Because members are becoming more cognizant of their out-of-pocket expenses, many are turning to complementary and alternative medicine therapies as a less-expensive alternative
BECAUSE MEMBERS are becoming more cognizant of their out-of-pocket expenses, many are turning to complementary and alternative medicine (CAM) therapies as a less-expensive alternative to prescription medications and other traditional medical treatments for chronic conditions. CAM therapies dovetail into the concept of prevention and lifestyle choices as well.
The use of such non-traditional medicine has held steady during the past decade. The 2007 National Health Interview Survey (NHIS) indicated that about 38% of adults use CAM therapies, a 2% increase since 2002. The same survey showed that U.S. adults spent $33.9 billion out of pocket on visits to practitioners and purchases of CAM products, classes and materials, while nearly 12% of children aged 17 years and under also use some form of CAM therapies.
"There is an increasing interest in providing managed complementary care benefits across the industry-from both employers and health plans," says Douglas Metz, MD, chief health services officer for American Specialty Health (ASH), which provides programs for prevention and wellness, fitness, and specialty managed care, including CAM therapies, to health plans and employer groups. "Many health plans and employer groups will offer CAM services as a way to sweeten the benefits package for members."
Appropriately managed, CAM therapies can provide value to a certain population. A chiropractic benefit is a common example.
"There is clinical evidence that shows the inclusion of chiropractic services in a benefit plan reduces the per-member, per-year costs for someone with back pain compared with those who do not have that benefit," says David Olsen, CEO of HSM Inc., a specialty healthcare services company that works with health plans to provide CAM services.
While there is steady use of CAM therapies in the market and evidence that they can bring value, they remain a small piece of the pie.
"When you talk about cost of care, we're more concerned with cancer and transplants than we are with CAM benefits," says John Frederick, MD, chief medical officer of Golden Valley, Minn.-based Preferred One. "The benefit is not huge for us."
So Preferred One, instead of administering CAM benefits itself, contracts with Minneapolis-based HSM, which builds CAM provider networks across the country. Preferred One provides acupuncture and chiropractic benefits, as well as massage therapy to some of its employer groups. HSM pays the providers and manages utilization. With self-insured employer groups, Preferred One collects premiums and reimburses HSM for care provided.
"We're not completely hands off, but we don't have to get too involved in the day-to-day operations," Dr. Frederick says.