Clinical and Cost Outcomes of an Integrative Medicine IPA

Abstract

Objective

We hypothesized that primary care physicians (PCPs) specializing in a nonpharmaceutical/nonsurgical approach as their primary modality and utilizing a variety of complementary/alternative medicine (CAM) techniques integrated with allopathic medicine would have superior clinical and cost outcomes compared with PCPs utilizing conventional medicine alone.

Design

Incurred claims and stratified randomized patient surveys were analyzed for clinical outcomes, cost offsets, and member satisfaction compared with normative values. Comparative blinded data, using nonrandomized matched comparison groups, was analyzed for age/sex demographics and disease profiles to examine sample bias.

Setting

An integrative medicine independent provider association (IPA) contracted with a National Committee for Quality Assurance (NCQA)-accredited health maintenance organization (HMO) in metropolitan Chicago.

Subjects

All members enrolled with the integrative medicine IPA from January 1, 1999 through December 31, 2002.

Results

Analysis of clinical and cost outcomes on 21,743 member months over a 4-year period demonstrated decreases of 43.0% in hospital admissions per 1000, 58.4% hospital days per 1000, 43.2% outpatient surgeries and procedures per 1000, and 51.8% pharmaceutical cost reductions when compared with normative conventional medicine IPA performance for the same HMO product in the same geography over the same time frame.

Conclusion

In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone. While certainly promising, these initial results may not be consistent on a larger and more diverse population.

Introduction

The escalation of medical expenditures is an urgent problem. Although various types of managed care, once thought by some to be part of the solution to increasing medical expenditures, have been used for decades, little evidence exists that this or any other cost-containment strategy has significantly influenced a 50-year trend of increasing medical expenses on a long-term basis.1., 2., 3., 4., 5. Managed care rates are now posting double-digit annual increases,⁶ with pharmaceuticals estimated to account for 50% of the cost increases over the past 3 years.⁷

While the health care system excels in acute care and crisis disease state management, this accounts for only a small percentage of the total medical care in both cost and volume rendered daily.⁸ The greater health care burden is the prevention and treatment of the multiple chronic disorders in the general population that now account for the majority of health care expenditures.⁹

Chronic diseases are a major public problem in the United States. Currently, about 40% of the US population (approximately 100 million Americans) suffer from at least 1 chronic disorder.⁹ This high level of prevalence within the United States raises concerns about the efficacy and limitations of our conventional health care system.¹⁰ Such concerns appear to contribute to public and professional interest in alternatives to conventional modern medicine.

Studies now suggest that 50% of the deaths¹¹ and 70% of the diseases¹² in the United States are caused by unhealthy lifestyle habits such as smoking, alcohol abuse, and improper diet. Unlike the preantibiotic era when mortality was primarily because of infectious diseases, our nation now faces a behavior-induced epidemic of chronic illness. Managed care and government policy makers are faced with the dilemma of trying to decrease medical costs caused mainly by lifestyle choices while continuing to maintain personal freedom of choice.

Iatrogenic illness (an adverse condition arising from the treatment of a physician) is estimated as the etiology of 15% of our hospital days, and pharmaceuticals are estimated to cause between 100,000 to 250,000 deaths per year,13., 14. as well as nonquantifiable morbidity. Prescription drug addiction, administering the wrong drug, and prescription overdoses are a large percentage15., 16. of reported deaths by medical mistake. The National Conference of State Legislatures, November/December 2000, estimates the cost of lost income, disability, and health care resulting from medical mistakes is as much as $29 billion per year.¹⁷

Given these facts, it may be time to rethink this country's current medical model with its overall reliance on pharmaceuticals as a first line option. Complementary/alternative medicine is one viable approach that should be considered because it addresses the privacy, quality, and expense considerations facing health care delivery systems.

Unlike conventional medical education and care, which relies heavily on high technology and pharmaceuticals, complementary/alternative medicine exists in a “low-tech arena.” “Low-tech” therapeutic modalities such as chiropractic manipulation, homeopathy, stress management, massage, and use of herbal medicines are perceived by the public as more gentle, less morbid, and less costly than conventional modern medicine.¹⁸

Many previous studies on various complementary/alternative medicine (CAM) modalities have illustrated improved clinical outcomes and substantially decreased costs compared with standard conventional medical practice protocols.19., 20., 21., 22., 23., 24., 25., 26., 27., 28., 29., 30., 31., 32., 33., 34., 35., 36., 37., 38., 39., 40., 41., 42., 43., 44. However, while individual diagnostic categories have been analyzed, a study of the clinical outcomes and cost effectiveness of primary care physicians (PCPs) specializing in CAM, and more particularly chiropractic care, within the context of a classical gatekeeper health maintenance organization (HMO) has never previously been attempted.