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Meditate On This

Employers advocating alternative medical treatments need to create financial incentives.

Take a Deep Breath and Relax

Popularity of selected complementary health approaches used by adults during 12-month period in 2012

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I’ll do pretty much anything to avoid going to the doctor, urgent care center or the emergency room. Unless I’m convinced it’s life or death, I’ll apply the appropriate home remedy and wait it out. Most of the time, whatever was bothering me will go away in a few days. Or I learn to live with it until it does. (If you want to see this attitude taken to the extreme, watch this clip from The Vikings to see the measures some people will take to avoid going to the doctor or, in this case, the orthopedic surgeon: bit.ly/1QkwxYM.) It’s not that I’m cheap. It’s that I’m afraid the doctor will find something seriously wrong with me well beyond what I went in for. I know that’s not an enlightened opinion. But I also know that doctors are motivated by their training and by their medical school debt to find things to fix.

That skepticism may be part of the reason more than one-third of adults use non-traditional medical interventions to treat whatever is ailing them. That’s according to new data from the U.S. National Center for Health Statistics (1.usa.gov/1DCXGD8).

Non-traditional medical care often is referred to as “complementary and alternative medicine,” or CAM. The use of CAM has gotten so prevalent that the U.S. National Institutes of Health runs the National Center for Complementary and Integrative Health, an information clearinghouse on such treatments that helps the public separate medical fact from fiction (1.usa.gov/1zfXLX4).

Of the 16 complementary health approaches studied by the NCHS, nonvitamin/nonmineral dietary supplements by far are the most popular (see chart, right). Hypnosis, biofeedback and ayurveda, an herbal treatment process, are the least popular.

Some 38 percent of people with private health insurance use alternative medical treatments, despite the fact that most health insurance plans don’t cover them. That means people are paying big bucks out of pocket for things like massage therapy, guided imagery and acupuncture.

In an earlier study, the NCHS said adults spent $33.9 billion on CAM products and services in 2007, which represented 1.5 percent of all national health expenditures that year (1.usa.gov/1FYPIGo). Using my fuzzy math skills and applying that same percentage to the annual $2.9 trillion being spent on health care services now, it would mean that some $43.8 billion is going to CAM products and services currently.

The new NCHS data, though, suggest that we, as a country, may have reached our upper limit on how much we’re willing to spend out of pocket. The percentage of adults using CAM in 2002 was 32.3 percent. It bubbled up to 35.5 percent in 2007. But it slipped back to 33.2 percent in 2012.

Employers that believe non-traditional medical treatments work and are more cost-effective than traditional care is will need to create financial incentives directly or through their insurance carrier to encourage workers to increase their use of CAM, particularly those services shown to help manage chronic medical conditions. Employers that don’t think CAM is effective shouldn’t pony up any money for it. More than one-third of workers will pay for it out of pocket anyway.

Short Take
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A report from the RAND Corp. gives new meaning to the phrase “sick and tired.” The research outfit from Santa Monica, Calif., looked into what health insurers are doing to help enrollees with chronic medical conditions better manage their health (bit.ly/1Q04Bid). If enrollees with conditions such as asthma, diabetes and high blood pressure do that, they won’t go to the doctor or hospital as much and run up big bills that health insurers have to pay. A survey of 25 health plans by RAND found that all 25 offer chronic-care management programs to enrollees. That’s good. But it found that the plans are having a tough time getting enrollees to participate despite offering them a variety of incentives (see “Carrots” chart). That’s bad. And it found that hospitals and doctors that contract with the plans aren’t too interested in getting patients to participate either. That’s really bad.

Both are bad for employers, which end up paying most of the bills for workers with chronic medical conditions who don’t take care of themselves. It’s time for the business community to take charge by creating financial incentives for plans and providers to get workers enrolled and actively participating in chronic-care management programs. Employers must shift the financial risk of chronic-care management to those who pay the claims and provide the care. Changes such as adjusting premiums paid to plans or payments made to providers for program participation would turn the situation around quickly. Money may not be enough to motivate employees in poor health, but it will motivate businesses like health plans, hospitals and physician practices.

Update

In two previous columns, we talked about the coming of age of telemedicine and the low-cost and convenient medical treatment option it offers employers and employees. Last November, we urged employers to lobby their state legislatures to require health plans to offer telemedicine as a covered benefit (bit.ly/1rKQhyy). In March, we reported that even without such a law in place, Minnesota got passing grades from the American Telemedicine Association for a favorable telemedicine coverage climate and for flexible licensing laws that allow physicians to practice telemedicine (bit.ly/1ctorQd). Well, you can bump both grades up to an A+ after the state passed the Minnesota Telemedicine Act. Gov. Mark Dayton signed the act into law as part of the omnibus Health and Human Services finance bill on May 22 (bit.ly/1Jjvzfh). It defines telemedicine as “real-time two-way, interactive audio and visual communications” between licensed health care providers and patients that facilitate “the assessment, diagnosis, consultation, treatment, education and care management” of a patient’s health. (Phone calls, emails and faxes don’t count.) The law requires health plans to offer telemedicine as a covered benefit, and it requires insurers to reimburse providers at the same rate they pay them for in-person visits with patients for the same services. The provisions take effect on Jan. 1, 2017. Like I said, it’s time to turn that office supply room into a patient exam room. Think of it as a healthy way to improve productivity.

 

David Burda (twitter.com/@davidrburda, dburda@msp-c.com) is editorial director, health care strategies, for MSP-C, where he serves as the chief health care content strategist and health care subject matter expert.

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