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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3091.0: Monday, December 12, 2005 - 11:15 AM

Abstract #119329

Evidence-based health care within a specialty benefits organization

Steven M. Hilles, DC, Clinical Quality Management, American Specialty Health, Inc., 777 Front Street, San Diego, CA 92101, 800-848-3555 x3274, stevenh@ashn.com

American Specialty Health, Incorporated (ASHI) is one of the nation's largest organization for complementary health care benefit programs, health education programs, and health-related products measured in terms of annual revenues, members, employees, contracted providers, and contracted health plans. ASH covers over 12 million lives nation wide.

ASH goal is to be the national leader as a full-service specialty benefits company to facilitate the integration of evidence-based complementary health care and health education programs into third-party reimbursement and employee benefit plans. It is the expectation of our customers to provide high quality, safe, effective, efficiently delivered, evidence based Complementary Health Care (CHC) services that result in high patient satisfaction and clinically effective outcomes for members at a cost that is of value to the third party payor. As a managed care company ASH must also understand the complexity of the stakeholders; patients, practitioners' employers and heath plans.

As a managed care company ASH direct patients toward one set of practitioners (our network) and away from another set. As such, we are not passive with regard to the type and quality of care provided. ASH agrees with the recent IOM report that the standards (peer review evidence) for CHC should be no different from the standards for conventional medicine. ASH has developed a peer consensus process for the evaluation of diagnostic and treatment procedures or techniques. This process drives decision- making in coverage determinations, credentialing of providers, and quality management. A description of this process and the procedure algorithm will be described.

Learning Objectives:

  • At the conclusion of this session, the participant will be able to

    Keywords: Chiropractic, Evidence Based Practice

    Presenting author's disclosure statement:

    I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commertial supporters WITH THE EXCEPTION OF I am the Director of Clinical Quality Management at American Specialty Health, Inc..

    Handout (.ppt format,

    Implementing Evidence-Based Health Care within the Chiropractic Profession

    The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA