As we head into the next century, healthcare finds itself looking back into the past five millennia. Perhaps there have been some "unconventional" approaches to health over the past 5,000 years that have proved quite effective. And there now seems to be payers willing to reimburse for such treatments.
Who would have thought that the likes of Mutual of Omaha, American Medical Security or Oxford Healthcare would consider paying for acupuncture, herbal medicine or reversing coronary heart disease through a regimen of exercise, meditation and diet?
Our friends in the Far East look at us as babes in the woods while we try to integrate what they consider simple common sense in creating a synergistic clinical model. Blending Western and traditional medicines is status quo at hospitals in China. They're convinced both paradigms have much to offer.
Their ancient physicians also practiced under the original capitation model. In China a doctor was paid by his patients to keep them healthy. The twist was that when they got sick, payment stopped. That was quite a motivator for doctors to learn preventive medicine. This concept might well encourage today's HMOs to develop programs that truly maintain health.
Unfortunately in the United States, these approaches have been thrown under the moniker of "alternative" medicine, connoting an either-or status. In Great Britain, this field is complementary medicine, a label that tells both patient and physician that they have choices and adjuncts in their quest for wellness.
In a complementary, multispecialty setting, practitioners can offer the best that alternative and conventional healthcare have to offer. The question is, who's in charge of disease and utilization management? Here the gatekeeper model with the primary-care physician overseeing case management would seem to be the optimal approach. If this style of care is ever to be capitated, there must be some form of conventional oversight because most alternative practitioners only have experience in a fee-for-service environment. The physician as director makes the most sense. The secret here, as practice management companies are finding, is collecting the right mix of clinicians and administrators to keep an eye on the bottom line but not at the expense of the patient.
At American Holistic Centers we have been able to treat both acute and chronic problems using an integrated approach of conventional and alternative therapeutic modalities. Last year we admitted only 12 people to the hospital, and that's with a base of 7,100 patients. Along with this we attained high scores in a recent patient-satisfaction survey.
Sandy Mathy, vice president of American Medical Security, a Green Bay, Wis.-based firm looking to carve out a niche in this market, makes this observation: "We're sending a message loud and clear to clients, healthcare providers and the entire insurance industry: Alternative care has its place alongside conventional care. Not in place of or one step behind it, but shoulder-to-shoulder with conventional medical practices."
In the Jan. 22 issue of MODERN HEALTHCARE, Ira Studin, president of the research and consulting unit of WellCare Management Group, noted that "the single most critical issue the (HMO) industry faces is production, specifically at the clinical level. If HMOs are going to continue to pay for and deliver services, the production of clinical value has to become the primary focus."
Meanwhile, an oft-quoted study in the New England Journal of Medicine revealed that one-third of Americans were using unconventional care, with more visits per year to unconventional practitioners than to primary-care physicians. These individuals are spending billions out of their own pockets, therefore sending everyone a message about how they perceive these services' clinical value.
The newfound legitimacy and efficacy of this medicine has brought out the movers and shakers of medicine. For example:
Former Surgeon General C. Everett Koop, M.D., is chairing a Congress on Alternative Medicine May 24-26 in Washington.
Marc S. Micozzi, M.D., executive director of the College of Physicians of Philadelphia, has written a text on complementary medicine aimed at doctors and published by the same firm that produces Gray's Anatomy.
Grant Hospital-Columbia/HCA in Chicago opened a unit on preventive and holistic medicine.
Even the American Medical Association is urging physicians to learn more about alternative medicine.
David Edelberg, M.D., founder of American Holistic Centers, looks at it this way: "How can we (as physicians) dissuade our patients from seeking alternative healthcare that would have a positive influence and will do no more harm? At the same time, both physicians and alternative practitioners alike must learn to know when its use is appropriate."
This is no longer an issue of whether or not an insurance plan might reimburse chiropractic services on a limited basis or if a doctor should recommend acupuncture for tennis elbow. It's about realizing that health goes beyond the mere absence of disease. If we are going to truly manage people's health and well being, this approach must be a proactive one, rather than waiting around for disease to happen and react to it.