Special Report: Florida Medicaid Integrative Therapies Pilot Project with Licensed Acupuncturists, Massage Therapists - Part 1, Overview

Summary:  Medicaid costs are soaring. States are hurting. Strains from pain-related conditions factor in heavily. Meantime, surging prescriptions of pain medications create new sets of adverse consequences. Can an integrated care program featuring licensed acupuncturists, massage therapists and holistically-oriented nurse managers be part of the solution? Since 2002, via legislation and a Medicaid waiver, the state of Florida has engaged an "Integrative Therapies Pilot Project" to answer these questions. Chicago-based Alternative Medicine Integration Group (AMI) won the contract. This Integrator Special Report looks at AMI's clinical integration and payment model, patient and practitioner experience, and clinical and cost outcomes and controversies in the analysis of costs and cost-savings. Is this a model which Medicaid should widely promote? Part 1 of this 5-part exploration is an overview of issues and findings.

Florida's Agency for Health Care Administration

Unfortunately, the assertion has remained largely untested. The NIH National Center for Complementary and Alternative Medicine has only recently announced a an exciting program which might fund explorations of the effectiveness and cost-effectiveness of integrative therapies in real-time settings.

pitched the idea of potential benefits from such a project to legislators. AMI eventually won the contract to develop and manage the pilot in a 3-county area in the Tampa Bay area.

Vendor to AHCA on the pilot project

Since early 2004, AMI, an Integrator sponsor, has managed up to 500 patients per month out of a rotating pool of approximately 2500 eligible

• Part 1: An overview
• Part 2: Clinical management model.
  
• Part 3: Experience and outcomes for patients and clinicians.
  
• Part 4: Strategies and disputes in understanding cost outcomes.
  
• Part 5: Perspectives from national leaders in integrative community medicine. 

2.   Florida Legislature Enables Medicaid Waiver to Cover Unique Services

Florida prorgam from which pilot participants were drawn

An article last year on the pilot in the St. Petersberg Times ("Yes, Medicaid Pays for This," October 2, 2006) captured the context of the Florida legislature's decision to go outside the box of conventional treatment succinctly: "With Medicaid gobbling ever-larger chunks of state revenue, the Legislature is experimenting."

AMI's integrative therapies demonstration project was enabled by the Florida State legislature in 2002 through a clause in the state's Fiscal Year 2002-03 General Appropriations Act, Chapter 2002-225 of the Laws of Florida. The target of the appropriation was the improvement of the "quality of care and cost-effectiveness of a disease management initiative" in a localized area. The state was authorized to seek "federal Medicaid waivers or state plan amendments" if the disease management initiative would offer services not typically covered by Medicaid. The initial plan was for a 3-year pilot.

The initiative was engaged at a time that Florida's Agency for Health Care Administration identified chronic pain as the leading cost driver of any chronic disease. According to Langford, these costs outpaced those related to HIV/AIDS, asthma, hypertension and diabetes.

After approval by the legislature, management of the program was eventually granted on May 6, 2003, to Chicago-based Alternative Medicine Integration of Florida, LLC (AMI). The AMI proposal was for a AMI set about building its care model and networks of practitioners.

3.   Covered Services and Management Model

In the first phase of the program, patients were recruited through communication with conventional primary care providers (PCPs). Once the physicians agreed to have their patients participate, AMI had the opportunity to directly solicit participation of patients via mail and phone through lists provided regularly by MediPass.

Care Manager Tracy Woolrich, RN, HHP - nurse and holistic health practitioner

Rick Adams, program beneficiary

As part of the contract, AMI is required to gather outcomes on patient perceptions of their experience. These must be reported annually to the legislature. To date, AMI's reports suggest that Adams' experience is the norm. For instance, in a 2006 patient survey, AMI found that 94% of respondents (30% response rate) agreed that "program treatment providers help (me) to reduce (my) levels of pain." This is up from 86% in a prior reporting period. An AMI-conducted analysis, based on functional outcomes gathered with each visit, found that on the Physical Component Summary of the SF-12, participants showed a 24% improvement over baseline.