This morning I had the pleasure of speaking with Matt Minela, Insurance director of the Association of New Jersey Chiropractors (ANJC). Why? Well they like us provide a medical alternative that can be a huge cost savings for hospitals, insurance plans and patients. I was wondering how they are doing with ACOs? Like us they can keep people out of emergency rooms saving thousands of dollars per visit. Like us they can provide very cost effective treatment that allows for prevention and diagnosis of serious systemic illness before it costs lives and huge expense to health care organizations. It is a dialog that I think should continue and so did he.
Matt told me that they had been approached by an ACO for a medicaid based program. He was finding that most ACOs are forming around hospitals. This ACO had not planned on considering chiropractic. A second party involved in the ACO suggested that chiropractors be included as they had a proven record of bringing down costs of care for musculo-skeletal pain issues. Nevertheless, the hospital was not interested in allowing access to chiropractors as primary care agents, they were looking at keeping MDs as the gatekeepers. This is what happened with HMOs in the 1990s.
He then mentioned that he had an opportunity to contact an old established California ACO. Their program was based on a “fee for service” with the caveat of capitated risk. After the ACO received its funding for the year and paid its top brass their guaranteed salaries, money went down to the doctors to pay “competitive” fees. If there was a profit at the end of the year, it was shared by a complex formula. If there was a loss the same applied. They would not share how this was done. Again as he viewed it, the structure was again the pyramid with an insurance company having no risk just profit and the doctors taking all the risks. Sound familiar? He posed the same question I do. He said we are fighting for inclusion in these ACOs but do we really want to be part of this kind of risk?
I still have not resolved this issues in my mind but believe we have one choice! Get big, powerful and untied so that we can at least have an influence if ACOs become the game your must be part of.