Delivering Integrative Healthcare Under Consumer-Driven Health Plans: An ABC Coding Case Study

1. Delivering Integrative Healthcare Under Consumer-Driven Health Plans: An ABC Coding Case Study 6121 Indian School Road NE, Suite 131 Albuquerque, NM 87110 Tel: 505-875-0001 Fax: 505-875-0002 www.alternativelink.com

2. Delivering IHC Under CDH PlansAn ABC Coding Case Study • Case Study Overview • Enabling Technologies & Outcomes • Implications & Imperatives

3. Case Study Overview Using ABC Codes to Improve Care, Claims & Outcomes Ardent / Lovelace Sandia / Bridgesdeployed the nation’s only system for automatically processing insurance claims for integrative healthcare. The system was designed to save more than 75% in claims management costs for one of the fastest growing segments of care. It was also designed to improve the economic & health outcomes of care so more beneficiaries could get better care at a lower cost.

4. Promote a unique brand image & attract healthier beneficiaries Appeal to wellness-oriented populations Reduce administrative & medical costs in the senior plan Leverage information technology & focus on high cost CAM-responsive diagnoses Expand savings to other plans& enhance overall performance Apply best IHC / CDH practices Case Study OverviewArdent / Lovelace Sandia / Bridges (Business Goals)

5. Empower patients through education Provide access to an integrative healthcare team Promote open communication between patients & practitioners Focus on restoring & maintaining total well being Measure success, identify what works & replicate it Case Study OverviewArdent / Lovelace Sandia / Bridges (Care Goals)

6. Case Study Overview Ardent / Lovelace Sandia / Bridges (Data Goals) • Unbiased Measurement!

7. Case Study OverviewCoding & the National Health Information Infrastructure • International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM ) • AMA’s Physician’s Current Procedural Terminology (HCPCS Level I/CPT) • Healthcare Common Procedure Coding System (HCPCS Level II) • Code on Dental Procedures & Nomenclature (CDT) • National Drug Codes (NDC) • What Was Missing & Why Did It Matter?

8. Case Study OverviewCritical Insight: Growing Demand for IHC / CDH • 40% - 69% of Americans use integrative healthcare. • 56% of Americans believe health plans should cover integrative healthcare. • >8 states have passed health freedom legislation to support access to integrative healthcare. • 60% of physicians have made integrative healthcare referrals. • 50% of physicians will increase usage of integrative healthcare. • 70% of family physicians want integrative healthcare training. • 80% of medical students want integrative healthcare training. • 64% of medical schools offer courses in integrative healthcare. • 67% of HMOs offer integrative healthcare of some kind.

9. Acupuncture Allopathic Medicine Ayurvedic Medicine Body Work Botanical Medicine Chiropractic Clinical Nutrition Conventional Nursing Holistic Medicine Holistic Nursing Homeopathic Medicine Indigenous Medicine Massage Therapy Mental Healthcare Midwifery Naturopathic Medicine Oriental Medicine Osteopathic Medicine Physical Medicine Somatic Re-education Case Study OverviewCritical Insight: Shifting Consumer Demand

10. 629 million CAM office visits  1.4 billion CAM office visits 386 million PCP office visits  1.1 billion for MD/DO office visits Source: http://www.medinfo.ufl.edu/cme/grounds/pauly/; Eisenberg,et al, JAMA,Nov11,1998, Vol 280, No 18; HHS 1999/2000; Alternative Link 2004 Case Study OverviewCritical Insight: Growing Number of IHC / CDH Encounters

11. Case Study OverviewCritical Insight: Growing Number of IHC Practitioners

12. Enabling Technologies & Outcomes Data Standards for Research, Management & Commerce New IHC / CDH data elements included... • ABC Codes Think: “More Complete, Accurate & Precise Codes (Like UPCs)” • Practitioner Identifiers (Code Modifiers)Think: “Qualifications of the Caregiver” • Relative Value Units (RVUs)Think: “Resource-Driven Pricing Rationale” • Legal Practice Guidelines Think: “Per Intervention, Per Practitioner & Per State Legality”

13. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

14. Major Practitioner Types Modifier • 1A Doctor of Chiropractic • 1B Licensed Massage Therapist • 1C Doctor of Oriental Medicine • 1D Registered Midwife • 1E Naturopathic Doctor or Physician • 1F Clinical Nurse Specialist • 1G Certified Nurse Midwife • 1H Nurse Practitioner • 1J Licensed Practical Nurse • 1K Registered Nurse • 1L Doctor of Osteopathy • 1M Medical Doctor • 1N Physician Assistant Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

15. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines Financial Value ABC Code Hierarchic Description Legal? Detailed Description of Intervention

16. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

17. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

18. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

19. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

20. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

21. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

22. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines

23. Enabling Technologies & Outcomes ABC Codes, Practitioner Identifiers, RVUs & Legal Practice Guidelines • Financing • Improved pricing • Improved contracts • Improved revenues • Administration • Improved inter- & intra-organizational interactions • Improved allocation of organizational resources • Improved operating efficiencies • Improved bottom line • Delivery • Improved patient-practitioner & practitioner-practitioner relationships • Improved understanding of optimal treatment pathways • Improved outcomes, esp. for chronic conditions

24. Implications & ImperativesImproved Care, Claims & Outcomes • ABC codes, practitioner identifiers, RVUs & legal practice guidelines create bottom line performance improvements by supporting... • electronic data collection (for research) • electronic data analysis (for management) • electronic data interchange (for commerce)

25. Implications & ImperativesImproved Care, Claims & Outcomes • ABC Coding Manual for Integrative Healthcare • Practitioner Guides to Billable Interventions Using ABC Codes • Superbills for Integrative Healthcare • HealthIntel Database (Codes, Identifiers, RVUs & Legal Logic) • ABC / CPT / HCPCS II Crosswalk • Relative Values for Integrative Healthcare Using ABC Codes • CAM Market Report

26. Implications & ImperativesMore Complete, Accurate & Precise Data for the NHII ABC Codes Need for Research Tools to Identify the Most Cost-Effective Approaches to Care Need for Management Tools to Improve Business Processes in Healthcare Need for Commerce Tools to Support Industry Efficiencies Need for Expanded Standards to Support Consumer Demand for Integrative Healthcare Need for Complete Standardsto Support the National Health Information Infrastructure Need to Resolve U.S. Healthcare Challenges: Access, Quality & Costs

27. Implications & ImperativesImproved Access, Quality & Cost-Management Alternative Link delivers information products & consulting services that help health-promoting organizations & individuals finance, administer & deliver cost-effective care that improves individual & public health, business & industry efficiencies & socioeconomic development. 6121 Indian School Road NE, Suite 131 Albuquerque, NM 87110 USA Tel: 505-875-0001 Fax: 505-875-0002 Email: Mail@AlternativeLink.com Web Site: www.AlternativeLink.com