / 10:00am-11:00pm Pacific
Margaret Flinter, PhD, APRN, FAAN, Senior Vice President and Clinical Director, Community Health Center, Inc.
Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc.
James J. Lehman, DC, MBA, DIANM, Director of Health Sciences Postgraduate Education, University of Bridgeport,
Chiropractic Orthopedist, Community Health Center, Inc.
Lesly Valbrun, DC, MPH, MBA(c), Chiropractic Resident, University of Bridgeport, Community Health Center, Inc.

2. Continuing Education Credits
In support of improving patient care,
Community Health Center, Inc. / Weitzman
Institute is jointly accredited by the
Accreditation Council for Continuing Medical
Education (ACCME), the Accreditation Council
for Pharmacy Education (ACPE), and the
American Nurses Credentialing Center
(ANCC), to provide continuing education for
the healthcare team.
A comprehensive certificate will be sent after
the end of the series, Summer 2022.
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3. Disclosure
• With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship
between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which
would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenters and may not reflect official policy of
Community Health Center, Inc. and its Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under
investigation (not FDA approved) and any limitations on the information hat we present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.
• This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non-
governmental sources. The contents are those of the author(s) and do not necessarily represent the official
views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit
HRSA.gov.
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4. At the Weitzman Institute, we value a
culture of equity, inclusiveness, diversity,
and mutually respectful dialogue. We
want to ensure that all feel welcome. If
there is anything said in our program
that makes you feel uncomfortable,
please let us know via email at
nca@chc1.com
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5. National Training and Technical Assistance Partnership
Clinical Workforce Development
Provides free training and technical assistance to health centers across the
nation through national webinars, learning collaboratives, activity
sessions, trainings, research, publications, etc.
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6. Objectives
• Discuss the need for chiropractic services.
• Describe the impact of having chiropractic specialists on the
primary care team and what they can do for patients.
• Review the integration of chiropractic services.
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7. Barriers to Entry and Chiropractic Integration
• Primary care providers were the
gatekeepers in CHC primary care sites
• Primary care providers had never
referred to a chiropractor
• Primary care providers expressed
significant concerns regarding use of
chiropractors
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8. Growth and Progress
• Silos are giving way to systems
• Scope of practice is expanding across disciplines
• Education and training is transforming
• Technology is giving rise to virtual care
• Interprofessional practice and integrated teams are increasingly the
norm
• Fee for service is very slowly giving rise to value-based payment
• Consumers are seeking care where, when, how, and with whom they
want it
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9. Acute and Chronic Pain
• Low-back pain is one of the most common chronic pain conditions
treated by primary care physicians.1
• “Underserved patients are most affected, and disproportionately
may use opioid medications as they lack access to other therapies.”2
• “Patients with high-impact chronic spinal pain use opioids at a rate
almost 4x that of those with low-impact pain.” 2
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1. Blondell RD and Ashrafioun L. Treating Opioid Dependency and Coexistent Chronic Nonmalignant Pain. Am Fam Physician. 2008 Nov 15;78(10):1132-1133.
2. Prater, C., Tepe, M., & Battaglia, P. (2020). Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain. Journal of primary care & community health, 11,
2150132720953680. https://doi.org/10.1177/2150132720953680

10. Neuromusculoskeletal Conditions Treated
• Acute and chronic pain:
• Spinal pain
• Cervicogenic headaches
• Myofascial pain syndromes
• Piriformis syndrome and sciatica
• Nerve root radiculopathy and brachial
plexopathy
• Peripheral compression neuropathies
• Coccygodynia
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11. Status of Chiropractic Services
in Community Health Centers
• More data is needed regarding integration of chiropractic services
• Medicare coverage of chiropractic for specific treatments
• Medicaid coverage in most states may be limited by age
• Chiropractic in FQHCs around the country as of 12/31/20211
• Regenesis Health Care, Inc: South Carolina
• Utah Navajo Health System, Inc.: Utah
• Avenal Community Health Center: California
• Community Health Center, Inc.: Connecticut
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1. HRSA (Help Desk)

12. The Potential of
Chiropractic Services
• “Chiropractic care in the health care system must be transformed from alternative and separate to
alternative and mainstream.” 1
• "In addition to the lower costs for VA care cited above, a study done of integrative primary care by
Alternative Medicine, Inc., a Chicago-area group, showed lower costs for patients receiving chiropractic
care, compared to those who received traditional care alone. This resulted in 43% fewer hospital
admissions, 58.4% fewer hospital days, and 51.8% lower drug costs.“2
• “Patients with lower back pain who received chiropractic services were less likely to use narcotic drugs.” 3
• “In a 2018 report of a study conducted among 14,025 veterans of recent wars, the percentage of patients
receiving opioid prescriptions was lower after receiving DC care for low back pain as compared with
before.”4
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1. Flinter, M., Lehman, J. J., Channamsetty, V., & Anderson, D. R. (2016, January). Integration of Chiropractic for Chronic Pain Treatment into Community Health Centers. ACA News. Retrieved May 25, 2022, from
https://www.bridgeport.edu/files/docs/academics/programs/postgrad/ortho-nmm/aca/aca-news-health-care-reform-integration-chiropractic-chronic-pain-jan-feb-2016.pdf
2. Henderson, R. by E. (2022, March 9). U.S. health care systems reduce costs, improve patient experience by delivering integrative care. News. Retrieved May 25, 2022, from https://www.news-medical.net/news/20220309/US-health-care-systems-reduce-costs-
improve-patient-experience-by-delivering-integrative-care.aspx
3. Rhee Y, Taitel MS, Walker DR, Lau DT. Narcotic drug use among patients with lower back pain in employer health plans: a retrospective analysis of risk factors and health care services. Clin Ther. 2007;29 Suppl(Suppl):2603-2612.
doi:10.1016/j.clinthera.2007.12.006
4. Whedon, J. M., Toler, A. W., Kazal, L. A., Bezdjian, S., Goehl, J. M., & Greenstein, J. (2020). Impact of chiropractic care on use of prescription opioids in patients with spinal pain. Pain Medicine, 21(12), 3567-3573.

