Cost-effectiveness of integrative medicine suggested in stdy

A study of integrative care in HMOs suggests success.

Results of a follow-up study released today from the Journal of Manipulative and Physiological Therapeutics (May 2007;00:1-7) reinforce and amplify the effectiveness of an integrative IPA management model vs. conventional strategies to decrease clinical utilization and costs over an extended period of time and in a safe and highly regulated large Chicago HMO environment. The unique feature of the care model was that doctors of chiropractic (DCs) represented two-thirds of the primary care providers involved.

In the report, "Clinical utilization and cost outcomes from an integrative medicine independent physician association: an additional 3-year update," authors Richard L. Sarnat, MD, James Winterstein, DC and Jerrilyn A. Cambron, DC, PhD analyze utilization data from the IPA and include first-time comparisons in data points among primary care physicians (PCPs) whose training backgrounds were in chiropractic, osteopathic and allopathic medicine.

Author Dr. James Winterstein says, "Health care delivery in the United States has become 'business centered' rather than 'patient centered. The AMI model, through the integration of allopathic, osteopathic, chiropractic and various forms of alternative and complementary medicine, has demonstrated the potential to revolutionize health care delivery by refocusing on the needs of the patient. This model eliminates the turf battles and in doing so, greatly diminishes costs while helping the patient optimize health with fewer high tech procedures and less hospitalization. These should be the intentions of all who function in health care delivery."

According to Mike Flynn, DC, board member and spokesperson for the Foundation for Chiropractic Progress (, "This continuing study clearly establishes the ability of the doctor of chiropractic to function effectively and efficiently as primary care gatekeepers in a managed care setting. Decreased utilization was uniformly achieved by all providers."

Results of the study demonstrate clinical and cost utilization decreases based on 70,274 member-months over a seven-year period. Differences in utilization include: 60.2 percent in-hospital admissions, 59.0 percent hospital days, 62.0 percent outpatient surgeries and procedures and 85 percent in pharmaceutical costs when compared with conventional medicine IPA performance for the same HMO product in the same geography and time frame. The IPA's current PCP 21-member physician panel includes a mix of 14 DCs, and seven MDs and DOs.

Dr. Flynn notes that the current study updates the authors' initial report (JMPT, 2004) and covers a larger population than originally reported. Methodology included demographic analysis and patient satisfaction surveys to determine clinical utilization and costs. Comparisons to the original publication's comparative blinded data, using non-random matched comparison groups, were also assessed for differences in age and disease profiles to compare outcomes.

HMO members are recruited to the IPA during an open enrollment period offered to the total plan population. Members obtain information about the IPA from the HMO's standard primary care and specialist physician directories or their companies' human resources personnel. No marketing incentives were used by the HMO to attract potential patient enrollees to the IPA study during any of the years of operation.

"This study gives credence to the perspective that the power to achieve reduced utilization results from the underlying philosophy of patient management and is not the result of differences in PCP education or licensure," says Dr. Flynn. "As our nation faces the acute challenges of rapid escalation of health care costs, and with conventional strategies for clinical improvement and cost containment failing to achieve targeted goals, all stakeholders can look to this study for evidence of an integrative model's ability to deliver tangible results."

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About F4CP

The Foundation for Chiropractic Progress is a 501c6 corporation that represents a cross section of the chiropractic and vendor communities with the goal of increasing the public's awareness of the benefits of chiropractic.

Law Offices of Michael H. Cohen offers general corporate legal services, litigation consultation, and expertise in health law with a unique focus on holistic, alternative, complementary, and integrative medical therapies. The law firm represents medical doctors, allied health professionals (from psychologists to nurses and dentists) and other clinicians (from chiropractors to naturopathic physicians, massage therapists, and acupuncturists), entrepreneurs, hospitals, and educational organizations, health care institutions, and individuals and corporations.

Michael H. Cohen is Principal in Law Offices of Michael H. Cohen and also President of the Institute for Integrative and Energy Medicine (also known as the Institute for Health, Ethics, Law, Policy & Society), a forum for exploring legal, regulatory, ethical, and health policy issues involved in the judicious integration of complementary and alternative medical therapies (such as acupuncture and traditional oriental medicine, chiropractic, massage therapy, and herbal medicine) and conventional clinical care. The most recent published book by Michael H. Cohen on health care law, regulation, ethics and policy pertaining to complementary, alternative and integrative medicine and related fields is Healing at the Borderland of Medicine and Religion. This book completes the cycle begun in Complementary and Alternative Medicine: Legal Boundaries and Regulatory Perspectives (1998), and continued in Beyond Complementary Medicine: Legal and Ethical Perspectives on Health Care and Human Evolution (2000), and Future Medicine: Ethical Dilemmas, Regulatory Challenges, and Therapeutic Pathways to Health Care and Healing in Human Transformation (2003).

As of 2007, health care and corporate attorney Michael H. Cohen has been admitted to the Bar of California, Massachusetts, New York, and Washington D.C., and to the Bar of England and Wales as a Solicitor (non-practicing). For more information, see the FAQs for the Law Offices of Michael H. Cohen.