Jeffrey Sollins, MD (third from left), Director of Bridges in Medicine, Albuquerque, NM, with members of his integrative health care team (L to R): Russell Canfield, MD (primary care), Kristy Kennen (psychotherapist), Angelique Cook-Lowry, OMD (Oriental medicine), Angela Barnett, MD (primary care), and Yasuaki Nagatomo (Tai Chi). Bridges in Medicine is the first integrative clinic in the country to become eligible for Medicare reimbursement.

In 1979, internist Jeffrey S. Sollins, MD, was running the biggest emergency room group in the state of New Mexico. From his position in the toughest trenches of modern medicine, he saw the end results of poor diet, unhealthy lifestyle, addiction, social violence, spiritual and personal exhaustion. He also saw the toll modern medicine’s daily grind takes on physicians. All this gave rise to a dream.

“My patients were clearly looking for something I couldn’t give them, and frankly, I was hungry to do something that I wasn’t able to do.”

A longstanding interest in music and years of practicing Japanese Shotokan Karate had keyed Dr. Sollins into the nuances of the mind-body relationship, and he began to explore “energy medicine” techniques aimed at bringing this dimension into the clinical setting.

Fast-forward 25 years, and you’ll find a far more fulfilled Dr. Sollins running Bridges in Medicine, a comprehensive, interdisciplinary holistic health program in partnership with the Ardent-Lovelace Sandia Health System, Albuquerque.

Bridges in Medicine now serves 20,000 people, offering a broad spectrum of healing modalities including acupuncture and Oriental medicine, chiropractic, holistic nutrition, herbal medicine, homeopathy, massage and other physical therapies, Reiki, Feldenkrais, and other energetic techniques, art therapy, yoga, and traditional Native American and Hispanic medicine, all seamlessly integrated with conventional allopathic medicine. Bridges in Medicine is also the first integrative health program to be accepted into the MedicarePlus system, allowing Dr. Sollins and his colleagues to receive Medicare reimbursement and to offer covered services for Medicare beneficiaries.

Dr. Sollins described his journey from the depths of the ER to the leading edge of the holistic health movement at the annual meeting of the American Holistic Medical Association.

Not Just a Job, It’s an Adventure

“I started Bridges in Medicine to heal my own life, my own issues, and my own dissatisfactions,” he acknowledged. “I did a very good job as an internist and emergency physician. But it was just that: a job. I didn’t feel like I was really able to give my patients the time and heart-space they needed. So I dreamed of merging our high-tech healing tools with the soulful aspects you see in what was then called “alternative” medicine, and I sought a way to try and explain this to big health care systems that only thought about the bottom line.”

He began to study energy medicine techniques like Therapeutic Touch and Zero Balancing, as well as initiating dialogs with practitioners of natural therapeutics in the Albuquerque area. By 1997, these dialogues became more formal.

“I put together a group of alternative and conventional practitioners, shamans and gynecologists, massage therapists and internists. We had all kinds of healers, nearly 60 of them. And we had a meeting where I asked each practitioner to give a brief summary of what he or she did and how it worked and what it was based on. By lunch, there was a tremendous energy in the room, and suddenly, people started trading business cards!” A second meeting later that year consolidated the group, which became the seed for Bridges. The collegial respect and open-mindedness of those first meetings has remained with the project ever since.

Four Medical Worlds, One Goal

The group organized itself into four “worlds:” conventional medicine, energetic medicine (Reiki, therapeutic touch, Feldenkrais, acupuncture and Oriental medicine), mechanical medicine (chiropractic, massage, other manipulative modalities), and behavioral/spiritual medicine. They decided to make an experiment: they would work collaboratively in the management of a couple of chronic disease cases.

Dr. Sollins referred two of his chronic disease patients—one with sinusitis and one with fibromyalgia—for collaborative consultation. “These were very typical cases. The patient with sinusitis was doing two or three courses of augmentin and cipro per year, with multiple costly physician visits.” In this case, after obtaining an MRI and an allergist’s confirmation of the diagnosis, Dr. Sollins assembled a team of practitioners from different disciplines that together developed a comprehensive 90-day treatment plan involving nutritional changes, therapeutic touch, chiropractic and acupuncture.

Both patients responded well. The gentleman with sinusitis had only 2 recurrences since 1997. Needless to say, he was excited about his results. Fortunately for Dr. Sollins and his team, the patient happened to be the director and owner of a regional health insurance company. “He got so excited about this that he went to one of our area hospitals and said, “You need to talk with these guys.” He also introduced me to Melinna Giannini, founder of Alternative Link, who was working on developing an entire coding system to cover alternative medicine services.”

Code Talking

The latter connection proved to be essential in establishing Bridges as a viable, reimbursable health program. “We knew that if we could go to the hospitals and health plans with coded services and information to manage these services, it just might be a go.” Alternative Link’s ABC codes (see related story, p. 1) provide a comprehensive framework for reimbursement, utilization review, and outcomes research in alternative medicine via a set of more than 4,000 codes designating type of service, type of practitioner, and relative value. The ABC codes are in use in hundreds of clinics around the country, as part of a pilot project approved by the Department of Health and Human Services last year.