13. The Potential of Chiropractic Services (continued)
• Chiropractic care is safe and increasingly accepted by the public.1
• A study by researchers Fritz, Kim, and Dorius demonstrates lower utilization of
surgical, medical, and diagnostic services for new episodes of low-back pain if
patients begin with chiropractic management.2
• “Resident training within community health centers for chiropractic graduates
leading to board certification in chiropractic orthopedics will increase the number of
chiropractic specialists.”1
• Health center workforce programs might consider partnerships with schools of
chiropractic medicine and chiropractic residencies.
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1. Flinter, M., Lehman, J. J., Channamsetty, V., & Anderson, D. R. (2016, January). Integration of Chiropractic for Chronic Pain Treatment into Community Health Centers. ACA News. Retrieved May 25, 2022, from
https://www.bridgeport.edu/files/docs/academics/programs/postgrad/ortho-nmm/aca/aca-news-health-care-reform-integration-chiropractic-chronic-pain-jan-feb-2016.pdf
2. Fritz JM, Kim J, and Dorius J. Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs. Journal of Evaluation in Clinical Practice (2015).

14. Value to Providers and Patients
• “Board-certified chiropractic specialists focusing on the evaluation and management
of neuromusculoskeletal conditions and chronic pain should integrate into
community health centers as credentialed members of the primary care team.”1
• Patient education on self care is valuable
• Posttraumatic chronic pain is a frequent diagnosis
• Patients present with neurological issues due to COVID such as headache syndrome
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1. Flinter, M., Lehman, J. J., Channamsetty, V., & Anderson, D. R. (2016, January). Integration of Chiropractic for Chronic Pain Treatment into Community Health Centers. ACA News. Retrieved May 25, 2022, from
https://www.bridgeport.edu/files/docs/academics/programs/postgrad/ortho-nmm/aca/aca-news-health-care-reform-integration-chiropractic-chronic-pain-jan-feb-2016.pdf

15. How One Health Center
Embraced Chiropractic Care
• A 2012 study published by CHCI confirmed low rates of referral to
chiropractic or any complementary/alternative providers1
• An opportunity for University of Bridgeport College of Chiropractic
Medicine to extend its reach, provide training opportunities, and
service
• An opportunity for CHCI to address a fundamental problem—acute
and chronic pain, and the increasing burden of pain medications
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1. Anderson, D., Wang, S., & Zlateva, I. (2012). Comprehensive assessment of chronic pain management in primary care: a first phase of a quality improvement initiative at a multisite Community Health Center. Qual Prim Care, 20(6), 421-33.

16. Chiropractic Care at CHCI
• Appointed to Medical Staff
• Fully embedded into Pods
• Co-located exam rooms
• Seamless Referral/Recall
• Direct support for providers
• Support in pain diagnosis
• Support in pain management
• Support for patients
• Share the care
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17. Chiropractic Care at CHCI
• In Calendar Year 2019, there were
2,895 patients who had 18,023
visits for chiropractic care at CHC.
• 58% of patients had visits with diagnosis of chronic pain syndrome
• 20% of patients had visits with diagnosis of chronic pain due to trauma
• 8% of patients had visits with diagnosis of low back pain
• 6% of patients had visits with diagnosis of other chronic pain
• 6% of patients had visits with diagnosis of myalgia, unspecified site
• 5% of patients had visits with diagnosis of acute pain due to trauma
• 5% of patients had visits with diagnosis of cervicalgia
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• Patient insurance as of today included:
• 73% Medicaid
• 10% Private
• 9% Uninsured
• 8% Medicare

18. Patient Satisfaction with Chiropractor
In calendar year 2021, CHCI’s Chiropractors were in the top quartile
for provider specific patient satisfaction measures
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Survey Item Provider A Provider B Provider C
Provider Listening 91.7 97.5 95.0
Provider Explanation 95.0 95.0 96.3
Provider Advice and Treatment 95.0 96.3 93.8
Provider Knowledge of Health
History 96.7 97.5 91.3
Quality of Care 95.8 97.2 93.4
Overall Satisfaction 94.7 96.8 94.0

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Primary Care Provider Perception of
Integrated Chiropractic Service

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Primary Care Provider Perception of
Integrated Chiropractic Service

21. The Chiropractic Resident Experience
• Exposure to chronic pain cases
• Integrative model
• Access and Accessibility to Chiropractic care
• APRN/FNP Residency & Training Program
• Interprofessional Education
• Communication, Coordination, Collaboration
• Interprofessional consultation with primary care providers
• Provides Primary Care Providers with an in-house non-pharmacological
treatment provided by a chiropractic specialist
• Providing the best and most appropriate evidence-based patient-centered
care
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22. The Chiropractic Resident Experience (continued)
• Impacts the primary care model positively
• Reduction of opioid and medication use
• Improving patient outcomes
• High level of patient satisfaction
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23. Questions?

24. Contact Information
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For information on future webinars, activity
sessions, and learning collaboratives:
please reach out to nca@chc1.com or visit
https://www.chc1.com/nca