About Ali Alhimiri
Dr. Ali Alhimiri is a Physical Medicine & Rehabilitation Physician who provided a high level of cost-effective and patient function-centered care since 2002 and is committed to continually improving patients’ access to evidence-based care for spine and joint pain. He has successfully treated thousands of patients with pain and his insight led directly to the development of Modus unique and innovative approach. Ali holds a medical doctor’s degree from the University of Baghdad, Iraq. Completed residency training at Wayne State University-affiliated hospitals in Detroit, Michigan. Board-certified by the American academy of physical medicine and rehabilitation in 2003.
About Modus
Modus optimizes your existing MSK providers network by targeting and avoiding undesirable doctors and therapists while promoting only the safest, most trusted clinicians. Our sophisticated and patented technology ensures patients are guided only to those who have consistently delivered better value. Modus allows employees to recover faster and resume work quicker, thus reducing the employers’ costs of care.
Medical Travel & Digital Health News (MTDHN): Please tell us about your professional experience and how you got involved with Modus.
Ali Alhimiri (AA): I’m a physical medicine rehab physician and have been in practice in the suburbs of Detroit, Michigan, treating patients with musculoskeletal conditions. My specialty is basically focused on helping people regain function. We are located just outside of Detroit, but our solutions are available nationwide.
The creation of Modus is a very simple, personal story. Many patients that come to my office have been harmed by physicians who performed overly aggressive care, typically for financial gain, causing long-term disability and financial hardship for them but also for their, families, community, and employers.
There’s a multi-billion-dollar industry that benefits from the status quo of health care in this country: more care, poorer outcomes. We believe care should improve patient outcomes and improve function. For any patient, for example with back, improved function is the ultimate outcome measure that really matters: can you function better or worse after our treatment?
People care about their function which impacts their quality of life. Function is important regardless of medical specialty or condition, if a patient is getting symptoms from her/his back, head or heart, it will affect how they function to care for themselves, their household, work and leisure activities.
Sadly, not all doctors are created equal. For the past years, we have been analyzing Medicare claims data has been published and made publicly available for any individual or companies. Using our patented proprietary technology, we’re able to see the value difference doctors provide their patients based on claims data.
We can tell how the pattern of practice and the philosophy of physicians, from those that are doing aggressive procedures or overly prescribing opiates, which are causing long-term harm and disability to those who have been consistently prescribing the right type of treatments.
MTDHN: What is your business model?
AA: It’s a business-to-business model. We sell our solution to health plan sponsors, including employers, health plans, unions, and so forth, to cover musculoskeletal care.
In group health, it’s about 30% of the cost, which is massive, the number one spend and represents 90% of workers comp costs.
MTDHN: How does your revenue model work? What fees are associated with your services?
AA: It’s a per member per month (PMPM) basis. It starts at $3 PMPM, the price is based on the type of package, location and factors based on claims data and claims history.
We’re very confident that we can reduce cost and achieve better outcomes and function and offer a money-back guarantee if we don’t meet our target ROI.
MTDHN: What procedures are covered?
AA: We cover medical doctors, surgeons, physical and occupational therapists, and all the care that is provided.
When it comes to physicians, we cover pain management, interventional pain management, different types of surgeons, orthopedics, spine, joint, neurosurgery, and so forth. Eventually, we plan to venture into primary care and other specialties that are high spends, such as cardiology and oncology.
MTDHN: Do patients make their own arrangements? Can they choose any doctor or hospital?
AA: In group health, we vet a plan sponsor network of doctors, and then offer their patients a digital care navigator to tell them which doctor costs what and what kind of outcome they should expect versus other doctors. This lowers cost and enhances outcomes. The patient makes the choice based on which doctors seem right for them in terms of safety and cost-effectiveness.
In workers’ compensation, the employers tell employees which doctors they can go to so there is no need for the digital care navigator.
MTDHN: What aspect of your platform has had the biggest impact?
AA: The biggest impact is on improved function including reduced short- and long-term disability, and opioid use. We achieve this by ensuring that the care provided follows best practices and evidence-based care. In the end, providing better, not more, care also reduces the overall costs of care.
MTDHN: Are you aware of any competitors?
AA: Musculoskeletal care is very prevalent. In fact, 80% of people experience musculoskeletal issues throughout their lifetime. It’s also very expensive and there are many solutions to choose from with varied levels of efficacy.
For example, you see discount networks that offer cheaper fees to the providers but fail to address the overall cost of care or outcomes for the patients.
Other competitors are virtual or digital providers of therapy or physicians. The problem with them is that it’s difficult to build a true relationship without hands-on diagnosis and therapeutics. That being said, virtual care can be useful for example what has been going on with the pandemic, but it can’t replace the main services of healthcare.
MTDHN: Why do you think that your approach is more successful?
AA: We created technology that focuses on finding the right clinician for the patient’s needs. We’re at the front lines of care, being hands-on, communicating, and building a relationship and better care experience for each patient.
Our technology also focuses on functional outcomes. Our differentiator is that we offer an alternative for better care. If you are denied certain care, our alternative network of doctors s can provide it for you.
MTDHN: Where do you see the industry going from your perspective?
AA: We’ve seen increased focus on discount networks and virtual care by clinicians without relationships with patients, but it’s a blunt instrument that doesn’t work for every patient. Because discount networks offer lower price per unit, they need high volume to keep up. Ironically, even though they are more and more discount networks, the overall cost of care keeps on getting higher. That’s because they don’t address outcomes.
Also, there’s no focus on relationships with patients because you have an assembly line of available physicians or therapists who pop up on a screen. It’s good for simple urgent matters, but it shouldn’t be a solution for addressing overall cost and healthcare quality.
Overall, with these offerings, the cost keeps going up although outcomes and wellness of our population is getting worse despite the high cost.
It’s really unstable and unsustainable and causes a lot of harm to patients, families, communities and employers. Healthcare bills are the number one reason for bankruptcies in this country.
MTDHN: Is there anything else that you’d like to share with the readers?
AA: We offer something that is unique. We address that unsustainable cost trajectory and help plan sponsors, benefit advisors, TPA manage rampant costs and improve quality.
Most employers don’t have the time to gain insight or help manage these costs. They just look at health as a line item and part of doing business. It doesn’t have to be that way. If you hire a partner with the right people and the right companies, you can introduce intelligence and insight to address the logistics of your healthcare, which is the number one cost in any company.