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CAM "Insurance Laboratory" Finding: Limited $$ Risk from ND, LAc, DC and LMT Services PDF Print E-mail
Written by John Weeks   

CAM "Insurance Laboratory" Finding: Limited $$ Risk from ND, LAc, DC and LMT Services

{mosimage}The Washington State Legislature passed a law in 1995 which required all health plans to include "every category of provider." By doing so, Washington became what researcher William Lafferty, MD, calls "an important laboratory to assess the magnitude of economic risk when a third-party payer covers CAM providers."

In a recent article in the American Journal of Managed Care, Lafferty's research group presents data which measures that risk. The writers conclude:

"The number of people using covered CAM insurance benefits was substantial; the effect on insurance expenditures was modest." 
Lafferty, et al Insurance Coverage and Subsequent Utilization of Complementary and Alternative Medicine Providers. Am J Manag Care. 2006;12:397-404

The Lafferty paper, one in a series based on an NIH NCCAM-funded project, looks at covered services provided by four distinctly-licensed provider types: chiropractors, naturopathic physicians, acupuncturists and massage therapists. The providers were all parts of CAM networks serving members of three unnamed health plans in Western Washington.
Chiropractors have been covered since a state mandate in 1983. Coverage of the other three disciplines was in it 6th year at the time of the study. A synopsis follows.

_____________________________

At a Glance Data from Lafferty Study on
Covered CAM Services in Western Washington

Total  plans  analyzed
 3 
Total enrollees
 600,000
Year of analysis
2002
Making CAM claims
13.7% 
Acupuncture claims
 1.3%
Naturopathic Medicine claims
1.6% 
Masasge services
2.4% 
Chiropractic services
10.9% 
Typical complaints for which DC,
LAc and massage services
were covered
Musculoskeletal 
Typical complaints for which ND
services were offered
"Broader array of
problems"
Visits per user (median)
Acupuncture (6.52)
ND (4.25)
Massage (7.88)
Chiro (7.27)
Expenditure per enrollee
 Acupuncture ($6)
ND ($9)
Massage ($18)
Chiro ($41)
Median per visit cost, CAM care
$39.00 
Total costs per enrollee, all services
$2589 
Total costs per enrollee, CAM services
$75 
Percent of costs spent on CAM
2.9%


_____________________________

The group, which includes CAM cost expert Dan Cherkin, PhD, concludes that "despite the increase in CAM provider use and a mandatory requirement in Washington State to include CAM providers in insurance, the overall percentage of insurance expenditures for CAM remains small 6 years after passage of the requirement."

Finally, the team calls for future studies to evaluate:
" ... whether CAM therapies actually substitute for more expensive conventional care. Only then can the total impact of CAM integration on healthcare utilization be measured." (bold added)

Comment: Lafferty's group asks the primum non nocere (above all do no harm) question which energizes the financially-focused medical insurance world. Will including these CAM providers harm my bottom line?
An aside: Anyone close to this drama in Washington over the last decade will know that the state's health plans have kicked and screamed in the media, the legislature, and the courts, that being forced to cover these CAM providers was going to be a financial disaster. Had it not been for the Chicago-style political battling of the then Insurance Commissioner, consumer-oriented and CAM-friendly Deborah Senn, who ensured the "every category" language be in the law, forced insurers to comply, then fought them in state and federal court, we would have never had Lafferty's "insurance laboratory."

And the envelope please ... 

 
The opportunity in
Washington State is
not about the cost
effectiveness of CAM
therapies.

Rather,
it is
to see whether

the increased use of
CAM practitioners
may substitute for
more expensive care
of conventional
practitioners.

While concluding that "the effect on insurance expenditures was modest" is not precisely a synonym for "no harm," Lafferty's group's conclusion is at least a pretty strong stop your whining already, and let's get on with it. Perhaps we can, with these result, finally begin to ask questions which will measure what many CAM providers have asserted for decades: Use us more and you can save money.

Interestingly, this assertion is not what Lafferty suggests we next begin to explore. In one of CAM integration's classic conceptual errors, Lafferty frames the next round of questioning not around what he has been studying - which is the effect of the inclusion of new "categories of providers". Rather, Lafferty frames the next phase around therapies: " ... can CAM therapies actually substitute for more expensive conventional care?" 

Conflict mediators suggest that we are often best to not personalize hotly-debated topics.  Such as whether one type of provider's care is more cost-effective than another's. But here Lafferty needs to re-personalize - or to be more specific - re-providerize, his question. The opportunity in Washington State is to see whether the increased use of CAM providers may substitute for more expensive care of conventionally-practicing providers. Is including these new providers additive or is it cost-saving, relative to conventional care only?

But the ultimate test of
"the total impact of CAM integration on healthcare utilization" requires yet a further analysis. We need to be looking at outcomes after health plans are directing care proactively toward these CAM providers, or to integrated teams, which appear to be cost-saving. What savings may we find if CAM practitioners or integrated teams are strategically engaged?

With this information, we'll finally, to echo some lines of the poet T.S. Eliot, be back where we started again. In this case, we'll finally be looking at how CAM-IM can practically influence meaningful healthcare reform. We do have a problem with cost in our healthcare system, don't we?


A note of thanks to Deborah Senn: We all owe Ms. Senn, a note of thanks for her public service in helping us come out of our collective ignorance. Senn is presently an attorney in private practice in Seattle after the US Chamber of Commerce, backed by the insurance industry, made an illegal $1.4-million contribution to buy TV ads in the last two weeks of a primary election campaign in her run for state Attorney General in 2004. Analysts agree that the illegally-funded ads played a major role in killing her bid.

A note of thanks to the participating plans: Yes, they fought the legislation, and fought Senn, but the three plans which participated in the study did not need to reveal anything. Thanks for making your experience public.




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