As Congress explores strategies for “Investing in a Healthier America”1 through chronic disease prevention and treatment, an overlooked solution stands ready: licensed naturopathic doctors (NDs). These providers, trained in prevention-focused, whole-person care, could be key allies in addressing our nation’s chronic disease crisis—if only federal barriers to their inclusion in our healthcare system were removed.
The Chronic Disease Crisis
According to the Centers for Disease Control and Prevention’s (CDC) website,2 a staggering 90 percent of our nation’s $4.5 trillion in annual health care expenditures are for people with chronic and mental health conditions. More than two-thirds of Medicare beneficiaries are treated for two or more chronic diseases,3 creating a crushing financial challenge for our system to provide the best care. As health care costs spiral upward, and America’s outcomes in managing chronic diseases regularly rank well below other developed countries, it’s clear that our current approach isn’t working.
Evidence-based, Cost-effective Prevention
A body of literature, too vast to enumerate here, supports the cost-effectiveness of lifestyle-oriented self-care, nutrition, preventive behaviors and other modalities that are grounded in the approach used by naturopathic doctors to manage, improve or reverse these conditions. The preventive focus of naturopathic care addresses many modifiable risk factors—lifestyle behaviors, physical activity, sedentariness, obesity, alcohol consumption, dietary choices and environmental exposures—associated with the increased cost of chronic diseases.
Recent research demonstrates the effectiveness of naturopathic medicine in preventing and treating chronic conditions. A comprehensive Health Technology Assessment (HTA)4 published by the World Naturopathic Federation found that 81.1 percent of studies on naturopathic clinical practice identified positive responses to primary or secondary outcome measures. This evidence base spans over 300 clinical studies involving more than 100 different health populations.
The positive outcomes and cost-effectiveness of naturopathic care is particularly relevant as we seek solutions to our chronic disease health care crisis:
• An overview of 12 clinical research papers investigating naturopathic treatments for cardiovascular conditions found that 91 percent reported a positive outcome in at least one primary or secondary outcome.5
• Numerous studies have demonstrated that using non-invasive, non-toxic approaches in addressing chronic diseases, such as cardiovascular disease, lowers health care costs.6,7
• Patients with the greatest disease burden show the most significant reduction in total medical expenditures when utilizing integrative medicine.8
• A study found that patients receiving one year of care under the supervision of a naturopathic physician experienced a 3.1 percent reduction in 10-year cardiovascular disease event risk compared to patients receiving conventional care. They were also 16.9 percent less likely to have developed metabolic syndrome.9
And, these are just a small sampling of the naturopathic and integrative medicine research conducted on myriad chronic diseases, the majority of which demonstrate positive results in at least one primary or secondary outcome.
Federal Barriers to Prevention-focused Care
Despite this compelling evidence, significant federal barriers prevent the integration of naturopathic doctors into our health care system. An outdated definition of “physician” in the Social Security Act excludes NDs, creating a cascade of obstacles that prevent Medicare beneficiaries from accessing naturopathic care, and make it more difficult for hospitals, rural clinics, community and county health departments, and Federally Qualified Health Centers, which all receive substantial funding from Medicare, to hire NDs.
This exclusion persists even as major healthcare institutions recognize the value of whole-person, prevention-focused approaches. The Veterans Health Administration, for instance, has implemented a Whole Health Initiative that directly aligns with naturopathic principles—yet cannot hire NDs due to the lack of an employment classification for these providers.
Policy Solutions for a Healthier America
There are many solutions to invest in prevention and chronic disease treatment for a healthier America. Some will take years or decades to implement, as changing the dominant paradigm will not happen overnight. However, some policy changes are simple, and could make an immediate difference to millions of people very quickly.
At the very least, policymakers should ensure that all licensed health care professionals who prioritize the kind of wellness approach that is the foundation of naturopathic doctors are recognized, enumerated in statute and eligible for insurance coverage—especially government-sponsored medical coverage—to support patient access to true preventive, whole-person, root-cause approaches to health restoration and wellness.
Congress and regulatory agencies can immediately address the federal barriers that prevent patient access to licensed naturopathic doctors, and to naturopathic medicine that prioritizes the type of preventive health care known to save money, improve outcomes and most importantly prevent the chronic diseases that are killing Americans and bankrupting our system. The following policy changes would dramatically improve patient access to preventive medicine for millions of people:
1. Modernize the definition of “physician” in the Social Security Act to include licensed naturopathic doctors.
2. Direct the Centers for Medicare & Medicaid Services to require states receiving federal Medicaid funding to credential and cover NDs where they are licensed.
