Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #119329

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.

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