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COCSA Endorses AMI Managed CAM Integrative Medicine Model PDF Print E-mail
Written by John Weeks   

Congress of Chiropractic State Associations Endorses Alternative Medicine Integration Group: Joint Venture Engaged

Summary: On July 18, 2007, the Congress of Chiropractic State Associations (COCSA) announced an endorsement of Chicago-based complementary and alternative management company Alternative Medicine Integration Group (AMI). COCSA explained their endorsement of AMI as a belief that the firm's outcomes-oriented chiropractic care management approach "is not business as usual" for managed chiropractic. COCSA asserts that AMI's approach is better for patients, practitioners and purchasers clinically and economically. This article takes a look at this surprising "joint venture" between a managed care firm and a national association of practitioner associations.
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Image In a surprising move for an organization of practitioner organizations, the Congress of Chiropractic State Associations (COCSA) announced on July 18, 2007 that they have chosen to endorse a firm, Alternative Medicine Integration Group (AMI) which operates in the most controversial of arenas - managed care.

In a media release,
COCSA president Jerry DeGrado, DC gave his blunt view of the extraordinary move: "The AMI Group is not business as usual. We want chiropractors, patients and payers to understand this. We are thrilled to endorse AMI."

Contacted by the Integrator, DeGrado ticked off his explanation regarding AMI: "The way they go about their business will be very valuable for chiropractors.
AMI has an outcomes-based approach. Their process of claims review is a breath of fresh air. The data that they acquire in their business model is very valuable. We feel this relationships will help us show how we can best help not only our patients but also offer what will most help purchasers."

The context: A pitched battle against typical managed chiropractic

Jerry DeGrado, DC, COCSA president
COCSA presents its decision to endorse AMI, an Integrator sponsor, as part of its "role as a clearing house to help solve member state associations' problems."  COCSA has been monitoring issues of chiropractors regarding managed chiropractic. 

Says DeGrado: "The old way of managing chiropractic care is simply not working. We need a new, patient-centered approach to achieve a new and better outcome for everyone involved. This joint venture is a win-win relationship for the chiropractic profession. It will provide doctors of chiropractic with a more positive outlook and a scientifically solid platform for the future of chiropractic."

AMI's outcomes and data-centered business model

AMI Group, COCSA's joint venture partner, made a name for itself nationally through a unique HMO product using a network of non-pharmacologically oriented primary care practitioners. (See related Integrator article.) In that product, AMI contracted an integrated group of broad scope chiropractors and integrative medical doctors and osteopaths to serve a Blue Cross Blue Shield of Illinois (BCBS Illinois) population. AMI has twice had its outcomes - which have documented 50%-85% lower pharmaceutical, procedure and hospital costs in this population as compared to one managed by a typical primary care network - published in the peer-reviewed literature.

James Zechman, AMI's CEO and chair
James Zechman, CEO and chair of AMI, makes it clear, however, that the BCBS Illinois product is not what most captured COCSA's interest. AMI also offers what it calls "integrative wellness programs for preferred provider organizations." Its most mature activity has been in the state of Maryland, where AMI forged a close working relationship with the Maryland Chiropractic Association. The association helps guide AMI's peer-review process. The number of Maryland consumers who have access to covered chiropractic has grown, according to Zechman. The state became a test case that stimulated the COCSA endorsement.

For the Maryland contract, AMI developed what it calls its
ChiroOutcomes Measurement System (ACOMSsm). COCSA describes the program by stating that AMI "uses condition-specific clinical criteria and validated assessment tools to measure patient improvement and evaluate provider performance using real-time data supplied directly from both patient and the treating doctor of chiropractic."

In addition, a significant portion of AMI’s review process uses network chiropractors to educate their peers as an overall process of quality care management. “It’s always chiropractor to chiropractor and includes mentoring,” asserts Zechman.  Adds DeGrado: “It’s not a punitive process. The system means those who have been walking the line get to help gate-keep those who haven’t. If the small percentage of outliers fall in line, we’ll all be happy. It’s a much more graceful system than what’s typically out there.”

