cfo magazine nura life sciences webinar presentation on integrative medicine for self insured payors

CFO Playbook on

Health Care Cost Management

CFO Playbook on Health Care Cost Management

Guests:

• Wayne H. Miller, founder and CEO of Nura Life Sciences

• Dr. Leonard A. Wisneski, MD, FACP, clinical professor of medicine at George Washington University Medical Center, adjunct faculty in the division of integrative physiology at Georgetown University

2


• Self-funded corporate health care plans lack efficacy data.

• As a result, the 50-year-old health care payment system has become dysfunctional.

• What is needed is an EVA approach to health care cost management which focuses on value.

3


• Why is efficacy data missing?

• The health care system was never built to collect the data.

• U.S. HHS official: “We don’t have a way to pay for things that work.”

4


Anecdote from an official at a Fortune 100 company that spends $100 million per month on health care:

“We don’t have any data.”

No quantitative basis of how we will allocate the $1.2 billion health care budget.

This is how the self-insurer health care ecosystem works.

5


• The backbone of the health care payment system is coding.

• Coding is based on how much training a doctor/practitioner has gone through, plus how much time a treatment takes.

• But no data is collected related to telling companies whether what they are paying for what works.

6


• The embedded dysfunction of the health care payment system influences the behavior of constituents.

• As a result, it is nearly impossible to create incentives to help create a more efficient system.

• In addition, the current payment system does not capture the activities of more than one million practitioners that work in the integrated medicine field.

7


• Until you access the data where it lives in the process, you will be unable to build efficiency into the system.

• Currently, the system pays for the time of the activity, not the value.

• As a result, incentives are misaligned.

8


• If real-time, health-treatment data is captured, that information would help corporations drill down into which treatments work and which ones don’t.

• Integrated medicine is a multidisciplinary approach to health care, similar to the way a money manager uses a portfolio approach to diversify risk.

9


• How does having this data reduce corporate health care costs?

• Using an integrated approach that includes conventional and alternative medical treatments drives value into your capital spending.

10


Capturing the data is something only the private sector can do.

Private sector capital is at risk.

Corporations know how to use data to drive efficiencies.

This is similar to a supply chain exercise, which corporations regularly control.

11


• Some self-funded plan data can be found:

Existing third-party administrators;

Mining claims data.

• However, there are system snags:

Treatment innovation that is more expensive is more acceptable;

Treatment innovation that is less expensive cannot be measured or value quantified.

12


• Budgeting & forecasting health care costs have traditionally relied on increasing last year’s spending.

• Yet the forecasting goal should be to reduce last year’s expenditures related to chronic conditions by 20% (chronic conditions account for 75% of all corporate expenditures).

• Compensation incentives should drive this cost-reduction effort.

13


Dr. Leonard Wisneski

A presentation within today’s presentation that will:

Define integrated medicine for corporate executives;

Highlight research results from the Bravewell Collaborative;

Identify chronic pain as being paramount to lost employee time.

14

Integrative Medicine:

The Future of Healthcare Delivery

Leonard A. Wisneski, MD, FACP

A ROSE BY ANY OTHER

NAME

• Integrative Medicine- Universities, Public

• Complementary and Alternative Medicine

(CAM) - Government

National Center for Complementary &

Alternative Medicine (NCCAM)

1. Formed in 1998 by Public Law 105-277

2. Authorization a) Conduct scientific research on CAM

b) Train researchers

c) Disseminate authoritative information about CAM to the public and health professionals

d) 15 R 25 grants were awarded between 2000-2003 in order to support the incorporation of CAM information into allopathic health professions schools curricula at the undergraduate, graduate, and continuing education levels

Definition of CAM

NCCAM

Health promotion, illness prevention,

and healing practices that are outside

what is considered to be conventional

medicine.

NCCAM

“Integrative Medicine should integrate the

most effective treatments for patients by

combining both conventional and

alternative approaches to address all

aspects of health and wellness – biological,

psychological, social, and spiritual.”

Consortium of Academic Health Centers

for Integrative Medicine (51 med schools)

“The practice of medicine that reaffirms the

importance of the relationship between

practitioner and patient, focuses on the whole

person, is informed by evidence, and makes

use of all appropriate therapeutic approaches,

healthcare professionals, and disciplines to

achieve optimal health and healing.”

NIH/NCCAM

CLASSIFICATION OF CAM

1. Whole Medical

Systems

• Traditional

Chinese Medicine

• Ayurveda

• Homeopathic

Medicine

• Others

2. Mind-Body

Medicine

• Biofeedback

• Hypnosis

• Meditation

• Prayer

• Others

NIH/NCCAM

CLASSIFICATION OF CAM

3. Biologic-Based

Therapies

• Dietary Therapy

• Herbal Medicine

• Neutraceuticals

4. Manipulative/Body

Based Methods

• Osteopathic

Manipulation

• Chiropractic

Medicine

• Massage Therapy

5. Energy Therapies

• Therapeutic Touch

• Qi Gong

• Bioelectric Field

Manipulation

• Reiki

• Diagnostic Devices

• Therapeutic Devices

Integrative Medicine:

Proposed Classification

1. Conventional Diagnostics and Therapeutics

2. Traditional Medical Systems

3. Bioenergetic Medicine

4. Nutritional Based Therapeutics

5. Manipulative/Body-Based Therapies

THE EMERGING

PHILOSOPHY OF MEDICINE

• Remember the Healing Power of Nature

• View the Whole Person

• Identify and Treat the Cause

• The Physician Is a Teacher

• Prevention Is the Best Cure

“Students must have sufficient knowledge of the commonly employed alternative remedies to counsel patients about those that are harmful, those that might interact adversely with prescribed medications, those that are harmless and can be used with impunity, and those that have been shown to be beneficial.” Jordan J. Cohen, President of AAMC Academic Medicine, June 2000

RECENT HISTORICAL MILESTONES

President Clinton establishes the White House

Commission on Complementary and Alternative

Medicine Policy (2000).

