Don’t Delegate! Integrate!

Most health professionals who have been in the game long enough know that the healthcare industry as a whole is moving in the direction of integration.

Integration of behavioral, medical, and holistic services is delivered most cost effectively and efficiently when all health practitioners treating and caring for the same patients communicate and understand how to make the team concept work. That means that mutual understanding of each clinician’s roles and access to patient data is crucial to make the system work best and produce the best outcome. That means it requires teamwork. However, the large insurance carriers are strongly resisting integration because it affects their bottom line. Notwithstanding they need control in order to be profitable. The problem is the fine line of medical decision-making is playing out by unqualified insurance company executives, negatively affecting quality care and outcomes.

DR Bruce


For the past ten years, there has been a popular trend in behavioral medical practices, especially in substance abuse centers (SACs). That trend is the offering of holistic treatment (or complimentary medicine), including chiropractic care, acupuncture, and other non-traditional medical services within the recovery setting. It has become popular primarily for marketing and differentiation reasons. It gives that SAC a marketing edge on its competition for the highly valued “client.” What is often overlooked is the underutilized value of what holistic treatment, integrated into the clinical system of the SAC, does for treatment outcomes. But is anyone really measuring outcomes? Some are and some are not. However, insurance carriers are finding new ways to rope in reimbursement in the form of in-network contracts that coerce SACs into restricting care and alter outcomes. Quality is at the top of their list. Costs are. Some of the contract acronyms like “bundling” and “daily rates” (code words for “cost containment”) speak volumes about the priority of profit.

The current state of most of non-traditional (and traditional) medical services in SACs can be described as fragmented, and of low quality, at best. It happens because most behavioral professionals and their business consultant counterparts are not necessarily knowledgeable nor do they care where healthcare is moving in general. They are focused on insurance reimbursement and being careful not to rock the boast. It is about survival and conformity. They mostly live in the era of the last century of managed care. Here is where privately owned medical specialties thrived but slowly became squeezed. Today SACs are heavily insurance-dependent. Outsourcing health services may seem to be the easy way to shed additional risk, overhead, and insurance issues. What should be clearly understood is that any time two treating parties or more care for a patient they become a permanent care partners with each other forever. Any good attorney could potentially connect the dots should a malpractice or liability case become litigated. So what? It’s easier to hire a private practitioner and let them do their own thing then it is to integrate them into the system.

All this integrative stuff sounds like good medicine, if one understands the advantages and disadvantages in the manner in which the non-traditional medical services are managed. When one examines closely what is taking place in most SACs that decide to offer holistic health services, it is typically done as an after thought because someone told them it was a good thing to do. Perhaps a local practitioner offered them a “no out of pocket” cost in exchange for providing the SAC with health services. This service is typified by informal business arrangement where no remuneration is transferred between the SAC and the local practitioner. Essentially, the local practitioners provide their own equipment and staff. You don’t get charged and you don’t collect. Sounds pretty easy, right? On the surface this sounds very attractive … and straightforward. However, this is not integration. This is delegation. And it comes with a different set of risks.

If you don’t believe the healthcare system is moving toward integration, then you probably didn’t notice how much more challenging it is to receive reimbursement for services these days. The integrated SAC practitioner of today understands how to maximize reimbursement, document outcomes, and justify the care, in order to help these patients get better and help you get paid appropriately. Those who embrace the new generation of health care understand that we all must get better and work within the system, and not be separate from it. It does not mean to surrender to the insurance carrier’s will either. It does require a complete and total commitment to moving forward towards integration. Delegation of medical services, whether traditional or non-traditional, focuses resources in the fragmented health system of the past and is equivalent to inviting the fox to the henhouse. So integrate all of the health services your SAC provides. Don’t delegate any of your clinical services, unless you’re comfortable leaving patients in the lurch and letting the insurance carriers call the shots. Because let’s face it, you can’t separate what you do based on an insurance carrier’s contract and the vendors you select. Neither can you improve your outcomes and reduce your risk without integration.


Whether you manage a detox facility, PHP, inpatient center, or IOP, we hope you find the information valuable, and if you have any questions please email us at or call us direct at 772-288-6456.

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DR Bruce
Doctor Bruce Hansbrough received his chiropractic medical degree from Life University, in Marietta, Georgia. He has worked in integrative settings in Martin and Palm Beach Counties since 1993. Doctor Hansbrough is board certified with the American College of Addictionology and Compulsive Disorders (ACACD) and performed his residency at the Exodus Treatment Center and Concept House in Miami.

He has served as an integrative medicine consultant for mental health and addiction recovery centers. He is also board certified in occupational health completing his occupational health residency at Northwestern Health Sciences University in Minneapolis and is a Diplomate of the American Chiropractic Board of Occupational Health.

Doctor Hansbrough is a veteran and served as a commissioned officer from 1980 through 2002 in the United States Navy and Naval Reserve with three tours of duty in the Middle East and Persian Gulf regions. Doctor Hansbrough is also a graduate of the LEADERship™ program of Martin County and received the prestigious Chiropractor of the Month award from the nationally acclaimed Chiropractic Leadership Alliance in June 2010.
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