How Chiropractic Helps the Insurance Industry

Report suggests covering chiropractic care of neck and low back pain increases value-for-dollar of health benefit plans.

By Peter W. Crownfield, Executive Editor

Insurance companies and others hesitant to expand coverage of chiropractic care should review a copy of a report commissioned by the Foundation for Chiropractic Progress and prepared by Mercer Health and Benefits, a San Francisco-based human resources and financial advisor.

Study Parameters

Niteesh Choudhry, MD, PhD, assistant professor at Harvard Medical School, and Arnold Milstein, MD, MPH, chief physician at Mercer Health and Benefits, evaluated the peer-reviewed literature and constructed an economic model to estimate the likely impact of expanding chiropractic coverage for neck and low back pain within U.S. health plans, including the relative cost-effectiveness of coverage of chiropractic physician services compared to coverage only for medical physician services (medical doctors, osteopathic doctors, physical therapists and others).

Dividing differences in total costs of care per episode of care between chiropractic and other care modalities by differences in their effectiveness provided the authors with estimates of effectiveness measured in dollars per quality-adjusted life years (QALY) units. According to the report, estimates based on dollars per QALY units "are a common currency for assessing the value of health care interventions and thus facilitate the comparison of chiropractic care for spinal disorders with other treatments for these conditions as well as unrelated disorders."

To calculate unit prices payable by U.S. insurers for the coverage of low back and neck pain care, the authors pulled billing data from Mercer HealthOnline, which houses data for more than 80 large employer-sponsored health plans covering nearly 3 million members. Of note, prescription drug expenditures were not included in the analysis; inclusion of said expenditures presumably would have increased non-chiropractic costs of care significantly.

Take-Home Points

• Chiropractic care is widely used, with almost half of all patients with persistent back pain seeking this form of treatment.
• "Chiropractic care is more effective than other modalities for treating low back and neck pain."
• Chiropractic care for the treatment of low back and neck pain "is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds."
• "Insurance coverage for chiropractic physician care ... is likely to drive improved cost-effectiveness of U.S. care."
• These findings "support the value of health insurance coverage of chiropractic care for low back and neck pain at average fees currently payable by U.S. commercial insurers."

To download a complete copy of the Choudhry and Milstein report, visit www.f4cp.com/MercerReport.htm. To review other recent study findings suggesting the cost-effectiveness and clinical value of chiropractic care, read "The Research You've Been Waiting for? (Aug. 26 issue) and "Cost-Effective Care: The Evidence Mounts" (Sept. 9 issue).

New Pilot on Quality Shows Cost-Effectiveness of Chiropractic Care for Musculoskeletal Disorders

A new pilot program shows that conservative heath care, including chiropractic, may reduce overall health care costs in patients with musculoskeletal disorders, such as back and neck pain. The pilot, conducted by Wellmark Blue Cross and Blue Shield to measure quality of patient care for its members in Iowa and South Dakota, also shows promising outcomes for the patients choosing chiropractic and other conservative care.

“The cost-effectiveness and safety of chiropractic has been documented in several studies. ACA is pleased that insurance companies are starting to recognize the value that doctors of chiropractic and other conservative providers can offer to their members,” said ACA President Glenn Manceaux, DC. “Especially during the health care reform debate, it’s important that chiropractic and other conservative care methods are taken into serious consideration as a cost-effective alternative to the utilization of expensive surgery and hospital-based care,” he added.

Wellmark conducted the Physical Medicine Pilot on Quality in 2008 for Iowa and South Dakota physical medicine providers. A total of 238 chiropractors, physical therapists and occupational therapists provided care to 5,500 members with musculoskeletal disorders. According to Wellmark, data from participating clinicians show that 89 percent of the patients treated in the pilot reported a greater than 30-percent improvement in 30 days.

The pilot compared data for Wellmark members who received care from doctors of chiropractic or physical therapists with a member population with similar demographics who did not receive such services. The comparison showed that those who received chiropractic care or physical therapy were less likely to have surgery and experienced lower total health care costs, according to Wellmark.

Chiropractic is widely recognized as one of the safest non-invasive therapies available for the treatment of back pain, neck pain, headaches and other neuromusculoskeletal complaints. A significant amount of evidence shows that chiropractic care for certain conditions can be more effective and less costly than traditional medical care. Recent research includes:

• A study published in the October 2005 issue of the Journal of Manipulative and Physiological Therapeutics (JMPT) found that chiropractic and medical care have comparable costs for treating chronic low-back pain, with chiropractic care producing significantly better outcomes.
• A March 2004 study in JMPT found that chiropractic care is more effective than medical care at treating chronic low-back pain in patients’ first year of symptoms.
• A study published in a 2003 edition of the medical journal Spine found that manual manipulation provides better short-term relief of chronic spinal pain than do a variety of medications.

The American Chiropractic Association is the nation’s leading chiropractic organization representing more than 15,000 doctors of chiropractic and their patients. To find a chiropractor near you, visit www.acatoday.org.

Corporate Healthcare Costs are on the rise. Are you prepared?

Corporate wellness is an important issue, because well employees are happy, productive employees who help businesses succeed and thrive. Nearly 85 percent of American businesses have some form of a wellness program in place, most often composed of guidelines for smoking cessation, weight management, fitness and back care.

Corporate Wellness is not a new topic.  In fact, participation in corporate wellness programs has increased almost 60% since 2006.  Poor employee health is directly related to health care costs, workers compensation costs, long term and short term disability costs, absenteeism and decreased productivity.

In addition to the direct costs of poor employee health, the soft costs of poor health in the workplace are now beginning to be recognized.  Recent studies suggest that Presenteeism—when employees in poor health show up for work—costs employers between 150 and 200 billion dollars annually, more than 60% of the cost of employers' total healthcare dollars.  Consider other soft costs of poor employee health—decreased employee morale, increased turnover rates, lower productivity and job dissatisfaction—and it is apparent that the corporate healthcare crisis goes far beyond what is measurable in dollars and cents.

Consider these recent national health care and wellness statistics:

•  Starbucks spent more on health care than on coffee (Wall Street Journal)

• Every GM vehicle includes $1500 in health-care costs/vehicle (more than cost of steel) while every Japanese vehicle includes only $450 in health-care costs/vehicle (Wall Street Journal, 4/9/06)
• Health care spending is 4.3 times the amount spent on national defense (California Health Care Foundation. Health Care Costs 101 - 02 March 2005)
• Workers are now paying $1,094 more in premiums/year than they did in 2000, and the average annual worker health-care premium is $2973 for family coverage. (California Health Care Foundation. Health Care Costs 101 -- 2005. 02 March 2005)
• Since 2000, employment-based health insurance premiums have increased 73%, while wage growth has only increased 15% (The McKinsey Quarterly Chart Focus Newsletter, "Will Health Benefit Costs Since 2000, employment-based health insurance premiums have increased 73%, while wage growth has only increased 15% (The McKinsey Quarterly Chart Focus Newsletter, "Will Health Benefit Costs Since 2000, employment-based health insurance premiums have increased 73%, while wage growth has only increased 15% (The McKinsey Quarterly Chart Focus Newsletter, "Will Health Benefit Costs Since 2000, employment-based health insurance premiums have increased 73%, while wage growth has only increased 15% (The McKinsey Quarterly Chart Focus Newsletter, "Will Health Benefit Costs Eclipse Profits," September 2004)