Is The Multidisciplinary Approach The Answer To Managed Care?

by Bob Braile, D.C.
President of I.C.A.

Many individuals in our profession are attempting to solve the onslaught of managed care with alterations in the way we deliver our services. For almost the past two decades chiropractic has been engaged in a battle to get equal inclusion in the insurance industry for our services. Now we are faced with the latest mutant of insurance coverage called managed care. Although this new system is a third party based system, the rules have drastically changed.

One of the more widely discussed issues in our profession has been the establishment of multidisciplinary practice groups for inclusion into managed care programs. This hotly debated issue has created much fervor in our profession as some tout this as the way to adapt to the managed care situation, while others see this as getting into bed with the enemy.

In the March ‘96 issue of the ACA today newsletter, there appeared a feature article on the ACA’s Manage Care Conference. In this article the keynote presentation, by Russ Coile, a "futurist specializing in the health care industry" was emphasized. To quote the article, "Coile said that chiropractors need to move decisively to take control of capitation and get organized for survival. This means that chiropractors must (emphasis added) affiliate with emerging multiprovider networks or multidisciplinary groups that include physicians, physical therapists, and other health care providers."

If this is the opinion of the keynote speaker at this managed care conference, one can only conclude that this is the party line of defense for our profession by that association. With this in mind the question begs to be asked, Is this our only and best solution to this managed care situation? I resoundingly answer NO!!!

My strong NO on this subject is not based on philosophy, although it would be a legitimate concern that we are losing our principles when we lose our separate and distinct identity. It is not based on tradition, although these practice amalgamations fly in the face of traditional chiropractic opposition to much of medical care. And although both of these two areas are enough of an argument unto themselves, my answer of NO is based upon the history of our profession, the market in general, and the patient in particular.

The history of our profession

To see what I am about to explain we must realize one fact. The past two decades of chiropractic and insurance were actually a "glitch" in our history. Over our 100 years, the first 80 had no third party reimbursement. Only the last twenty consisted of insurance. Unfortunately, most of our practitioners today were born into this insurance era, and now do not see other alternatives except those suggested by Mr. Coile et al.

We must also realize that all of the big gains we have made in our history were due not to ourselves, but rather to our patients. The fact that we have licensure at all is a testament to those we have helped in our practice, who were then there for us later. The reason they did this for us was because our energies were aimed toward them. Our time, efforts and love were geared toward every patient we cared for. The patient was the consumer, and the product was aimed and offered only to them.

The health care marketplace.

Make no mistake, the reason health care delivery is in a crisis situation and has undergone this mutation into managed care is NOT because of we chiropractors. It is because the medical system is an expensive failure. No longer can society afford to pay for a system of questionable effectiveness with a huge price tag. The once mighty medical express train has in fact derailed. Do we really believe that insurance companies and managed care organizations would be able to wheedle so much power if the consumer could afford medical services? Of course not. The only reason we have insurance is because people are convinced that they cannot afford medical health bills should a health crisis arise.

The patient

If we look around at our consumer, the patient, we can see trends. Today more than ever before patients are more health and fitness conscious. They read the labels on more of the products they buy, they avoid chemical additives when it is easy to do so. They exercise more. And unlike the past twenty years, more people are willing to pay for health and wellness. This is evident by the number of flourishing health food stores, health clubs, and health products sold that do not have insurance coverage. More people are searching for health and wellness, which just happens to be the forte` of chiropractic.

So if we review the past, we can see we have a profession that has grown due to its direct patient contact. We have a consumer looking for health and wellness and willing to pay a reasonable sum for it. And we have a medical profession entering an era of implosion. What this ads up to is that we as chiropractors are in a stronger position in the upcoming market than the medical profession. This translates simply into, "They need us, more than we need them."

The failure of the medical paradigm is not going to be solved simply by refinancing the same programs through managed care. The medical model is inherently flawed. Chiropractor have been right for the past 100 years when we have said health is an inside-out phenomenon, and not an outside-in treatment.

Add to this the fact that the managed care model is also flawed. This system bypasses the consumer and attempts to set up an agreement between big business and doctors. In this arrangement the consumer is only a commodity to be herded like sheep from one plan to the next. A system such as this that does not directly market to the consumer is not going to last in its present form beyond the initial fear sales.

What we presently have is a medical system that is failing and a managed care system doomed to ultimate failure. This sure does not sound to me like the kind of a system I want to hitch my wagon to. This indeed is a train that has not only derailed, but is headed off a cliff. And while this is happening there are those in chiropractic scrambling to hop onto this train as it races toward the its ultimate demise.

Indeed what we have in chiropractic is so special, so unique, and so timely, all we need is to re-think our marketing and remember that we got where we are through the strength of our relationship with our patients. We are the most consumer oriented health care profession on the market today. This, and our unique offering, are the reasons we will survive and flourish in this new managed care era. All we need to do is re-focus our energy, marketing and practices away from the third party payers, and back toward our consumers, the patients.

This is not to say that we should all give up insurance and convert to cash only practices. Some have done so very successfully. But no matter how we choose to practice our efforts and energy in practice must be geared toward the patients. Our service must be affordable for the ever-increasing legions of those with no chiropractic coverage, or inadequate chiropractic coverage. Let us not forget that chiropractic got where it is because we could help the helpless, return the worker to work faster, and care for people with quicker results at less cost than allopathic care.

Many chiropractors have recognized this situation and have acted on it. Today in the midst of managed care, some doctors functioning outside the system have some of the largest most successful practices in years. While some who cling to the practice concepts of the past are crying poverty and failure, others who focus on the patient are seeing volume of people they only dreamt possible.

The choice as I see it is simple. We can, as some have suggested, jump onto the derailed medical train in the hopes of securing the last remnants of a failing managed care system. Or we can proudly and independently step up and proclaim our rightful victory, serve our patients based on their needs and abilities, and reap the bountiful harvest.

To answer the original question, "Is The Multidisciplinary Approach The Answer To Managed Care?" For the medical profession it may be, because they have much to gain by being associated with a winner,... but for us, we’re better off without them!