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Dynamic Chiropractic – February 15, 1991, Vol. 09, Issue 04

The Managed Care Advantage: Why Conservative Chiropractic Care Can't Help But Win

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
As you went through grade school, you had an opportunity to meet many different people, some you liked and some you didn't. Most of the time you were taught to try to get along with everyone. It wasn't long before you realized that some children were more popular than others.

If you played sports, those children who excelled in a specific sport increased in popularity. Sooner or later you encountered a child who couldn't play by the rules. They would cheat whenever the opportunity arose and argue vehemently when caught. There was only one way to deal with such a person: you didn't invite them to play.

The health care world is in a radical transition. Cost containment has become the primary goal. For years, health insurance companies have hired hundreds of actuaries in an effort to help predict how much to charge in premiums in order to cover their costs and still make a profit. Ultimately, the actuaries always come back with the same response: There is no way to make dependable forecasts when you can't control the type, cost, or amount of care given.

The insurance industry is not replete with fools. It was not long before someone realized that the only way to control costs was to make the providers part of the team. Thus, managed care programs were born. The object was that if the health care team could provide high quality care for the patients/insured and keep the costs down, they would share in the money saved.

While this idea controlled who would provide the care, it didn't address what care would be provided. With any given health problem, there are a number of different health care solutions: some more effective than others, some more costly than others. To address this issue, the health care algorithm was born.

A health care algorithm is a very complex flow chart that determines the course of treatment and re-evaluation that a patient undergoes once they have been diagnosed. Simplified, the most effective methods of treating a problem are selected and ranked according to effectiveness, cost, and risk.

Obviously, under this scenario high-risk surgery with millionaire surgeons and mega-buck machines would rank last, while conservative, low-risk care would come first. The only question the conservative, low-risk care must address is effectiveness. If the conservative, low-risk care can show that it is also highly effective, it could well be the first choice for care.

According to Russell Coile Jr., health care futurist, fifty percent of all health care provided will be through managed care organizations by the year 1995. These managed care programs are (and have been) developing these types of health care algorithms. Fortunately, there are also a number of chiropractic research projects that are attempting to demonstrate the advantages of positioning chiropractic care at the front of the algorithm for applicable conditions.

But there are still two issues that need to be addressed in a more complete manner:

First, we must fund the necessary research to continue to demonstrate the cost effectiveness of chiropractic care. The Meade et al. study was a very important part of this research, but much more needs to be accomplished in order to establish this fact beyond all doubt.

Second, remember what you did when you discovered that someone was always cheating ... you didn't play with them anymore. While it is certainly true that many of our problems are being resolved from within the profession, we must continue this endeavor.

The move towards managed care will intensify the magnifying glass through which the chiropractic profession is examined. We already have a problem with DCs in Washington and Colorado who are abusing the CHAMPUS (Civilian Health and Medical Program United Services) demonstration project. They see this as an opportunity for two years of "easy money." The preliminary figures are showing the entire profession as being abusive and much less cost effective than most of the profession really is.

If their abuse continues, it may ruin our profession's chances of being accepted into CHAMPUS. Unfortunately, a few can undermine the reputation and apparent cost effectiveness of all. The chiropractic profession cannot afford to let this happen. Our future is at stake.

Over the next few months, we will be bringing you more information about the various managed care options and how you can benefit from them.

DMP,Jr.,BS, HCD(hc)

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