Sherry McAllister

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The nation’s opioid crisis has received enormous media, government, and healthcare industry attention in the past few years, with a few glimmers of hope emerging in that time. For example, a study published this year showed the overall number of opioid prescriptions have decreased 

 since 2010, with the largest decrease in 2017, and that high-dose prescriptions have decreased by more than 53% since 2006.

The prescribing shift has been driven by changes in regulations, awareness, and education, as well as 

. However, more work still needs to be done to encourage patients to access effective, nonpharmacological pain management methods. These methods include chiropractic care, removing the health plan-imposed barriers such as strict utilization limits and high out-of-pocket spending requirements.

 has shown private and government health plans may inadvertently be steering their members toward opioids by not covering, restricting benefits, or charging higher co-pays for chiropractic care.

More recently, UnitedHealth Group’s OptumLabs subsidiary and the Boston University School of Public Health released a 

 that showed higher out-of-pocket costs made it less likely for patients with low back pain to choose noninvasive treatments, such as chiropractic care. Health plan members with a deductible of greater than $1,500, for example, were less likely to choose a doctor of chiropractic (DC) as an entry-point provider.

Many leading payers, however, are supporting more progressive policies that embrace chiropractic care, physical therapy, acupuncture, and other safer, nonpharmacological methods. For example, in October, UnitedHealthcare 

 health plan participants enrolled in certain employer-sponsored medical plans will have zero out-of-pocket spending, including their deductible, if they select chiropractic care for the treatment of low back pain. UnitedHealthcare estimates that by 2021 this benefit design has the potential to reduce the number of spinal imaging tests by 22%, spinal surgeries by 21%, opioid use by 19%, and lower the total cost of care for members and employers.

Other health plans are also expanding or emphasizing coverage in 2020 for chiropractic and other drug-free pain management methods. Tricare, the federal government health insurer for the military, is the most prominent leader in this trend. The payer now only 

 chiropractic care for active-duty troops, activated guards, and reserve members, but not families, retirees or their families.

Next year, however, Tricare is expected to approve 

 coverage of chiropractic care to family members, retirees, and their family members. Although the benefit may not be awarded until 2021 or 2022, that is still a major step in the right direction for one of the biggest payers in the country.

This coverage determination, perhaps not coincidentally, comes after the 

 of a 10-year study of military members involving three clinical trials which showed chiropractic care improved strength, endurance, and response time among service members with lower back pain.

Non-military seniors in many parts of the country could receive improved access to chiropractic care thanks to benefit expansions involving some large Medicare Advantage plans. 

 in California expanded wellness benefits for its Medicare Advantage plans to include up to 24 visits per year with a DC, therapeutic massage, acupuncture/pressure, or any combination, at no extra cost. Similarly, Independence Medicare Advantage in the Philadelphia metropolitan area is 

 its members routine chiropractic coverage, in addition to the six visits per year Medicare approves, at no additional cost.

Community-Based Care Programs Fill Gaps In Traditional Health Services

 Mutual of Omaha Medicare Supplement members could access the insurer’s Mutually Well program that offers access to a network of services from Tivity Health’s WholeHealth Living Choices, which includes more than 20,000 providers. Specialties include chiropractic, acupuncture, massage therapy, and nutritional programs.

Health plan members without adequate chiropractic coverage may have other options to lower the out-of-pocket spending barrier to their care. For example, Sam’s Club began a healthcare discount 

 in Michigan, Pennsylvania, and North Carolina in October where its members can buy one of four bundles of services designed to supplement existing insurance to reduce out-of-pocket spending. Bundles offer reduced costs on dental, vision, telehealth visits, prescription drugs and up to a 30% reduced cost on chiropractic, massage therapy, and acupuncture services. The program is expected to expand nationwide.

While this is not health insurance coverage, such a discount program may nonetheless enable more patients to seek chiropractic care and experience the nonpharmacological pain relief and improved mobility they have sought for many years, but haven’t been able to obtain due to costs or other health plan limitations. Removing those financial and bureaucratic barriers could improve patient outcomes and increase their satisfaction with their health plan. After all, recent survey results show that 

 of adults would prefer to first address their neck or back pain using methods other than prescription medication while DCs earn higher scores than medical doctors in qualities such as listening, convenient/quick access to care, demonstrating care/compassion, and explaining things well.

Coincidentally, similar satisfaction survey scores were earned by health insurers, according to the American Customer Satisfaction Index’s (ACSI) Finance, Insurance, and Health Care 

 2018-2019. Health insurers earned 74 out of 100 in 2019 for policyholder satisfaction, the highest level in a decade, ACSI reported.

To capitalize on this trend, further curb opioid prescriptions, and cost-effectively improve patients’ outcomes, payers would be wise to continue to expand such patient-centered health plan benefits and policies concerning chiropractic care in 2020 and beyond.

Sherry McAllister, DC, is executive vice president of the 

 (F4CP). A not-for-profit organization, the F4CP provides information and education regarding the value of chiropractic care and its role in drug-free pain management.

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