Research in Washington State

This is part of a larger article I wrote several years ago on the Affordable Care Act. Read the whole thing here.

Beginning in 1996, the state of Washington mandated that private insurance companies must cover every category of health care provider given that the provider is giving treatment for a basic service that he or she is licensed for. In short, that means CAM providers in the state of Washington are covered under private insurance policies in the same way that conventional providers are covered. A visit to an acupuncturist, for example, would be available as readily as a visit to a medical doctor.

From the mandate:

“(1) Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1996, shall:
(a) Permit every category of health care provider to provide health services or care for conditions included in the basic health plan services to the extent that:
(i) The provision of such health services or care is within the health care providers’ permitted scope of practice; and
(ii) The providers agree to abide by standards related to:
(A) Provision, utilization review, and cost containment of health services;
(B) Management and administrative procedures; and
(C) Provision of cost-effective and clinically efficacious health services.” [source]

This wouldn’t mean that everyone in Washington would start getting CAM treatments, but it would mean that those who did utilize CAM weren’t just those who could afford to pay out-of-pocket. Recently, researchers took a look at two years worth of claims to see if patients who did and did not use CAM treatments differed in total medical expenses. Read the full analysis here.

Because most CAM research relies on self-reported data (ie, whether the patient feels better after a treatment), these studies often have an inherent bias. Whether or not CAM treatments provide tangible evidence of being effective, they often lead to a general sense of well-being. While the interaction between mental and physical health cannot be denied, this was not what researchers wanted to study. Rather, this study took a “cost-minimization approach” in order to find out whether CAM users differed from nonusers in their medical costs.

In an analysis of insurance expenditures for matched groups of CAM users and CAM nonusers, it was found that CAM users had significantly lower overall expenditures. Specifically, while they did have a slightly higher expenditure for outpatient visits (including massage appointments, chiropractic adjustments, etc, which the other group – by definition – did not utilize), inpatient expenditures and other expenditures (imaging, lab work, etc) were significantly lower. It was found that CAM users were less likely to be hospitalized, less likely to get a hysterectomy within one year of diagnosis, and more likely to have some type of imaging done and done early. Although having more imaging done should seemingly be more expensive, the imaging was typically of a less expensive variety. And because the imaging was done early, it had the benefit of being a preventative measure.

Researchers predicted that, given the findings, CAM users would save an enormous amount of money:

“Given the expected $356 lower expenditures for each CAM user, we would expect an overall $9.4 million lower expenditure in a group of 26,466 CAM patients with these medical conditions compared to a similar group of CAM nonusers of equal size.”

For some analyses, subjects were divided into three levels of “disease burden”, which created groups based on their expected resource use. The low disease burden group were generally healthy individuals, high disease burden group were generally unhealthy individuals, and the medium disease burden group was in between these two. When divided in this way, CAM users in the low and medium groups had higher overall expenditures than CAM nonusers – they had more outpatient visits to CAM providers, and neither group had many inpatient visits or labs. But in the high disease burden group, CAM users had significantly lower expenditures than nonusers, which more than made up for the higher expenses of the healthier groups. CAM was used for preventative care by the high risk group, just like in the other groups, but it was also the less expensive way to treat acute problems.

What should we take away from this study? First of all, it means that insurance companies are currently doing things exactly backwards. When they limit CAM coverage to those who are already healthy or those who can afford to pay extra, they lose money. Insurance companies should be begging their less healthy clients to utilize CAM treatments for both acute issues and preventative care.

We’ll be hearing from some LMTs in Washington later on to see how these laws affect the providers on a day-to-day level. I’ll also be interviewing Deborah Senn, JD, the architect of the Washington law, who is now working with IHPC for the implementation of Section 2706 of the Affordable Care Act.

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