Published: Thursday April 1, 2004
Issue 37
Integrative
Medicine
Alliance
Online Newsletter
Profile: INTERVIEW: Richard Furber, president & CEO Medimerge
By
Catherine Saar
Personal experience
motivated Richard Furber to start MediMerge Group, LLC in 1999. After spending
17 years as a Wall Street executiveoverseas, he returned
to America
and acquired an innovative
medical device company. Surprised by how poorly the health care system was
running, he studied the industry until he found a way he thought he could help
change it. A UC Berkeley graduate, the 54-year-old executive claims that he has
always been interested in health care and that after an encounter with an
amazing homeopathic physician in
London
back in 1984, he also became a proponent
of integrative medicine.
As CEO and
President, Furber’s vision is that MediMerge revolutionize healthcare delivery.
He wanted to design and administer health plans that lower costs for the payer
while increasing benefits for health and wellness for the member. Although
MediMerge innovates in many of the ways it approaches healthcare, a key
difference between other care providers and his company, he says, is their
health advocacy process.
MediMerge
incorporates the services of a Certified MediMerge Health Advocate™, a
registered nurse, whose purpose is to help members and their physicians explore
a comprehensive and integrative approach to health and disease.
“Behavior is such a key
component in so many health issues,” Furber says, “that I wanted to have a
health plan in which people did not necessarily have to be ill to receive
benefits. According the Center for Disease Control, more than half of all
health costs from illness result from behavior and can be reduced by someone
understanding what aspects about diet, exercise and avoidance can be changed.
And that doesn’t always require a doctor. You just need someone listening and
putting a few things in order at the appropriate time, like suggesting that you
change your diet. Our Health Advocates are designed intothat process. That’s
in the background of our model.”
“I wanted a health professional that knows who you are
and that you could contact and it didn’t cost you anything for making contact
and exploring health concerns. So, appropriateness of treatment, coupled with
an intervention model reduces cost, but not at the expense of restricting care.
That’s the mission,” he added.
MediMerge
also offers other information resources, including access to an on-line library.
Apparently, providing information is not the only way that MediMerge differs
from other healthcare companies.
The company
creates a custom plan for each of its corporate health plan clients following a
review of two years of medical claims data. They then deliver a plan that
focuses on proactive intervention and preventative techniques to reduce employee
health risks. In their approach, preventative care includes complementary
alternative medicine (“CAM”) as well as
allopathic (i.e. traditional) treatments, depending on what they believe will be
most effective in a specific case.
However, MediMerge
wants to be clear that they are not strictly a CAM health agency although they
regularly include CAM in their total approach
to providing the best combination of care for members. According to Furber, “We
look at appropriate care for you as a plan member, and we bring to bear
proprietary research that helps us to know that many ailments, like back pain,
for instance, are better treated with alternative treatments. We are sensitive
to innovation in health care, but the standards for return on care have to be
the same for allopathic care and for CAM. ”
Furber further explains
that MediMerge uses proprietary analysis to review standard allopathic treatment
versus integrated treatment for various ailments. The analysis considers
effectiveness for the patient as well as correlates cost to treatment
alternatives. Then they measure financial outcomes and track the health risk of
the member population over time. MediMerge offers its clients a guarantee of
sorts, in that if their plan doesn’t meet cost reduction objectives and result
in reduced health risk for the members over time, they offer to credit back a
portion of their fees.
In addition
to offering integrative health plan design and pricing, third party
administration, utilization review, care management, and wellness/prevention
services, MediMerge is also launching a provider network called the Integrative
Medicine Network (“IMN”) www.integrativemedicinenetworks.com.
The IMN includes many different modalities, such as allopathic doctors, nurses,
chiropractors, naturopaths, massage therapists, acupuncturists, homeopaths,
practitioners of Ayurvedic medicine and botanical medicine as well as others.
Because
MediMerge actively incorporates integrative practices in its plans, Furber says
he is often asked his thoughts on how to mainstream CAM.
To facilitate larger acceptance of alternative care,
Furber urges CAM providers to keep detailed
records. “CAM practitioners need a
communication tool set that speaks to the type of treatments they do,” he says
and suggests at this stage, practitioners should become familiar with ABC codes™
and the use of encounter forms. “While existing codes don’t suffice for
CAM practitioners, we advocate the use of “ABC”
codes which were specifically developed by a company called Alternative Link
(alternativelink.com) to address the needs of the integrative health
practitioner,” he said.
“ABC codes give integrative practitioners a viable tool
to compete to show that they are staying within the scope of practice. ABC has
4,300 codes that were approved by the Department of Health and Services in
February 2003. Within the next five or so years, use of these alpha codes will
be commonplace,” Furber added. “ Early adapters will have an advantage in the
next stage of how health plans are administered and how CAM is reimbursed.”
“It’s critical for our
business to review the CAM practitioner and to
create ever increasing and ever better protocols for treatment and diagnosis.
In our network, a provider can participate as an affinity member only, but then
we won’t know the treatment or outcomes with their patients. On the other hand,
our health advocates can directly refer a member to a practitioner who is
participating as a preferred provider. In that case, the practitioner sends us
an encounter form thatbecomes part of the
member’s medical record. Then, coordinated treatment plans can be achieved with
the patient receiving care on both the allopathic side and the alternative side
as well.”
In the April/May issue
of Integrative Medicine: A Clinician’s Journal www.imjournal.com, Furber co-authors an
article with James F. Sargent. The article, entitled "Motive and Influence in
Mainstreaming Integrative Medicine: Introducing the IMSI Rating," presents a
provocative perspective on decision making in health plan design and delivery in
the healthcare industry. The article can be viewed by clicking on this link: MainstreamingCam_MotivationInfluence.pdf
MediMerge Group, LLC is headquartered
in Manchester, Massachusetts
. For more information about
MediMerge, visit www.medimerge.com
Catherine Saar is the
editor of the IMA Newsletter and earns her living thorough freelance writing,
editing and marketing consulting. You can reach her at catsaar@aol.com.
