From: Dr. Sig Miller (webinfo@ChiroViewPresents.com) December 3, 2000 ChiroView Presents Triad Healthcare Just mentioning the words "managed care" is going to get your juices going. And I know that broadcasting on this topic will bring many thousands of posts from you, along with creating a "helluva" lot of work for me in getting through each one. As promised, several weeks ago when attending the Congress of Chiropractic State Associations and the World Federation of Chiropractic conferences in Ft. Lauderdale, Florida, I had the distinct pleasure of attending a luncheon featuring a speech made by Triad's director of clinical services, Agostino Villani, DC. He was elegant, professional, visionary, and very articulate. And his message was very different from anything I had heard in the past when discussing issues relating to "managing care". Agositino has allowed me the opportunity to broadcast his speech, "unedited", for all of you to review so you can make up your own minds. I ask you to remain open-minded because I believe they are different. And by the way, just for the record, I approached them to broadcast this information. Triad requested nothing from me. I will certainly pass your comments along to Triad, but if you want to contact them directly, call 800.550.0540 or click www.ncmic.com. Enjoy! Sig Sigmund Miller, DC - Editor To become a CVP member subscriber, click www.ChiroViewPresents.com Triad Healthcare Triad Healthcare, Inc. is NCMIC¼s national chiropractic IPA. We have been in operation since 1997. Today, our IPA includes 6000 chiropractic physicians representing over 7000 distinct locations, we provide through PPO contracts, access to chiropractic care to 40 million people, to my knowledge, the automobile insurers with whom we work are the only ones in the country whose nurses and adjusters work with chiropractic consultants on every case. Triad has developed a unique, patent pending, process for utilization management. It is based on patient outcomes and response to care, not guidelines. It is designed to capture the data necessary to measure and support the value of chiropractic care. We have created relationships within the healthcare industry that now provide us with access to crucial information on future trends and opportunities. We have attained accreditation from URAC for our credentialing, utilization management, quality management and network services. We have trained an entire managed care staff to understand chiropractic care as a value and a necessity rath! er than just a cost, and to appreciate a vision of chiropractic as an important player in national mainstream healthcare. What we have done is to put a truly chiropractically driven company on the national managed care map. None of these accomplishments have come easily, and while they may seem commendable, even admirable, they don¼t necessarily explain why NCMIC would want to do this. Why would a corporation as successful and as philosophically aligned with chiropractic as NCMIC diversify into an area as unpopular as managed care. Why would a company like NCMIC, financially secure, well defined and stable within its market venture into an industry where there are so many others, most of whom are unsuccessful. The reason is, necessity, we simply had to. To begin to understand why it is first necessary to understand how Triad differs from other national chiropractic IPA's. Because as we all know, the IPA¼s are more often part of the problem than the solution. And, in fairness, Triad does look a lot like every other IPA. But what if we take a closer look. Most IPA¼s are designed around the premise that chiropractic care is only appropriate for a very small percentage of the population therefore they credential limited exclusive panels. Triad is designed around the premise that everyone needs access to chiropractic care therefore we are an inclusive network. Most IPA¼s believe that chiropractors provide a large amount of clinically unnecessary care therefore they utilize guidelines to justify decisions made regarding individual patients. Triad knows that chiropractic care is administered in a competent and caring way. We know that the perception that the chiropractic profession has abused the third party system is a lie, a big one, created and perpetuated by the same people who have worked to contain and eliminate the chiropractic profession. Triad believes that this is unethical and inappropriate. Unethical, because a guideline cannot justifiably be used to evaluate the care being given in a unique clinical situation to a uniqu! e individual. The premise is intellectually flawed, inappropriate, because in their haste to contain chiropractic, they have thrown away the opportunity to create countless greater savings and value. Instead, Triad uses patient progress and outcomes to evaluate the clinical value of care. We recognize and defend the value of supportive and maintenance care. Between 1997 and 1999 Triad¼ UM program certified as clinically necessary almost 90% of the care requested by our providers. We certified care for episodes ranging from one visit to as much as 44 visits. We certified care for durations of time lasting as long as 18 weeks. We certified care for those patients needing to see their chiropractor weekly to support an unstable spine and we have certified care for those asymptomatic patients to see their chiropractor monthly to stay healthy. We have done what no other national chiropractic IPA has done, we have been honest. Most IPA's agree with the healthcare payer that chiropractic fees are too high. Triad knows that the chiropractor has never been paid fairly, or for that matter regarded fairly, in recognition of the value that we provide to the public. So we drew an absolute line in the proverbial sand relative to fees. We committed that we would sign no contract if we could not negotiate fees at or above that level. You might imagine the response from our sales staff. They warned us that we were pricing ourselves out of 80% of the market. They reminded us that our national IPA colleagues compete based on how low they are willing to go with their fees. But in actuality, they do more. They actually assist the payer industry in its effort to permanently drive down the economies of the entire chiropractic market. You see, it is not enough for the IPA to sell chiropractic to a payer for the lowest price, Triad has lost contracts where we had offered the lowest price to the payer. We could do this! because we were willing to operate the contract at a zero profit margin and return every possible dollar back to the provider as fees. This effort is unsuccessful, because the payer prefers the IPA who pays the