Founding of the Consortium of Academic Health

Centers for Integrative Medicine (2000).

Formation of the Integrated Healthcare Policy

Consortium (2001)

Institute of Medicine CAM Conference (2003)

Institute of Medicine CAM Conference (2009)

Integrative Medicine in America Report (2012)

SPECIALTY CENTERS FOR CAM

RESEARCH AND PRACTICE

• University of Colorado

• Harvard University

• Johns Hopkins University

• University of Maryland

• UCLA

• University of Arizona

• University of

Pennsylvania

• Emory University

• Georgetown

University

• Oregon Health

Sciences University

• Scripps

• Others

Several academic centers including:

SITE SELECTION AND METHODS • 60+ sites identified from Bravewell Clinical Network, Consortium of Academic Health Centers for Integrative Medicine and suggested by IM leaders • 29 chosen to represent the field

• • • • •

Directed by MD, other doctoral level provider or nurse

In operation at least three years

Significant patient volume

Prior clinical contributions to the field

Sites only delivering non-conventional care not included

• Directors responded to REDCap-based questionnaire • Site visits made by study team for qualitative data

WHO WE ARE • AFFILIATIONS

• • • •

27 centers affiliated with a specific hospital

26 centers affiliated with a healthcare system

25 centers affiliated with a medical school

1 center affiliated with a nursing college

• CARE MODELS

• • • •

26 offer consultative care

18 offer comprehensive care

13 offer primary care

15 offer inpatient services at affiliated hospital

• RESEARCH AND EDUCATION • 25 centers involved in research and 25 in provider education

THE NUMBERS GAME

• 29 Centers

• Questioned about treatment of

• 20 Medical Conditions • Using

• 34 Interventions

• YIELDS A LOT OF NUMBERS!!!

CONCLUSIONS AND NEXT STEPS

• Integrative Medicine is an established part of healthcare in the US with increasing acceptance and demand

• Integrative Medicine is truly integrative

• Integrative Medicine is being practiced in diverse sites with high concordance for specific conditions suggesting practice is evidence-informed

• Prospective outcomes data and cost-effectiveness data should be collected

• Systems to further identify and share best practices among centers and practitioners should be developed

The Integrative Healthcare Policy

Consortium

(IHPC)

IHPC

• Broad coalition of healthcare organizations, clinicians, patients and educators

• IHPC advocates for public policy that ensures all Americans access to safe, high quality, integrative, whole person healthcare

• Integrative healthcare includes conventional, complementary and alternative disciplines in a collaborative effort to influence the future of healthcare delivery in the United States

IHPC Mission

To direct the national healthcare agenda towards

a health-oriented, integrative system, ensuring

all people access to the full range of safe and

regulated conventional, complementary, and

alternative healthcare professionals, therapies,

and products, and to the building blocks of

health, including clean air, water, and a healthy

food supply.

IHPC Accomplishments

• National Policy Dialogue 2001

(Georgetown University)

• National Educational Dialogue 2004


• National Stakeholders Conference 2010


• Responsible for several inclusions in ACA

• Congressional Briefings 2011-2012

Affordable Care Act

• Section 2706: Non-discrimination in healthcare

• Section 3502: Inclusion of CAM practitioners in the Medical Home

• Section 4001: National Prevention, Health Promotion, and Public Health Council

• Section 4206: Demonstration projects concerning individualized wellness plans

• Section 5001: National Healthcare Workforce Commission

• Section 6301: Patient-Centered Outcomes Research

• Section 2301: Coverage for freestanding birth center services


Next steps:

• Collect data;

• Create a business model that funnels the right health care data into your working capital;

• Reduce total cost of self-insured health care plans.

44


Special invitations to CFOs

• Create a list of 10 clinical conditions/areas on which your company spends the most amount of money.

• Send the list to Wayne Miller who will produce a cost comparison between your current expense and the potential savings derived from a self-funded plan that includes conventional and integrated medicine.

Email: [email protected]

Email subject line: Health Care Cost Comparison

45


Special invitations to CFOs

• If you already understand the benefits of an EVA approach to health care plans, and would like to find out more about participating in a demonstration project to lower your plan costs contact Wayne Miller.

Email: [email protected]

Email subject line: Interested in Demonstration Project

46


Special invitations to CFOs and their colleagues:

• Join the discussion about using an EVA approach to reduce self-funded health care costs

Discussion Group on LinkedIn: http://linkd.in/QGhmy4

All participants in today’s webcast are pre-approved to join the LinkedIn discussion group.

Stay tuned to our next CFO Playbook Webcast on Thurs., Oct. 10, starting at 2 pm Eastern time –

The CFO Playbook on Risk Management: Best Practices from the London Olympics

47

http://linkd.in/QGhmy4

cfo magazine nura life sciences webinar presentation on integrative medicine for self insured payors

Documents