Thomas was recruited to Logan University to think about how to use outcomes research to further not only the chiropractic industry but expand the infusion of chiropractors locally and regionally beyond places like the VA and other Federally Qualified Health Care (FQHC) systems where the integration has already taken place. Today, Logan embeds chiropractic physicians in two different FQHC systems in St. Louis in multiple locations, and works with the department of defense at Scott Airforce Base treating the active military. They also work with the St. Louis VA at Jefferson Barracks, and have two outpatient health centers that includes musculoskeletal ultrasound and chiropractic pediatric services. Thomas says that one of the things that he and his colleagues have been thinking about as they meet up with more and more primary care providers who don’t quite know how to medically manage low back pain is how to develop and implement an integrated approach to acute and chronic pain issues at the provider and system level. 

“I think the healthcare industry and medical care communities finally have woken up, not just to the reality of overprescribing, but also to the fact that there are people who continue to take opioids who six months later, are still stuck with the same pain issues,” Thomas says. “So, what’s the next move? How do we improve care, lower costs to the consumer and scale the innovation? That’s where systems thinking comes in. It’s one thing to have an innovative model or a great idea, but if you can’t integrate and scale it into a system successfully, it’s ‘just’ a great idea.”

"What makes The Dartmouth Institute unique is the unapologetic way it goes about asking and equipping individuals to answer really tough, complex questions in healthcare. It really pushes people to think about systems in a unique way.

I think, dream, and talk in terms of systems. As a side note, I’ll also never forget the time our class got a call from Sen. Bob Dole. The senator had just had a triple abdominal aortic aneurysm that was caught by ultrasound and surgically successfully treated. He wanted to know if we should ultrasound our Medicare population, and my classmate and I had to put that decision analysis together. That was the best and most challenging project I ever did, but what was truly special was the ability to see firsthand how this sort of analysis could have policy implications for the U.S. Medicare population—all because the senator picked up the phone and called Dartmouth."