Academic journal article Frontiers of Health Services Management

Alternatives That Work-An Insurer's Path to Integrated Healthcare

Academic journal article Frontiers of Health Services Management

Alternatives That Work-An Insurer's Path to Integrated Healthcare

Article excerpt

IT CAN BE DONE.

It is possible to redesign and enhance healthcare delivery by integrating the best of traditional, complementary, and alternative medicine. We are witnessing unprecedented growth in the mainstreaming of complementary and alternative medicine as insurers, providers, physicians, and hospitals make inroads with programs that prove the value of lifestyle modification and natural healing practices in preventing illness and managing chronic disease. As McGrady states, the integration of conventional and complementary medicine has the potential to yield great individual health and wellness benefits. At the same time, this lower-cost, higher-touch approach can achieve significant cost savings.

This commentary examines complementary and alternative medicine from the dual perspective of both a payer and a provider. We at Highmark Blue Cross Blue Shield found that providing and paying for complementary interventions are the right things to do and represent a cost-effective approach.

THE HIGHMARK EXPERIENCE

At Highmark Blue Cross Blue Shield, we realize that health insurance encompasses far more than accurate claims processing. While we were always a socially responsible company, today we are much more. As Freshley and Carlson noted, Highmark was an early adopter and now ranks among national health insurers as a leader in preventive care and integrated medicine. That leadership grew from a belief in our responsibility to public health, from careful research, and from a working knowledge of complementary and alternative medicine programs that have generated remarkable results. Simply put, we believe that traditional and complementary care are inseparable.

In offering health promotion programs, we encourage our members to participate in creating and maintaining their own health. From its humble beginnings as an experiment, our wellness programs and holistic approach to healthcare moved front and center as we refocused our strategy and carved out our mission of "helping people live longer, better." We now offer a number of innovative programs.

HealthPLACE centers-wellness centers focused on prevention and education-serve as a resource for individuals who want to take a proactive role in managing their health. These centers have expanded steadily since their founding in 1986, and provide an extensive library of health information, screenings for disease and conditions such as hypertension as well as immunizations, and workshops ranging from disease self-management to nutrition, aromatherapy, and Tai Chi.

In 1997, Highmark became the first insurer to offer the Dean Ornish Program for Reversing Heart Disease free of charge to members. The Ornish program treats people with coronary artery disease through education and hands-on support that enables them to make dramatic lifestyle changes. In 1997, an estimated 607,000 coronary bypass surgeries were performed in the United States on 366,000 patients-a 432 percent increase since 1979 (American Heart Association 2000). At an average cost of $44,820 (in 1995), total costs for all bypass surgery that year exceeded $22.2 billion (American Heart Association 2000). Also in 1997, approximately 447,000 percutaneous transluminal coronary angioplasty (PTCA) procedures were performed in the United States-a 188 percent increase since 1979 (American Heart Association 2000). At an average cost per angioplasty of $20,370 (1995 figures), the total costs for angioplasties performed in 1995 alone was approximately $20 billion (American Heart Association 2000). The total costs of revascularization were $36.32 billion (American Heart Association 2000).

Our decision to adopt the Ornish program was firmly rooted in our mission. Knowing that heart disease is the number one killer in this country and that selfdestructive lifestyles are the underlying causes, Highmark decided it would be ethically irresponsible not to offer members this alternative-and fiscally irresponsible to not seek alternatives to invasive surgery. …

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