Alternative Link Investment Presentation

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Delivering Integrative Healthcare Under
Consumer-Driven Health Plans An ABC Coding Case
Study 6121 Indian School Road NE, Suite
131 Albuquerque, NM 87110 Tel [phone] Fax
505-875-0002 www.alternativelink.com
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Delivering IHC Under CDH PlansAn ABC Coding Case
Study

• Case Study Overview
• Enabling Technologies Outcomes
• Implications Imperatives

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Case Study Overview Using ABC Codes to Improve
Care, Claims Outcomes

• Ardent / Lovelace Sandia / Bridgesdeployed the
  nations only system for automatically
  processing insurance claims for integrative
  healthcare.
• The system was designed to save more than 75 in
  claims management costs for one of the fastest
  growing segments of care.
• It was also designed to improve the economic
  health outcomes of care so more beneficiaries
  could get better care at a lower cost.

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Case Study OverviewArdent / Lovelace Sandia /
Bridges (Business Goals)

• Promote a unique brand image attract healthier
  beneficiaries
• Appeal to wellness-oriented populations
• Reduce administrative medical costs in the
  senior plan
• Leverage information technology focus on high
  cost CAM-responsive diagnoses
• Expand savings to other plans enhance overall
  performance
• Apply best IHC / CDH practices

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Case Study OverviewArdent / Lovelace Sandia /
Bridges (Care Goals)

• Empower patients through education
• Provide access to an integrative healthcare team
• Promote open communication between patients
  practitioners
• Focus on restoring maintaining total well being
• Measure success, identify what works replicate
  it

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Case Study Overview
Ardent / Lovelace Sandia / Bridges (Data Goals)

• Unbiased Measurement!

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Case Study OverviewCoding the National Health
Information Infrastructure

• International Classification of Diseases, 9th
  Edition, Clinical Modification (ICD-9-CM )
• AMAs Physicians Current Procedural Terminology
  (HCPCS Level I/CPT)
• Healthcare Common Procedure Coding System (HCPCS
  Level II)
• Code on Dental Procedures Nomenclature (CDT)
• National Drug Codes (NDC)
• What Was Missing Why Did It Matter?

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Case Study OverviewCritical Insight Growing
Demand for IHC / CDH

• 40 - 69 of Americans use integrative
  healthcare.
• 56 of Americans believe health plans should
  cover integrative healthcare.
• gt8 states have passed health freedom legislation
  to support access to integrative healthcare.
• 60 of physicians have made integrative
  healthcare referrals.

• 50 of physicians will increase usage of
  integrative healthcare.
• 70 of family physicians want integrative
  healthcare training.
• 80 of medical students want integrative
  healthcare training.
• 64 of medical schools offer courses in
  integrative healthcare.
• 67 of HMOs offer integrative healthcare of some
  kind.

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Case Study OverviewCritical Insight Shifting
Consumer Demand

• Acupuncture
• Allopathic Medicine
• Ayurvedic Medicine
• Body Work
• Botanical Medicine
• Chiropractic
• Clinical Nutrition
• Conventional Nursing
• Holistic Medicine
• Holistic Nursing

• Homeopathic Medicine
• Indigenous Medicine
• Massage Therapy
• Mental Healthcare
• Midwifery
• Naturopathic Medicine
• Oriental Medicine
• Osteopathic Medicine
• Physical Medicine
• Somatic Re-education

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Case Study OverviewCritical Insight Growing
Number of IHC / CDH Encounters

• 629 million CAM office visits ? 1.4 billion CAM
  office visits
• 386 million PCP office visits ? 1.1 billion for
  MD/DO office visits
• Source http//www.medinfo.ufl.edu/cme/grounds/pau
  ly/ Eisenberg,et al, JAMA,Nov11,1998, Vol 280,
  No 18 HHS 1999/2000 Alternative Link 2004

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Case Study OverviewCritical Insight Growing
Number of IHC Practitioners
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Enabling Technologies Outcomes Data Standards
for Research, Management Commerce

• New IHC / CDH data elements included...
• ABC Codes Think More Complete, Accurate
  Precise Codes (Like UPCs)
• Practitioner Identifiers (Code Modifiers)Think
  Qualifications of the Caregiver
• Relative Value Units (RVUs) Think
  Resource-Driven Pricing Rationale
• Legal Practice Guidelines Think Per
  Intervention, Per Practitioner Per State
  Legality

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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
Financial Value
ABC Code
Legal?
Hierarchic Description
Detailed Description of Intervention
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines
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Enabling Technologies Outcomes ABC Codes,
Practitioner Identifiers, RVUs Legal Practice
Guidelines

• Financing
• Improved pricing
• Improved contracts
• Improved revenues
• Administration
• Improved inter- intra-organizational
  interactions
• Improved allocation of organizational resources
• Improved operating efficiencies
• Improved bottom line
• Delivery
• Improved patient-practitioner
  practitioner-practitioner relationships
• Improved understanding of optimal treatment
  pathways
• Improved outcomes, esp. for chronic conditions

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Implications ImperativesImproved Care, Claims
Outcomes

• ABC codes, practitioner identifiers, RVUs legal
  practice guidelines create bottom line
  performance improvements by supporting...
• electronic data collection (for research)
• electronic data analysis (for management)
• electronic data interchange (for commerce)

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Implications ImperativesImproved Care, Claims
Outcomes

• ABC Coding Manual for Integrative Healthcare
  
• Practitioner Guides to Billable Interventions
  Using ABC Codes
• Superbills for Integrative Healthcare
• HealthIntel Database (Codes, Identifiers, RVUs
  Legal Logic)
• ABC / CPT / HCPCS II Crosswalk
• Relative Values for Integrative Healthcare Using
  ABC Codes
• CAM Market Report

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Implications ImperativesMore Complete,
Accurate Precise Data for the NHII
ABC Codes
Need for Research Tools to Identify the Most
Cost-Effective Approaches to Care
Need for Management Tools to Improve Business
Processes in Healthcare
Need for Commerce Tools to Support Industry
Efficiencies
Need for Expanded Standards to Support Consumer
Demand for Integrative Healthcare
Need for Complete Standards to Support the
National Health Information Infrastructure
Need to Resolve U.S. Healthcare Challenges
Access, Quality Costs
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Implications ImperativesImproved Access,
Quality Cost-Management
Alternative Link delivers information products
consulting services that help health-promoting
organizations individuals finance, administer
deliver cost-effective care that improves
individual public health, business industry
efficiencies socioeconomic development. 6121
Indian School Road NE, Suite 131 Albuquerque, NM
87110 USA Tel [phone] Fax
505-875-0002 Email Mail_at_AlternativeLink.com Web
Site www.AlternativeLink.com