Dr. Sollins, who has more practical experience with the ABC codes than just about any other physician in the country, believes a system like this is essential for the evolution of holistic medicine. Beyond creating an infrastructure for insurance reimbursement, the codes also give practitioners a common language. “It is really about a mind shift. These days, it is not unusual for MDs to have acupuncturists or massage therapists in their offices or referral networks. But they don’t talk to each other. At Bridges, we have an integrated medical chart that all our practitioners use, and a coding system that ensures that everyone is speaking the same language.”

The codes are essential for generating the kind of outcomes research that will convince insurers and government payors to include more holistic services in benefits plans. “In order for our practitioners to get paid, they have to send me ABC coded encounter forms and CMS 1500 claim forms, along with patient notes, which I send on to the health insurance plan. With the help of the ABC coded encounter forms, we are able to track utilization and expenditures.” With a current referral base of well over 20,000 people, Bridges in Medicine will be able to generate a wealth of data on best practices in natural medicine in a relatively short period of time.

It was no small feat to teach independent-minded holistic practitioners to write detailed SOAP (Subjective/Objective Assessment Plan) notes, and it was a stretch for allopaths in the group to grasp some of the diagnostic and therapeutic concepts used by their new colleagues. In the end, though, everybody learned.

Rapid Growth Based on TEAMwork

Shortly after Bridges in Medicine was incorporated, the group began contracting with St. Joseph’s Health Care System, an Albuquerque area hospital group that was later merged with Sandia, a regional managed care organization. Sandia was acquired by Lovelace Health Systems, which recently teamed up with Ardent. Each step in this corporate family tree increased the number of patients with access to Bridges. “We went from 500, to 5,000 to 20,000 potential patients in just a few years,” Dr. Sollins noted. To keep up with the growth, he recently brought on two more family physicians, Russell Canfield, MD, and Angela Barnett, MD. The three MDs now work with an extended network of roughly 25 practitioners of various holistic health modalities.

At the heart of Bridges in Medicine is the TEAM: Trained Experts in the Art of Medicine. This is the aggregation of conventional physicians and licensed holistic health care professionals that work collaboratively with each patient to develop a tailored and integrated treatment plan.

The process begins with an initial primary care consultation with one of Bridges’ MDs or DOs. Then, the patient must complete a comprehensive questionnaire that synthesizes and integrates lines of diagnostic logic from allopathy, Oriental medicine, various botanical medicine disciplines, chiropractic and behavioral health care. Bridges also asks patients to compose a “Personal Story,” a review of their lives and health issues from their own perspective. According to Dr. Sollins, these often contain important clinical clues, as well as insights into patients’ views of themselves and their worlds.

After reviewing information from the history, physical exam, existing charts, the questionnaire and the personal story, the primary care physician assembles a TEAM of individuals best suited to a patient’s specific problems. The TEAM then works together with the patient to develop a multimodal therapeutic plan. Patients are asked for a minimum 90-day commitment to working with the treatment plan. “It has been our experience that a 90-day program is the minimal required amount of time to elicit physical, emotional, mechanical and spiritual responses,” Dr. Sollins said. Patients are, of course, given the freedom to opt out prior to the 90 days, but only after a final TEAM consultation.

Tight Budgets, Expansive Practices

The initial primary care consultation costs about $150, and TEAM consultations cost $300 per hour. Follow-up appointments cost about $75 per hour. While Medicare does reimburse for the Bridges program, Dr. Sollins noted that currently, Bridges must work with a cap of $1,500 per patient—a pretty tight margin, given the depth of services the program offers.

“Right now, our practitioners are making only 75% of their usual fees. Some are making one-third less than they would on the open market. Ultimately, I want to see them earning market value,” said Dr. Sollins. “Down the road, we won’t be able to do everything for $1,500 per patient.”

He hopes that the positive health outcomes and cost savings resulting from Bridges’ comprehensive care will convince insurers to allocate greater reimbursement for integrative health services. For the moment, though, the gap in fees is more than compensated by the satisfaction, camaraderie and self-education that come from collaborative practice. “We all learn from each other, and our patients really benefit from our collective experience. We get to work together optimally, and it is a win-win for everybody: the patients get services covered that weren’t covered before, practitioners learn from one another and share their strengths, and the health plan will come out of it with cost savings and the kind of data that no other plans in the country will have.”

Bridges in Medicine is still in its infancy, and it has a bright future, one that should give hope to other physicians who share the dream of integrated health care. “Working collaboratively and putting the patient at the center of it all really generates a tremendous amount of energy,” Dr. Sollins said. “When managed care first emerged, the running joke was, “How serious an illness can you afford?” We need to move forward from this. The real question is, “What is the cost of our failure to truly connect with our patients?”