Major Health Plan Savings in CAM-Oriented PCP Project for Blue Cross Blue Shield to Be Published
Written by John Weeks
Major Health Plan Savings from CAM-Oriented PCP Program for Blue Cross Blue Shield to be Published in JMPT
Summary Preview:
In 1999, Alternative Medicine Integration Group began a unique project
through HMO Illinois, a Blue Cross Blue Shield plan, through which
chiropractic doctors are serving as primary care providers (PCPs) inside a
broader network of conventional medical doctors. The Journal of Manipulative and Physiological Therapeutics
(JMPT) recently accepted for publication a report on seven years of data, and
70,274 member months. Utilization data on hospital admissions, lengths of stay,
pharmaceutical costs and outpatient surgeries were all between 59% and
85% less than the utilization by the HMO's typical population accessing care through conventional PCPs. This is the second JMPT
publication on the project, but the first in which outcomes of other
CAM-oriented PCPs are reported.
Send your comments to
for publication in a future Your Comments article.
An update on hard data from one of
complementary and alternative medicine's most intriguing experiments is
about to be published in the peer reviewed media. The findings are
significant:
60.2% decrease in hospital admissions
59% decrease in hospital days
62% decrease in outpatient surgeries and procedures, and
85% reduction in pharmaceutical costs off compared to normative values.
The setting is real world. Since 1999, some members of HMO Illinois, a subsidiary of Blue Cross Blue Shield of Illinois,
have had the opportunity to choose to receive their primary care
services through a network of broad-scope, primary care-oriented chiropractors. These
practitioners practice in a context of a separate IPA network of
conventional medical doctors, whose conventional services are used when necessary.
As it turns out, following 70,274 member months, the necessity for
conventional medical services of any kind is significantly below that
of other HMO members.
The Integrator recently learned that the Journal of Manipulative and Physiological Therapeutics (JMPT)
has accepted for publication a study with these outcomes. The study
reports data from 7 years of the unique managed care product developed
by Alternative Medicine Integration Group (AMI Group). JMPT, an Elsevier publication,
published an earlier report on the first years of the AMI Group's
product, from 1999-2002. In that time period, all PCPs were chiropractors. The soon-to-be-published report continues with
the years from 2003-2005 during which AMI's panel was opened to include CAM-oriented medical doctors and osteopaths.
Jim Zechman, chair and CEO, AMI Group
Jim Zechman, chair and CEO for AMI Group, an Integrator sponsor, shared that prior to being accepted, the outcomes had to be caveated in various ways. An abstract shared with the Integrator,
for instance, notes that the generizability of the outcomes "is guarded
due to the non-randomization and lack of statistical analysis possible
in this population."
Still, the conclusions, are powerful:
"The correlation between
CAM-oriented PCPs utilizing non-surgical and non-pharmaceutical
approaches and the observed reductions in both clinical and cost
utilization when compared to PCPs utilizing conventional medicine alone
continues to be observed over a longer period of time and a larger
population than was originally reported."
Zechman notes that the cost savings held regardless of the type of CAM-oriented PCP practitioner who used non-surgical and non-pharmaceutical approaches as a first line of treatment.
Comment: Fifteen years ago when some federal research dollars began to trickle toward CAM and integrative care, I guessed - or rather hoped
- that the literature would by now be strewn with reports like this.
These outcomes, after all, are what many who focus on using "non-surgical and non-pharmaceutical approaches" claim: diminished use of pharmaceuticals, fewer conventional procedures, and lower hospitals costs.
Since these are the claims, of course that is what we will be evaluating, right? ... or so the Pollyanna minds projected. The fact that the work of the AMI Group continues to stand pretty much alone is certainly due in part to the outrageousness - compared to norms - of the DC-PCP and now broader CAM-oriented PCP business model of their HMO product. Zechman and his partner Richard Sarnat, MD linked up with advisor Jim Winterstein, DC, president of National University of Health Sciences (NUHS). NUHS, whose multi-disciplinary university is the subject of a prior Integrator article,
prepares chiropractors for a broad scope practice. The group then found
a medical director inside Blue Cross Blue Shield who was willing to
give them some rope. Now Zechman and Sarnat have added some integrative MDs and DOs.
This is a business model that is full of the common sense that prevails in the CAM and IM communities about where our culture could find value in CAM and IM. Yet it appears to be the sort of un-common sense largely possessed by the practical approach of the AMI Group. Happily, after taking the rope offered by the friendly medical director, they didn't hang themselves.
Why haven't we seen more analysis?
But
there are other factors. Most insurers don't really have an incentive to
care about cost savings or to experiment with out-of-the-box products. Complementary Healthcare Plans' vice president Chuck Simpson, DC, points this out in a recent Integrator article.)
Then there are the predispositions
and biases of the research community and research funders against
looking at money and at whole practices and whole systems of care. Most
would, as one observer put it recently to me, rather prove without a
doubt something that is meaningless than to suggest, with caveated
uncertainty, a direction that could have a great deal of impact on our
personal and economic health.
Why haven't we, for instance, yet seen published data on the decision of Regence Blue Shieldthirteen
years ago in Washington State to allow its HMO members to choose
naturopathic physicians as primary care providers? Why is it that just
this past month we saw only the second NIH National Center for Complementary and Alternative Medicine program that has a focus on dollars and the real world. (See program announcement here.).
Fifteen years ago, many of us also hoped that the CAM and IM fields
would be viewed by now as part of the answer to the problems of an
out-of-control medical industrial complex, rather than as a peculiar
little undertaking in medicine's back-eddies. To elevate what we do, we
need more policy makers, funders, researchers, and business operators
to step out of the box as AMI Group has.
More on this when the study comes out. For now ...
Send your comments to
for publication in a future Your Comments article.
Disclosure: As noted, AMI Group is an Integrator sponsor.
An update on hard data from one of
complementary and alternative medicine's most intriguing experiments is
about to be published in the peer reviewed media. The findings are
significant:
T
