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Major Health Plan Savings in CAM-Oriented PCP Project for Blue Cross Blue Shield to Be Published PDF Print E-mail
Written by John Weeks   
Wednesday, 17 January 2007

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.

ImageAn 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.

Image 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.

Image
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.

ImageT
he 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 Shield thirteen 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.



Last Updated ( Friday, 02 February 2007 )
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