Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
Hearing David Elton, DC, senior vice president of clinical programs at OptumHealth, speak about the company's approach to saving almost a quarter of a billion dollars per year immediately made me want to share his riveting presentation with the entire chiropractic community.
In less than 6 minutes, Dr. Elton makes the clear argument for chiropractic and other conservative care as the most cost-effective preferred providers for back pain from a payer point of view. If you haven't done so already, please take the time to watch his presentation, available on the National Academies of Sciences, Engineering and Medicine website.
The data for the math has been available for some time now – at least the past 10 years if we look at the various studies that have been published to date. If you add in the experience data all payers have, you can imagine they have seen the evidence of chiropractic's effectiveness in their own networks.
It would be easy, and accurate, at this point to blame medical prejudice for the lack of inclusion, barriers to care and dearth of referrals. And we can certainly celebrate that OptumHealth has recognized chiropractic's economic superiority, demonstrating a $109 savings per back pain episode over medical primary care providers. But what messages do these conflicting points send to DCs?
Health Care Is a Business
Your practice is a business, hospitals are a business and health insurance is a huge business. That reality has both positive and negative potential. The good news is that chiropractic's has a $109-per-episode advantage that translates into $230 million a year if OptumHealth can move just 22 percent of its insureds from medical PCPs and specialists to chiropractic, acupuncture and physical therapy. Needless to say, this advantage only continues as long as chiropractic is more cost effective.
Based on additional conversations with those in the know, in order to secure their future and partner with most health insurance companies, doctors of chiropractic will want to have the following:
- Cloud-Based Electronic Health Records – Generally speaking, integrated care is better care. That doesn't mean it takes a DC, an MD and two surgeons to address every case of back pain. Every patient (and every payer) wants all of their health care providers to be able to see all of their patient records so everyone knows the whole story.
- Online Appointment Scheduling – Other providers are less likely to refer to a DC in the network if they can't schedule a patient appointment when they see the patient. It's that simple.
- A Willingness to Communicate – Every referral requires communication. Without it, the referrals don't keep coming.
- Clear Understanding of Expectations – Payers have different expectations than cash-paying patients. You need to recognize these expectations going in.
If You're Going to Join the Team, You Have to Wear the Team Jersey
No one is forcing any DC to join any network. This is a choice that can be uncomfortable at times, especially when payer oversight comes in conflict with patient need. I personally pay for my family's chiropractic care in cash from my health savings account. It makes for a better relationship and I don't have to ask for permission to get the care I need.
DCs are being invited to join networks based on chiropractic's superior ability to help restore health without the dangers of drugs or surgery. If you are offered a position on a network, it is because the payer expects you to deliver that superior care in a cost-effective manner, allowing it to make a profit. If you accept, you are joining the payer's team.
OptumHealth is looking to move 22 percent of its back pain patient episodes to chiropractic, acupuncture and physical therapy. If I have my math right, that equates to more than 370,000 additional patient episodes and an additional $200-plus million going to conservative care providers every year. I like that math; how about you?
Read more findings on my blog: http://blog.toyourhealth.com/ wrblog. You can also visit me on Facebook and Twitter (donpetersenjr, @donaldpetersen).