lowest possible fee to the doctor. This strategy creates the greatest possible depression of the market. The payer doesn¼t care if this results in the IPA paying only 35 cents on the dollar to the chiropractor. They are willing to allow this massive profit taking by the IPA, to create a market of providers who accept this dramatically reduced fee structure. Then, with the market under control, they sequentially begin to squeeze the IPA for more and more savings, year after year, until they have eroded the large profit margin and the IPA can no longer function profitably. This is the death sentence that the IPA deserves for selling this profession for 30 pieces of silver. But you might ask, what does the payer gain if the IPA can no longer exist. The payer gains what it set out to gain, it has created a market where chiropractic care has been ground down to a 25 dollar global fee or a 200 dollar annual case fee, a market under control, that no longer requires any complicated utilization management or peer involvement, a market that can be simply and efficiently managed by the very people who devised this strategy just a decade or so ago, and the very people who we have recognized for their century long efforts to contain and eliminate our profession. And the payer has done this acting through the IPA thereby avoiding any direct liability or responsibility. Now, we cannot fault these IPA's for what they do, this is what they were designed for, to satisfy the need created by our enemies. And while we might want to condemn this there is no need, their demise is imminent. These are the substantive differences between Triad and the typical national chiropractic IPA. There may be more or less depending on who we compare ourselves to, but I hope that the point is made. So as you can see, Triad doesn¼t really fit well into the managed care world. We might be described as a somewhat unusual looking bird, today. Certainly, this is how I have interpreted some of the looks and responses I have received from managed care executives when presenting Triad and ours ideas to them. So then, why is Triad here. It would seem to be a mistake to build a company that is at such odds with the industry in which in functions. Well, as I¼ve already said, we had to. The leadership and management of NCMIC, in 1996, had the intelligence to understand what was really driving the managed care industry. They had the vision to see what lay beyond the destruction. And they have the commitment and resolve to do something about it. They realized a few fundamental truths. 1. That chiropractic managed care, as it exists, is spiraling towards self-elimination. The popularity and simultaneous failure of the affinity plan is evidence of this truth. 2. That chiropractic and managed care are mutually exclusive. Chiropractic care does not need to follow the path of managed care and what happens to managed care does not need to dictate what happens to chiropractic. 3. And the third truth that they realized was that great opportunity was just out of site, over the horizon. NCMIC¼s leadership and management realized that chiropractors would soon stop participating in practice-limiting discounted networks. They realized that chiropractic benefit programs would continue erode at the hands of the IPA and be replaced by affinity plans operated by the same willing IPA accomplices. But they had the vision to see beyond this. They realized that the planning that had created the present market occurred in corporate boardrooms years ago. And they realized that if their vision of the failure of chiropractic managed care was accurate, then others knew it too and were planning again. They recognized that for chiropractic to assume its rightful place in mainstream healthcare, we had to become part of the planning process NOW. They saw no other business entity offering chiropractic care as a solution to this country¼s healthcare concerns, therefore, there was only one logical decision. Triad was conceived and developed to operate and represent the chiropractic profession, as a business entity, in a new healthcare market. A market defined by expanding chiropractic utilization, increased chiropractic responsibility, increasing levels of chiropractic reimbursement, and the re-defining of chiropractic as a valuable participant within mainstream healthcare. If you can¼t see this market, don¼t be concerned, it¼s not here yet, but its coming. Corporate America, today, is motivated by forces that were either not present or not evident just a few years ago. These forces are the following: 1. The huge public demand for and satisfaction with the chiropractic profession. 2. The media attention to and public demand for CAM. 3. The REAL public dissatisfaction and failure of allopathic medicine. 4. The inability of managed care to integrate the best and eliminate the worst within healthcare. 5. And the inability of everyone to control the pharmaceutical monster that is now threatening to derail every benefit system in the nation. Corporate America has learned that we, the so called greedy doctors, can¼t hold a candle to the pharmaceutical industry. This market, one that will demand a non-pharmaceutical leader, to help solve America¼s real healthcare crisis is on the horizon. Triad has been created to serve this market, and we are prepared and committed to this task as no other company can be. Today, Triad is on corporate agendas all around the country. Companies are working with us because we are already here. We have an infrastructure, a large network and market experience. We have demonstrated to them a commitment to positive change and an unwillingness to accept short term profits and status quo. Triad is prepared for the opportunities at hand; the chiropractic provider, in general, is not. Now is the time to organize our thoughts responsibly and share this vision of the future with our peers. Now is the time to create a true information synergy between business and the professional associations within chiropractic. That said, let me extend a hand to you with the utmost respect and sincerity. None of us live within a vacuum. Everything that we do individually ripples through our collective community, ultimately affecting us all. Let¼s work together to create the kind of synergy that successful professions have had with industry for decades. Lets demonstrate who we really are by putting aside those issues that cannot serve us and working on the issues that will create a stronger profession and a stronger industry. Please consider our offer to work more closely with you and to move forward together for the best interest of the chiropractic profession and the chiropractic patient.