Healthcare delivery system strategies involve modifying the system to support evidence-based practice adoption. This includes allocating resources, redesigning workflows, establishing clear expectations, and implementing performance measurement and improvement systems.

Healthcare systems and institutions can integrate chiropractic services within their network, as done in VA hospitals and dozens of private healthcare systems across the United States. When health systems have fewer or no chiropractors on staff, patients have difficulty accessing chiropractic care; conversely, having more chiropractors leads to much greater use of those services. Strategies that increase accessibility for patients in these integrated care settings include making chiropractic care available in the same location as primary care and other clinics. Where appropriate, offering chiropractic services across a geographic network may also improve access to care for patients. Where these community-based services are not integrated into the healthcare delivery system, establishing partnerships and connecting individuals directly with providers can support patient access.

Financial incentives may support integrating chiropractic services into healthcare delivery systems across different care delivery models. Adequate payment for chiropractic care services is essential for financial sustainability. This may include policy change and expansion of covered services. Crucially, healthcare systems may realize cost offsets by incorporating chiropractic services, particularly within value-based or capitated care models. In these models, reduced use of high-cost interventions (imaging, opioids, specialist visits, surgery) translates to significant cost savings for the healthcare system. Conversely, motivations in fee-for-service models may present inherent barriers to integration. Including chiropractic services within employee health plans can yield financial benefits for healthcare systems while improving patient access to these services.

Education sessions for providers and initiatives focused on improving patient outcomes, satisfaction, and access to chiropractic care may help to overcome initial resistance. Organizations looking to hire their first chiropractors looked at four key criteria:

1. commitment to evidence-based practice,
2. interprofessional clinical management,
3. interpersonal skills that fit within existing multidisciplinary teams, 
4. adoption of the organizational culture. 

Clinic structures vary widely based on available resources, requiring chiropractic care to be adapted to the specific delivery system or institution. Patients typically seek out chiropractic care directly or receive a provider referral, and ensuring system barriers do not hinder accessibility is essential. An active pragmatic clinical trial is studying the delivery of chiropractic care visit numbers and frequency needed for optimal outcomes in participants with low back pain. 

Chiropractors with strong interpersonal skills may increase engagement with other medical providers and lead to better implementation of chiropractic care. Fully integrating chiropractors into clinical environments, with privileges reflecting their full legal scope of practice, may also facilitate better diagnosis and management of pain conditions.   

Incorporating chiropractic care referrals and documentation within electronic health record systems may improve patient access to care and the overall coordination of care by facilitating communication and scheduling between medical providers and chiropractors. Telehealth may also expand patient access through virtual consultations, follow-up assessments, patient education, and remote monitoring.

Organizational change management strategies involve aligning people, processes, and systems to adopt evidence-based practices, such as chiropractic care, fostering a culture of continuous improvement, and overcoming resistance to change through communication, education, and support.  

Securing leadership support from key community members, including administrators and clinical champions, is important as motivation for organizational adoption and implementation of chiropractic care. Leadership support in the early use of nonpharmacologic options like chiropractic care and engaging with patients in the integration and implementation processes to enhance buy-in and satisfaction is valuable. 

Regulatory strategies involve creating a supportive policy environment by establishing standards, guidelines, and incentives to promote the adoption and use of evidence-based practice. 

Health systems policy change can create a more favorable environment for integrating chiropractic services, improving patient access, care coordination, and health outcomes. Policies should be patient-centered and prioritize the patient’s choice and access to a variety of care options, including chiropractic care. 

Policies regulating practice should facilitate collaboration between chiropractors and other healthcare providers and credential the chiropractor to function at the maximum of their scope in evaluating and managing neuromusculoskeletal conditions. For example, policies should support multi-component chiropractic care and not limit the chiropractor to delivering only spinal manipulative therapy. 

Health systems policy should adopt performance-based incentives and data collection and reporting to reward high-quality, cost-effective care, encouraging the integration of chiropractic services into care pathways. Adopting data collection on chiropractic care utilization and outcomes may inform policy decisions and demonstrate value. 

Expanding access and ensuring equitable payment for chiropractic care are important coverage and reimbursement reform areas. A pivotal area of focus is Medicare expansion of chiropractic care through national legislation, with bills with bipartisan support introduced in the House of Representatives and Senate during the active congressional session. As of 2025, chiropractors are only eligible for reimbursement for a single, specific service - manual spinal manipulative therapy. Other services that may be within the chiropractor’s legal scope of practice (e.g., examination procedures, exercise therapies, and acupuncture) are not reimbursed under current Medicare law. Medicare reform could expand coverage of chiropractic services and ensure Medicare patients have access to chiropractic care. 

Chiropractic care should adhere to the chiropractor’s scope of practice and clinical practice guidelines and best practices for specific musculoskeletal conditions. Chiropractors should regularly assess patient outcomes using standardized measures to track progress and modify treatment plans accordingly. Chiropractors should remain up-to-date on the latest research and best practices through self-study and continuing education. Patients should participate in treatment planning, goal setting, and shared decision-making. Care plans should be personalized and tailored to individual needs and preferences. Patients should be empowered through encouragement of self-management strategies.