New UnitedHealthcare benefit offers alternatives to opioids

Unitedhealthcare is introducing a new benefit for members with acute low back pain which is intended to make accessing physical therapy and chiropractic care more affordable.

The new benefit allows plan participants enrolled in certain employer-sponsored health plans to pay zero out of pocket for their first three visits to a physical therapist or chiropractor for the treatment of lower back pain, the insurer says.

After the initial three visits the employee would revert back to their original plan design, and pay for treatment how they would have previously. The benefit is meant to help encourage Unitedhealthcare members to choose noninvasive treatment options and also help to reduce the use of opioids and other prescription painkillers.

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“It’s prompting members to start down that noninvasive path,” says Will Shanley, director of public relations at Unitedhealthcare. “[Employees] pay nothing out of pocket to get rolling on the clinically recommended treatment path and that steers them away from those costlier and more invasive approaches that we know are not in the members’ best interest.”

Nearly 70% of people experience low back pain at least once in their lifetime, and about one-quarter of adults in the U.S. reported experiencing the condition in the past three months, according to Unitedhealthcare. Opioids are prescribed for nearly 9% of new back pain cases, with this condition ranking as the most common reason for an opioid prescription, according to data from OptumLabs.

The way this new benefit is designed has the potential to reduce the number of spinal imaging tests by 22%, spinal surgeries by 21%, and opioid use by 19% by 2021, according to UnitedHealthcare’s own analysis. It may also lower the total cost of care for eligible plan participants and employers.

“This new benefit design may help encourage people with low back pain get the right care at the right time and in the right setting, helping expand access to evidence-based and more affordable treatments,” says Anne Docimo, UnitedHealthcare's chief medical officer, in a statement.

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Opioid abuse is a significant issue in the U.S., with 130 Americans dying every day from an opioid overdose, according to the Department of Health and Human Services. Last year there were approximately 10.3 million people aged 12 or older who misused opioids.

UnitedHealthcare’s new benefit is now available for some new and renewing employers with fully insured plans and 51 or more employees in Connecticut, Florida, Georgia, New York and North Carolina. The benefit will be expanded to new and renewing employers with self-funded plans and organizations with two to 50 employees in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia starting next year. The insurer is planning a broader expansion of the benefit over the next two years.

“With millions of Americans experiencing low back pain currently or at some point during their lifetimes, we believe this benefit design will help make a meaningful difference by improving health outcomes while reducing costs,” Docimo says.

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