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 executive overseas, 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 to 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 into that 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 that becomes 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 through freelance writing, editing and marketing consulting.  You can reach her at catsaar@aol.com.