David Wells is bringing a New Age flavor to managed care.
Last July. the Encino-based acupuncturist/chiropractor incorporated AcuNet, an organized network of acupuncturists to service patients referred bv insurers. The network includes more than 100 acupuncturists who practice statewide. Wells serves as president. clinical director and chairman of the board.
"I want to make acupuncture more mainstream. There's still a resistance
to it that is found among people involved in traditional, Western-style
medicine," says Wells. a serious, soft-spoken man of 43 who has been
a licensed acupuncturist since 1986 and a chiropractor since 1979. He chose
to form a network after insurers began calling him regularly a couple of
years ago to make patient referrals.
"There is a need that has to be addressed," he says.
AcuNet dovetails nicely into the managed care concept, according to Wells, because it is the first organized network of acupuncturists formed to contract with health plans. It also plays into legislation passed in 1993 that allows HMOs and other managed care health plans to combine medical and workers' compensation coverage.
Commonly called independent practice associations, physicians' networks similar to AcuNet are often formed by doctors looking to improve their business positions when negotiating with health maintenance organizations and other carriers.
But acupuncture, which was developed in Asia thousands of years ago, has been virtually ignored by the wave of managed care that has swept the state the past two decades and the rest of the country since the 1980s. That lack of interest has persisted despite ample anecdotal evidence that acupuncture is effective at relieving pain and is often far less expensive than traditional surgery or therapies, Wells claims.
"A (spinal) disk injury can cost $1,500 to be diagnosed by an MRI machine, and $15,000 to be corrected by surgery. With acupuncture, that same injury can be treated with office visits twice a week,`and I can have the patient back to work within a week or two, with the whole thing costing maybe $1,200," he says. "Those are the types of figures health plans pay close attention to."
Wells - who chose to enter alternative medicine after he saw it effectively applied to an injury at a martial arts event in the early 1970s - is apparently one of California's most visible and publicly active acupuncturists.
He is president of the Council of Acupuncture and Oriental Medicine and a recent past president of the California Acupuncture Association. Both are considered among the profession's most influential trade organizations, according to Wells' colleagues. His vision of acupuncture being institutionally embraced is not far-fetched; to some extent, that occurred two decades ago in Caiifornia.
The state promulgated a licensing process for acupuncturists in 1975; in 1988, it sanctioned acupuncture treatment for workers' compensation recipients. Medi-Cal has been paying reimbursements for acupuncture since 1978.
To form the network, Wells raised about $100,000 from a core group of 80 acupuncturists. There are about 100 members in the network now, Wells says.
"These were people I knew personally to be ethical and professional," says Wells, who has established many contacts in the industry through his activism.
After securing capital, Wells says he combed over the state's acupuncturist directories to cobble together a provider network. For the moment, he runs AcuNet out of a small office in an Encino medical building, where he also treats patients. But he is seeking a separate office for the network.
AcuNet has already grabbed the attention of some fledgling workers' comp subsidiaries formed by HMOs. Last November, Compremier, the workers' comp branch of Cypress-based PacifiCare Health Systems Inc. - one of California's most respected and profitable HMOs - contracted with AcuNet to provide services for patient referrals. AcuNet expects to see its first Compremier-referred patients within the next month.
"We're impressed with them; we've done on-site credentialing with them, and they're very professional," says Vicki Merrill, Compremier's president.
Wells has formulated some fairly stringent rules for those wishing to join AcuNet. He requires that all in the network carry professional liability insurance policies for at least $1 million, compared to a typical acupuncturist's policy for $100,000 to $300,000 of coverage.
All members must also have been in practice for at least two years, work in a commercially zoned office building. and speak and write English fluently. About a dozen applicants were rejected through a screening process, Wells says.
In addition to landing the Compremier contract, AcuNet has obtained a letter of intent to do business with another large carrier, according to Karen Martin, AcuNet's marketing director. Martin would not disclose the plan's name until the deal is finalized.
AcuNet is also in talks with Orange County-based workers' comp administrators CorVel Inc. and Beech Street Inc., and Hollywood Presbyterian/Queen of Angels Hospital in Los Angeles, Wells says.
"Having an IPA (independent practice association) will help control and contain costs, to show our insurance companies that acupuncture is very effective in the long run," says Joseph Chan, an AcuNet member who practices in Torrance.
"I think it's going to really help, business-wise." says Karin Hillsdale, an AcuNet member who practices in Pasadena. "I think it's just really important that large (insurance) companies are going to know more about us."
Even more imponant, Hillsdale notes, is that by networking, acupuncturists will be able to create more accurate and coherent utilization and outcome studies - which could be used to emphasize the efficacy of such treatment.
"For those of us who have been active in trying to create more credibility and cognizance, this is the way to go," she says.
Acupuncture.com |