Aspects of the joint-venture and a "holy grail"

ImageIn the July 18, 2007 release, COCSA and AMI state that they "enthusiastically endorse the importance of this joint initiative to their shared mission of demonstrating the effectiveness and quality of chiropractic by supporting the objectives of COCSA's state membership." Zechman offers that he believes it speaks well of COCSA and the chiropractic profession that COCSA wishes to "use data as a positive approach to the future." Adds DeGrado: "Most chiropractors are doing the right thing. AMI's approach rewards them."

The Integrator asked COCSA's DeGrado if the joint venture has any specific benefits to COCSA or the COCSA'S state association members. DeGrado responds that "with any type of endorsement there are royalties," indicating that a state association can have such benefits for working with AMI. He adds: "There is a structure in the way AMI does business that could work for the state, which is linked to our promotion of this program." In the AMI model,
state associations also help select members of AMI's peer review teams.

The focus of the joint venture, however, is on what the parties believe AMI's technological approach can do for chiropractic's future. Zechman and his co-founder Richard Sarnat, MD, are proud of this technological core. Says Zechman: "Through ACOMS, we are able to gather patient data and marry it to clinical data and cost data. This is a kind of holy grail to us. We believe that anything short of this as a basis for managing care is insufficient and arbitrary."

Endorsement of products of any kind by healthcare practitioner association can be controversial. Ten years ago, the American Medical Association was reeling from revelations of endorsements of the products of the Sunbeam company. And if endorsement of consumer products by a practitioner association might be controversial, endorsement of a managed care organization by such an association might seem suicidal. It is this context that makes it extraordinary that COCSA would risk sticking their neck out.  But according to DeGrado it's worth it: "From our perspective it is a bigger risk to go with those are managing money and not care.” It will be interesting to see how much flak, or support, COCSA will receive for engaging this joint venture. 

The context of the COCSA decision is dynamic. For a decade, management of chiropractic, especially by American Specialty Health Plans and Minneapolis-based ACN Group (a part of the giant UnitedHealth Group), has been a core concern of chiropractic organizations. Diverse state and national associations have had these major players in their sights, skirting the edges of anti-boycotting laws. Both ASH and UnitedHealth have been known to be viciously competitive. How will these giants respond to the slap of this COCSA-AMI joint venture?

A personal note on writing about AMI

Meantime, I have been acutely conscious of the fact of Integrator sponsorship by AMI while reporting this development. My present awareness is partly because I learned of the joint venture as I was beginning to immerse myself in a separate Integrator series of articles relative to a different AMI product.

In Florida, AMI has been operating under a legislatively promoted Medicaid waiver to provide an unusual "integrative therapies pilot project." There, AMI is using a combination of massage therapists, acupuncturists, pharmacists, self-care strategies, plus management by holistically-oriented nurses, to care for a high-cost population with diverse chronic pain-related conditions. The upcoming Integrator series will include hard data on patient and clinical outcomes, as well as data and a dispute over interpretation of cost outcomes.

What intrigued me about reporting the Florida model is precisely what appears to have attracted COCSA and what peaked my curiosity about AMI nearly a decade ago. I was in regular touch with executives of many of the managed CAM networks. I regularly urged them to make the case for clinical value and global cost savings if they wished to expand the reach of CAM services as covered benefits.

Around that time, I learned of a little Chicago-based firm which was promoting a paradigm-shifting, data-oriented and outcomes-based approach to building its business; namely, AMI's HMO product with BCBS Illinois.
The founders were a medical doctor, Sarnat - an ophthalmologist who'd been a meditator for 25 years - and Zechman, an ex-Wall Street fellow. Sarnat provides an MD-cover for the out-of-the-box integrative strategies, plus, as I have observed, a certain meditation-induced, cognitive restructuring of the managed care template. Zechman passionately drives the business. Like COCSA, I have been drawn to AMI's data-based, outcomes-oriented approach and to aspects of the AMI model that seemed to respect values in the complementary healthcare community. I am hoping the COCSA-AMI joint venture will stimulate more creativity and adventurousness among other managed complementary healthcare businesses.

That said, the Integrator is continuously interested in data-based reports, particularly with a cost component, from any managed complementary and alternative healthcare entity. I would love to be disabused of my present belief that intriguing new models of integrated care are rare, and that most who claim to have useful data refuse to share their outcomes. My rule on reporting outcomes that might otherwise be considered proprietary is to work with the company on the story. Just let me know if there is something compelling out there I am missing, and I'll get to work on reporting it.

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