When the EHB Advisory Committee met earlier this year to discuss what Oregon’s 2017 Benchmark plan should look like, someone brought up the very good point that it should include the benefits found on the Oregon Health Plan (OHP), the state’s Medicaid program.
The reason behind this suggestion was that a huge number of people who will be on the exchange plans are constantly bouncing between OHP and private insurance, depending on their work situation and financial situation on any given month. Thus, having an identical scope of benefits between the two would provide a more-or-less seamless transition whenever the consumer qualified for Medicaid or had to purchase a private plan. If not the exact same providers (since not all providers work with OHP), then at least the same types of providers.
Alas, that was not to be. CAM providers were (yet again) not accounted for in the benchmark plan.
But were CAM providers really in a better position on OHP plans? Funny you should ask. In fact, back in March, the Health Evidence Review Commission (HERC), released a paper that suggested OHP take a very different approach:
Until now, the OHP has limited [back condition] treatment to patients who have muscle weakness or other signs of nerve damage. Beginning in 2016, treatments will be available for all back conditions. Before treatment begins, providers will assess patients to determine their level of risk for chronic back pain, and whether they meet criteria for a surgical consultation. Based on the results, one or more of the following covered treatments may be appropriate:
- Chiropractic manipulation
- Cognitive behavioral therapy (a form of talk therapy)
- Medications (including short-term opiate drugs, but not long-term prescriptions)
- Office visits
- Osteopathic manipulation
- Physical and occupational therapy
- Surgery (only for a limited number of conditions where evidence shows surgery is more effective than other treatment options)
In addition, yoga, intensive rehabilitation, massage, and/or supervised exercise therapy are recommended to be included in the comprehensive treatment plans. These services, which also have evidence of effectiveness, will be provided where available as determined by each Coordinated Care Organization (CCO). [emphasis mine]
Massage! Yoga! Manipulations! I love it. It feels like the people in charge are finally trying to figure out what actually helps reduce or manage chronic pain. This is a great development, and it has the power to change a lot of lives.
How do we solve the problem of chronic pain? For so long, the answer has been prescription medication. However, as I wrote about earlier, many people and organizations are starting to realize that these medications have drawbacks and limitations. Indeed, one of the reasons alternative care has taken hold in this country recently is because of the need to find another way to treat chronic pain.
Having options is nice, but it’s a luxury that people with limited means can barely afford. When your health insurance covers prescription medicine but not alternative care treatments, what can you do? In such cases, the choice between painkillers and CAM isn’t really a choice.
And the long-term use of painkillers can become a problem. As illustrated in this article, “In 2012, more than 900,000 Oregonians received an opioid prescription…About one third of hospitalizations related to drug abuse here are due to opioids.” Indeed, the HERC document points out that, “OHP has spent a great deal of public money on treatments such as surgery and medications, without good evidence that they improve patient’s lives. At the same time, narcotics also carry risks of dependency, misuse and overdose.”
Starting in January, OHP patients will have a real choice in how they want to manage their chronic back pain.
The weird tangent to all of this, however, is that Oregon’s Medicaid will soon have a wider scope of provider types and covered services than most of the plans on Oregon’s Exchange. Even in private plans that do cover certain CAM services, the insurance companies will still be allowed to discriminate against providers until 2017. Whereas, if a provider wanted to work with a Medicaid patient, he or she would only have to talk to the patient’s CCO to make it happen. It seems to me that the state is actually invested in making people’s lives better, while the insurance companies are focused only on the short-term gains.