alternative/mike1st/mark2nd

BEN SULLIVAN Staff Reporter

Aura out of whack? Chi not flowing like it should? In need of an herbal tonic? Soon you may need look no further for a dose of holistic healing than your friendly neighborhood HMO.

Long considered the domain of immigrants, or domestic quacks and hippies, alternative medicine is finding an unlikely ally in that most corporate of health worlds, managed care.

Though driven by sometimes different motives, alternative and managed care providers are finding common ground in their efforts to attract patients and keep them out of hospitals.

"People may have different incentives, but if (those incentives) line up correctly, the person who benefits is the patient," said Dr. Phillipa Kannealy, medical director of the Santa Monica-UCLA Medical Center.

To be sure, not all treatments that fall into the broad rubric of "alternative medicine" will be covered by health plans soon. Shamanism, aura adjustments and spiritual healing will likely remain fee-for-service until evidence is accumulated to support their efficacy, analysts say.

Plus, skeptics question how alternative medicine will translate to managed care.

Dr. Jay Gordon, a Santa Monica pediatrician who has used alternative medicine in his practice for more than a decade, said managed care plans will likely botch holistic treatment.

"I think they're going to be paying lip service to it, as they do for most things," Gordon said. "I don't think they'll be doing it for the benefit of the patients."

Still, longtime treatments such as homeopathy, acupuncture and chiropractic treatments are finding greater acceptance in Western care than ever before.

Since about 1995, most California HMOs have offered chiropractic services as a supplement to their standard plans, according to Alan Tomiyama, a spokesman for the California Association of Health Maintenance Organizations.

And for the first time, several statewide managed care groups will offer access to a network of acupuncturists, chiropractors, homeopaths and herbalists, according to Alan Kittner, CEO of San Francisco-based Complementary HealthCare Inc.

Kittner's firm has been tapped by the plans, whose names he would not disclose, to compile a network of alternative health care providers. While he said pricing is still being worked out, HMOs in other states offering similar services charge 2 to 3 percent over their standard premiums for access to such specialists.

"It's something that's been on our radar screen for a while," said Lisa Freeman, a spokeswoman for CareAmerica Health Plans in Woodland Hills.

Changing population demographics and a resulting openness toward holistic treatments prompted CareAmerica to first investigate alternative care, she said. And while so far the HMO offers chiropractic care only, other alternative medicine services are being considered.

Similarly, Glendale's Cigna HealthCare of California is looking at supplementing its chiropractic offerings, while Kaiser Permanente already offers both chiropractic and acupuncture products.

Alexander Bokor, medical director at Inter Valley Health Plans in Pomona, said he is exploring homeopathy as an occasional supplement to standard care.

Consumer demand has driven the marriage of corporate and holistic healing.

"You'll find health plans in general are implementing alternative care products because consumers much more today than ever before are demanding it," said Tomiyama. "It wasn't but a few years ago that chiropractic service was itself considered radical."

Last year, Americans spent roughly $10 billion on alternative medical products and services, and an oft-quoted study published in the New England Journal of Medicine found that one in three Americans had used some form of alternative medicine in the previous 12 months.

Even limited acceptance by managed care is a big shot in the arm for the alternative medicine industry, according to David Solin Lee, CEO of Emperor's College in Santa Monica, which offers a state certified master's degree in traditional Chinese medicine.

"We want to be a part of the mainstream," Lee said. "Surgery, drugs and other basic tools are very powerful, but we want to show that they're not for everything."

The battered reputation of the HMO industry similarly stands to benefit by incorporating what is popularly seen as a kinder, gentler form of medicine into its corporate structure.

And individual plans can use alternative medicine as a way to set themselves apart from a crowded pack, according to Randal Huyser, a health care analyst at securities firm Furman Selz LLC.

"It's particularly competitive in Southern California, where most HMOs have similar provider networks and look like commodity products," Huyser said. "I don't see some of the more far-out alternative medicines becoming readily reimbursed by health care plans, but there are certain areas that are becoming widely accepted by payers."

The question, though, is how effective the alternative treatments will prove to be.

"The decision to include these things in managed care is based largely on marketing questions and has nothing to do with medical appropriateness," asserted William Jarvis, a professor of public health at Loma Linda University and president of the National Council Against Health Fraud. "That (managed care is) now offering ineffective medicine because it has a positive glow to it will eventually be seen as exploiting unwary consumers."

Dr. Ka Kit Hui, director of the UCLA Center for East-West Medicine and a doctor of both internal and Chinese medicine, said the melding of Western and Eastern treatments has been studied in China for the last 40 years, "and there are still gaps in knowledge there."

"I'm happy that managed care is beginning to look into this, but they shouldn't jump into it without really thinking it through," Hui said.

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