Complementary and alternative medicine (CAM) treatments are all the rage lately for consumers, and many carriers are catching on to the trend by offering discounts on or coverage of certain benefits.
Cigna's Healthy Rewards discount program includes discounts for acupuncture, chiropractic care and massage, as well as natural supplements and many other health and wellness products and services.
Wendy Sherry, Cigna's vice president of product development, explains that CAM has the potential to lower traditional health care costs.
"For example, targeted use of chiropractic care to treat the back and spine can cost less than surgery. Using acupuncture instead of anesthesia can also cost less," Sherry says. "However, these are unproven approaches, which is why Cigna does not cover them as standard benefits."
"On the other hand," she continues, "when the benefits are not limited in some way - for example, with an annual maximum number of visits - people could use the treatment when it's not medically necessary, which is beyond the scope of health insurance coverage. That could drive up claim costs. It is also costly to manually manage claim reviews on alternative medicine benefits to ensure medical necessity."
Dr. Kenneth R. Pelletier, professor at the University of Arizona School of Medicine and the University of California School of Medicine, San Francisco, disagrees.
"Yes [these alternative medicines should be offered as part of a comprehensive health benefit package] because there is good evidence in favorable clinical outcomes, and in the cases where there has been a cost benefit analysis or a return on investment, the results are very promising." says Pelletier, who is also the chairman of the American Health Association and is a vice president with Healthtrac Incorporated.
He explains that by offering these alternative treatments under a benefit plan, employees return to work sooner and experience fewer relapses. Also, medical costs tend to flatten relative to what they would have been.
The most common and effective treatments include chiropractic, nutritional therapies, acupuncture and mind-body therapy. Research shows that acupuncture, for example, was present in 24% of company benefit plans, and only 26% of employers offered no alternative care benefits.
Chiropractic care, for which 72% of employers provided coverage in a 2009 Mercer study, for the limbs, joints or back pain is more cost-effective in comparison to the usual care regimen.
According to an October 2009 Milstein Choudry Report that measured the effectiveness of chiropractic care in treating low back pain and neck pain, this type of care not only was medically beneficial, but also cost-effective.
"[The authors of this study] felt that chiropractic care would be a clinically effective and cost-effective intervention to shift away from the traditional medical care and physical therapy care. Relative to the neck pain environment, their comment was that it would be highly cost effective," says Dr. Gerard Clum, president of Life Chiropractic College West. The researchers concluded that using chiropractic care in the lower back region would be cost-effective and would save a significant amount of money in treating neck pain.
The Center for Health Value Innovation used the Milstein report as a key element to develop its own report released at a May 2010 summit. CHVI implemented feedback from the 2009 study into the matrix to be evaluated from a value-based approach to health benefits.
"Their perspective was that chiropractic hasn't been evaluated in a value-based design perspective and if it were, it could have significant positive impact in terms of cost and patient outcomes," Clum explains.
CHVI also found that chiropractic care had the potential for significant savings, which leads Clum to conclude: "I don't think there's any question" that chiropractic services can lower traditional health cost for neck pain and low-back pain claims.
Convincing the C-suite
When convincing upper management to cover chiropractic care or other complementary treatments in a company's benefit package, HR/benefits pros should show them the evidence, Clum advises.
Implementing CAM treatments such as chiropractic care can reduce disability costs and absenteeism.
On the other hand, convincing employees is not a significant obstacle because of popular consumer demand.
"The consumer uptake for chiropractics has been tremendous, and frankly that's what's driven the industry for decades. The consumer demand has been there, but the system demand to respond to that has been what's lagged," says Clum.
Nutritional therapies also are popular and may be monitored by a registered dietician for weight loss, heart disease prevention or recoveries from heart surgery.
Acupuncture for back pain or post-operative pain also is generally coded and billed with most insurers covering it, says Pelletier. When treating some forms of acute pain, it can be less expensive than surgery, implants or electrodes.
Further, mind-body therapy, relaxation, or marital arts such as Tai Chi (which is probably not covered, even though studies have shown its positive outcomes for problems like heart disease and chronic pain) can be other considerations for employers looking into CAM.
Mind-body interventions have the greatest efficacy for the largest amount of people for the greatest variety of medical conditions, Pelletier emphasizes. It's also very inexpensive to deliver, while addressing a vast array of problems such as chronic pain, stress and depression. He says that most insurers cover these benefits if embedded in a stress management program. It's important to read over your plan coverage, as the carrier may cover this treatment though it may not be named.
Case study: Ford Motor Company
For their workers' compensation program, Ford Motor Company experimented with alternative medicine such as acupuncture and mind-body meditation.
The worksite assessment started in 2006 and was published in March of 2010. It studied workers at a Louisville, Ky., truck plant who complained of acute lower-back pain under workers' compensation.
Employees were divided into two groups: The control group received the usual care in the onsite clinic, which prescribed medication if needed and physical therapy. The second group received the usual care in addition to the intervention care, which entailed weekly acupuncture treatments and the Healthy Roads Program, in which participants were taught meditation skills to aid relaxation and help overcome pain.
The 25 total participants were reviewed at six and 10 weeks with a number of tests, which measured perceived pain and depression levels, among other metrics.
Researchers found that there was small, but statistically significant, improvement in pain findings in the experimental group over the control group.
Further, participants in the intervention group were using significantly fewer opiates or other treatments than those on standard protocol at six weeks. There also was a marginally significant reduction in physical therapy among those using complementary medicine in addition to the traditional regime.
When asked whether complementary medicine can lower traditional health cost claims, Walter J. Talamonti, medical director of clinical operations at Ford Motor Company, explains that "you can't make that [determination] at this point. That's a big jump." He adds that a formal study with more patients to measure would be needed to form an opinion.
Still, the findings from his observations at the Kentucky plant are promising. Employees can't work on the plant floor if they are taking narcotics for pain, so a program like Healthy Roads or an acupuncture regime may help them get back on the job sooner. They're considering another study on the effect of complementary medicine on injuries to the upper extremities as soon as next year.
When proposing the study, Talamonti used an evidence-based approach for getting permission from upper management. His hope for the pilot was to prove the efficacy of these alternative medicines definitively, but not enough people participated.
For this reason, although they may send an employee covered under workers' comp to an acupuncturist, these benefits are not yet covered under the general benefits package.
"We need to divide out [the treatments] and do a large study," he says. "Once we have the proper data, if it does work, then we have something that can be peer reviewed, published and therefore be able to implement it.
"If you're looking at evidence-based [programs] and you have to justify the cost, you would have a difficult time justifying it to upper management as to why you're doing this."
Ultimately, there was not enough power in the study because there were too few people, and you can't tease apart the impact of acupuncture and meditation, he explains. Nevertheless, he believes that they're headed in the right direction with these interesting findings.
"We'd like to continue looking at this, particularly for the upper extremities, but it will probably take more than one facility to get enough people to give the study adequate power," concludes Talamonti.
Though the studies are few, CAM therapies have the potential to offset serious medical costs for employers and employees.
"It's time to relook at everything to do with health care," says Clum. "Rearranging the deck chairs on Titanic is not going to help the ship. We need to take a hard look at what we're getting for the dollars that we're spending and explore if [there are] ways that we haven't normally thought of as a first course of action that could be more reasonable, more appropriate clinically and economically for the future of business, as well as the future of the consumer."
Conditions that can be treated with acupuncture
* High blood pressure
* Irritable bowel syndrome
* Food allergies
* Chronic fatigue
Emotional and Psychological Disorders
Musculoskeletal and Neurological Disorders
* Back Pain
* Headaches and migraines
* Colds and flus
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