Freelancers Union’s insurance company to innovate alternative care in patient-centered medical home; Grand Rapids ER’s new Center for Integrative Medicine anticipated to save system over $10-million each year; Arizona Center for Integrative Medicine partners with Maricopa County to pilot test integrative primary care clinic; Donna Karan brings Urban Zen Integrative Therapy program to UCLA

Freelancers Union’s insurance company to innovate alternative care in patient-centered medical home

The Freelancers Insurance Company (FIC) is pioneering strategies to bring alternative care into a patient–centered medical home, according to an article, Health Care for a Changing Work Force, in the December 1, 2011 New York Times. FIC reportedly has revenues of roughly $100 million and covers 25,000 independent workers.  Because FIC maintains a close relationship with its insureds, “it can be more effective [than most plans] helping its members make good health care decisions.” Sara Horowitz, the founder of the Freelancers Union, which owns FIC, explains: “We’re moving away from fee-for-service medicine to one where a primary care doctor aggressively coordinates care … We’re also trying to innovate with alternative care — promoting meditation, yoga, and nutrition which can have long-term beneficial effects.” The article notes that in 2012, the organization will be opening up the Brooklyn Freelancers Medical Practice. This center will be a patient centered medical home (PCMH) based on the model of Rushika Fernandopulle, MD who “pioneered a team-based model of care that is attracting attention across the country.” The FIC’s rates are already a third below market. (Thanks to Integrator adviser Glenn Sabin for the link to this article.)

Grand Rapids ER’s new Center for Integrative Medicine anticipated to save system over $10-million each year

A new strategy for emergency room services based on a close partnership with an integrative medicine center is expected to save upwards of $300 million a year when expanded to 8 hospitals. In an MP3 available interview, Corey Waller, MD explains that the person-centered, time-intensive approach that will be mounted in Grand Rapids, Michigan focused on high-utilizers. Waller’s team identified 953 people in the system who accounted for 20,000 visits in 2007-2011. A pilot study of just 30 patients found ER services could be reduced visits by 85% for each participant for a savings of $1-million. The intensive treatment at the integrative medicine center begins with a 4 hour visit. This includes an hour each with an MD, a nurse case worker, an MSW for psychiatric and substance-related diagnosis and then a “regular social worker” and office staff who focus on community support issues. Patients are being recruited to the center by directly calling those who used the ER 10 or more times in the previous year. The program is expected to cost $950,000 a year but is expected to save the ER $3.5 million and also reduce costs by some $25-$35 million for the two feeder hospitals. Spectrum health’s news release is here

Comment: My first feeling on listening to the MP3 regarded the horror of current practices. How can we have drifted to a point where such huge savings are ostensibly such low-hanging if we just organize some caring contact? Why are we only getting on this now? 

I also find it interesting and even ironic that Spectrum chose to call their new clinic a “center for integrative medicine.” While the program is patently “integrative,” no one associated appears to have any direct relationship to what may be called the movement for integrative medicine. The re-frame brings to mind the way that Christy Mack, head of the Bravewell Collaborative, pointedly declares that “integrative medicine is not CAM.” Now the Spectrum group appears to be declaring that integrative medicine is not integrative medicine. The Spectrum version is a bio-psycho-social-environmental team-based approach with no apparent connection with the integrative medicine in academic medicine field, such as Mack and Bravewell have backed. Nor does the Spectrum model reflect services advanced in the holistic medical community, or in the CAM disciplines. One way to look at this is to simply declare success. That said, it would be interesting to see how integrative medicine and CAM leaders might add value to this already remarkable integrative medicine initiative.

 

Arizona Center for Integrative Medicine partners with Maricopa County to pilot test integrative primary care clinic

According to a November 28, 2011 release, the University of Arizona Center for Integrative Medicine (AzCIM) has engaged a partnership with Maricopa County, Arizona [Phoenix] to pilot delivery of integrative medicine to the county’s 13,000 public employees. Medical outcomes and costs will be compared between patients receiving conventional medical care and those receiving integrative care. The Adolph Coors Foundation funded the pilot, which is expected to generate publishable data on the effect of integrative medicine on patients’ health.

The Phoenix Integrative Primary Care Clinic is slated to open in July 2012. Says Andrew Weil, MD, founder of the Arizona Center: “We believe this is the first step toward changing priorities of reimbursement, away from disease management and dependence on costly pharmaceutical drugs and other high-tech interventions, and toward sustainable wellness,” said Andrew Weil, MD. Roughly 1500 employees are expected to access services the first year. David Smith, Maricopa County manager explains the county’s interest this way: “Given the current health-care cost spiral and obesity crisis in the United States, the Maricopa County Board of Supervisors has decided to make preventive integrative care and treatment options more accessible to our employees.” Initial information on the program does not specify what sort of integrative services would be offered. A useful article on the project is here. A PDF of the agreement between the two entities is here.

Comment: The program, while certainly not the “first step toward changing priorities of reimbursement,” is an interesting and perhaps even high-risk gambit for the University of Arizona Center. The Center is not known for the clinical components of its training. It’s signature fellowship is principally online. What will an “integrative medicine intervention” include? What population(s) will the clinic target? A smart move might be to emulate the Spectrum Health program, reported above, and bring in those high utilizers.

 

Donna Karan brings Urban Zen Integrative Therapy program to UCLA

The New York-based Urban Zen Integrative Therapy Program is now officially bi-coastal. The Donna Karan backed program announced on November 18, 2011 that it is partnering with UCLA. A first group of 30 doctors, nurses and other allied health professionals began training in September. Gillian Cilibrasi, Urban Zen’s program director explains: “During this curriculum, medical professionals from the UCLA Health System (are) trained in five modalities of treatment: yoga therapy, Reiki, essential oil therapy, nutrition and contemplative care.” In comments contained in the release, David Feinberg, MD, MBA, president of the UCLA Health System, positions the Karan initiative as advancing UCLA’s long-time commitment to integrative approaches. Referenced were the UCLA Center for East-West Medicine and UCLA’s Mindful Awareness Research Center. The Ronald Reagan UCLA Medical Center, part of the UCLA Health System, is the first UCLA hospital and the first on the West Coast to adopt the Urban Zen program.

Comment: I confess to wondering when I first heard about Urban Zen’s go-it-alone expansion plans. Hollywood is clearly the next best place to leverage Karan’s name and involvement to secure the additional philanthropic support that UCLA has already announced that it will be seeking.