3. Prioritize the creation of a Qualification Standard and Employment Code for Naturopathic Doctors in the Veterans Health Administration (VA) and Department of Defense (DoD) so that these agencies can hire NDs who specialize in Whole Health, cost-effective, prevention-centered medicine.
4. Support changes to Medicare Quality Measures to ensure that providers are incentivized for helping patients reverse disease rather than simply ensuring medication adherence.
5. Support policies that promote the use of food as medicine, including coverage of food and nutrition “prescriptions” by physicians.
A Call for Comprehensive Reform
The evidence is clear: naturopathic care is effective, cost-efficient and aligned with the principles of prevention-focused medicine. Currently licensed in 26 U.S. jurisdictions, naturopathic doctors represent an underutilized workforce of providers trained specifically in the kind of preventive, whole-person care needed to address our chronic disease crisis.
As Congress explores strategies for investing in a healthier America, it’s time to remove the federal barriers that prevent patients from accessing qualified providers who specialize in prevention and chronic disease management. By modernizing our health care policies to include all qualified providers, we can build a health care system that truly prioritizes prevention, improves outcomes and reduces costs.
The solutions are available—we just need the political will to implement them. As we invest in the health of our nation, let’s ensure we’re utilizing all qualified providers who can contribute to preventing and treating chronic disease. The health of our nation—and our health care system—depends on it.
References:
1 House of Representatives Ways & Means Health Subcommittee Hearing on Investing in a Healthier America: Chronic Disease Prevention and Treatment, September 18, 2024 accessed at https://waysandmeans.house.gov/event/health-subcommittee-hearing-on-investing-in-a-healthier-america-chronic-disease-prevention-and-treatment/.
2 Centers for Disease Control “Fast Facts: Health and Economic Costs of Chronic Conditions,” accessed October 4, 2024 at www.cdc.gov/chronic-disease/data-research/facts-stats/index.html.
3 Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012, accessed October 4, 2024 at www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf.
4 Lloyd, I., Steele, A., and Wardle, J., Naturopathy, practice, effectiveness economics & safety. World Naturopathic Federation. Section 3, Chapter 8. 2022, accessed October 2, 2024 at https://worldnaturopathicfederation.org/wp-content/uploads/2021/12/Section-3.pdf.
5 ibid.
6 Herman PM, Szczurko O, Cooley K, Seely D. A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial. J Occup Environ Med. 2014 Feb;56(2):171-6. doi: 10.1097/JOM.0000000000000066. PMID: 24451612; PMCID: PMC3921268.
7 Tais S, Oberg E. The economic evaluation of complementary and alternative medicine. Natural Med J. 2013;5(2).
8 Sarnat RL, Winterstein J, Cambron JA. Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3- year update. J Manipulative Physiol Therapeutics 2007; 30(4): 263-269.
9 Seely D, Szczurko O, Cooley K et al. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. Can Med Assoc J. 2013; 185(9):E409-E416.
Laura Culberson Farr is executive director of the Association of Naturopathic Physicians (AANP), the professional membership association advancing recognition of licensed naturopathic physicians to transform access to whole health naturopathic medicine in the US. Farr brings nearly 30 years of service advocating for naturopathic medicine, its profession and health care reform generally. She has been executive director with the AANP since 2017. Through enhancing collaboration with AANP’s 48 affiliates, licensure has recently been achieved in Wisconsin, New Mexico and Idaho, with a dozen more states in active development of licensure initiatives to significantly expand patient access to naturopathic care. Prior to AANP, she served as the executive director with the Oregon Association of Naturopathic Medicine (OANP), where she successfully expanded prescribing authority and improved access to naturopathic doctors for Medicaid patients. Under her guidance, naturopathic doctors were recognized as Patient-Centered Primary Care Homes, further enhancing the quality of patient care. For her unwavering commitment to the profession, she was awarded the AANP’s Champion of Naturopathic Medicine Award in 2014. Farr is recognized for deep knowledge of the complexities of health care reform, expertise on how naturopathic doctors, conventional clinics, and insurers can collaborate to improve patient care and reduce health care costs, and a commitment to integrating naturopathic medicine into primary care systems across the country. Her dedication to advocating for naturopathic medicine mirrors the core values of the AANP. Follow the AANP: Facebook & Instagram: @theaanp | Twitter/x: @aanp
