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Mechanical Diagnosis Helps Practice Build Its Own Network

Many, if not most, private practice owners consider participation in a third-party administrator network essential for sustainable business. That's the model most clinicians and patients are used to.

But, what if a private practice could negotiate its own reimbursement processes with payers? That may sound unusual, but it might not be for long.

For Integrated Mechanical Care (IMC) and CEO Chad Gray, it's already been happening for nearly 10 years. That's because a decade ago, they launched a strategic plan focused on large, self-insured employers.

He found that a direct contract with the likes of Michelin is profitable and more streamlined, from a receivables perspective, than participating in a traditional TPA. But, it wasn't just a matter of making a spectacular pitch to executives and hoping for a dash of luck.

Gray’s company was able to earn the business thanks to meticulous record keeping that started some 25 years ago. What he began as a way to improve his own skills is precisely what self-insured employers want today as they try to flush unnecessary surgeries and expensive imaging from their care.

"You've got to convince the employer that your service has value: better results, lesser costs," Gray says. "We have clinical outcomes on tens of thousands of patients and we have economic outcomes that are evidence that we have saved our clients a lot of money."

MDT as the Foundation

That all originates with the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT), Gray says. Its core concepts of thorough evaluation and self-treatment tend to fix impairments quickly - just a handful of visits in most cases - and permanently.

The evidence-based MDT system begins with a thorough mechanical evaluation to establish a "cause-and-effect" relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.

A systematic progression of applied mechanical forces utilizes pain response to monitor changes in motion and function to classify the disorder. Clinicians then develop a plan of care that empowers patients to treat themselves when possible.

Frequent, even daily, analysis of clinical outcomes is a big part of the IMC process, thus the thousands and thousands of results Gray has on file.

"In any sort of process-oriented system, you've got to measure results and make adjustments based on those," Gray says.

He had to use this same approach to build his network of employers that he caters to with PTs and affiliate practices that use a quality assurance process he and his team built.

Removing Variability

"There is a growing awareness around the problems associated with variability in musculoskeletal medicine and that's creating a pretty big shift in the market," Gray says. "Employers are looking for accountability and reduced cost."

If you're going to deal with big corporations that thrive on consistency of products or services, you have to strive to remove variability from your own company. That's precisely what IMC's proprietary program does.

"Clinicians tend to meld their MDT training with other mechanisms and approaches for treatment," Gray says. "It's in their ‘toolbox,' but not necessarily the core methodology they use. Even within the MDT trained clinical groups themselves, who attempt to practice MDT solely, there is wide variability in process and, therefore, clinical outcomes.

"We had to create standards within our clinical practice. To do that, we had to create foundational training above and beyond MDT certification," he says.

With presences in six states at a dozen IMC locations, this was an essential consideration for assuring quality to big businesses and creating the network.

"IMC designed these enabling technologies that help reduce variability while increasing skill and ability," Gray says. “The IMC quality assurance process means I can plug a clinician in anywhere in the country and get the same results.”

He contracts with companies that range in size from 250 to 25,000 employees, using IMC clinicians to practice wherever they are.

How It Works

The consistent quality of IMC care revolves around MDT, of course, and accountability. Clinical outcomes are measured constantly and critiqued weekly.

It follows the MDT cause-and-effect basis: look at the outcome of your actions, adjust, repeat.

Every week, reports of pain and function data as well as treatment results are printed and posted in their respective practices. And every week, clinicians consult with IMC clinical leadership to meet challenges.

The meetings are growth-oriented and not punitive, Gray points out. In fact, they've created an immersed and motivated culture of self-improvement company-wide.

"When you work here, you're in it every day. You're entrenched in it and believing in it," Gray says.

Keeping Momentum

The IMC model is working and Gray is confident that the continued proof of results will keep it growing.

He holds the patients just as accountable as his employees.

"The patient is going to tell us what works and what doesn't," Gray says.

IMC’s surveys use body regions and indexes validated by decades of research. The second key to measurement is claims data, something that large, self-insured employers can readily provide in great detail.

"When you have access to claims data, you can find out who re-entered the system after treatment," Gray says. "You can look at it by region, by clinic, by clinician, by body part and by service...In essence, you can get a true picture of the results of the treatment provided, by following the claims data to determine if discharged patients do or do not re-enter the medical system and for what."

"If you don’t get them better and keep them better, it doesn’t always come up in a survey," Gray says.

More often than not, IMC’s patients are getting better. And that's helping large corporations get smarter as the shift toward self-insurance picks up steam.

Gray and IMC don't go "knock on doors" anymore. In fact, the employers are coming to him through introductions by their solutions providers, insurance brokers and thought leaders in the area of health care transformation. His existing clients speak with, about and for IMC at conferences, including the World Health Congress.

Gray just wanted to be a better clinician when he first started tabulating results. Now he's determined to create a better health care system.

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