Alternative medicine

Opioids pushed insurers to embrace alternative medicine

Over the past decade, some members of the medical community came to approve alternative forms of medical practice such as reiki, acupuncture, and even scientifically dubious practices like energy healing. For hospitals, alternative medicine has become a distinctive and salable feature set that helps sustain their revenue. However, insurance has been slow to cover these services, some of which have no scientific basis.

But insurers are increasingly willing to pay for some of the more established alternative medicines such as meditation, chiropractic care and acupuncture, which recent studies show can help manage chronic pain. As regulators and health systems scramble to curb opioid prescriptions, health insurers are taking a second look at these treatments.

The latest support for alternative medicine comes from the Center for Medicare and Medicaid Services (CMS). Last month, the nation’s largest healthcare payer expanded its coverage to include acupuncture for lower back pain. CMS will cover up to 12 sessions taken over the course of 90 days with the possibility of eight additional sessions if the patient shows improvement. However, since acupuncturists are not recognized by CMS and cannot charge for services, acupuncture work must be performed by a nurse practitioner, physician, or qualified medical assistant within a physician’s office. traditional. Still, the move illustrates the willingness of one of the nation’s most thorough payers to find value in methods he previously treated with skepticism.

Studies have shown that yoga, meditation, acupuncture, and chiropractic care can all be helpful for people with pain.

CMS isn’t the only payer considering other forms of pain relief. In November 2019, UnitedHealthcare expanded its chiropractic coverage with a new offering for lower back pain. Patients with access to the new plan pay $0 out of pocket when treating lower back pain with physical therapy or chiropractic care. According to its own internal analysis, UnitedHealthcare estimates that over the next year it will reduce spine surgeries by 21% and opioid use for lower back pain by 19% as a result of this plan. There are currently 30,000 chiropractors in its network.

The company also invests in acupuncture, yoga therapy, massage and nutrition counseling. “UnitedHealthcare has a very thorough process for evaluating healthcare professionals and reviewing published literature relating to new and emerging treatments and technologies, including holistic healthcare methods,” said David Elton, Chief Strategy Officer. providing chiropractic care, sports medicine and physical medicine. therapy at UnitedHealth Group Ventures, the venture capital arm of UnitedHealthcare. Among UnitedHealthcare searches is a study this showed that patients were significantly less likely to use opioids for lower back pain management if the initial care they received was from a chiropractor or physical therapist rather than a primary care physician.

Less pain, fewer tests and pills

CMS and UnitedHealthcare moves come nearly two years later the American College of Physicians published guidelines that lower back pain should be treated with acupuncture, chiropractic care and massage before anything else. “Physicians should avoid prescribing unnecessary tests and expensive and potentially harmful drugs, especially narcotics, to these patients,” said Nitin S. Damle, president of the American College of Physicians, at the time of publication. guidelines.

Much of the interest in holistic medicine is as an alternative to opioids for managing chronic pain. Studies have shown that yoga, meditation, acupuncture, and chiropractic care can all be helpful for those who suffer from pain, in some cases eliminating it and in others making it more bearable. Chiropractic care and acupuncture are more often covered by health insurers, although to varying degrees depending on individual plans. However, yoga and meditation, despite research, are not covered by health insurers.

A 2017 study sponsored by the National Institutes of Health found that groups that received yoga or physical therapy for chronic lower back pain were significantly more likely to stop using painkillers than those that received only self-care booklets and newsletters. There is also some evidence that meditation might be helpful in chronic pain management, although researchers argue there needs to be better quality data to confirm its value.

Good research on these issues is essential to get insurers on board. UnitedHealthcare says that when it decides to cover a new practice, it looks for high-quality published research, standards for treatment, and a method of accreditation or licensing for practitioners.

“The CMS decision is an important step,” says Dale West, executive director of the Academic Consortium for Integrative Medicine. “It will allow different payment models, it will allow an increase in the number of acupuncturists and access. An acupuncturist is not a CMS provider, so that’s what we need to change next. He adds that there is debate over whether including licensed acupuncturists under CMS will require an act of Congress or whether the Department of Health and Human Services can make this change.

CMS is notoriously specific about what it will and will not cover. For example, it only covers chiropractic care when the spinal vertebrae are out of alignment and that’s “medically necessary” to adjust them. West’s organization is currently updating a 2018 white paper that highlights pain management methods that don’t include surgery or medication. This will be a comprehensive review of the existing literature on the use of physiotherapy, massage therapy, chiropractic care, acupuncture, yoga, and mindfulness as treatment methods, including for pain management. Kensho Health, a platform that reviews independent providers of alternative medicine, is helping fund the study so it can be published later this year.

The hope is that the document will draw more attention to practices such as chiropractic care and acupuncture so that they are more widely adopted by payers and officials. It is updated in part to reflect a host of new findings that show the positive impact of using alternative practices such as yoga, acupuncture and chiropractic care to manage pain. Much of the new research comes from an explosion of funding to address the opioid crisis.

Even though the original whitepaper isn’t that old, West says it’s important to incorporate all the new data. “There have been a lot of new studies that have come out on efficacy and on economic impact,” he says. It will be important, he says, not only to prove that these methods work, but that they are less expensive than long-term painkillers.