Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain

Eaves, Emery R.; Hsu, Clarissa; DeBar, Lynn; Livingston, Catherine J.; Ocker, Laura E; McDonald, Sarah J; Dillon‐Sumner, Laurel; Ritenbaugh, Cheryl

doi:10.1089/acm.2018.0431

Cited by 13 publications

(14 citation statements)

References 37 publications

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“…A redesign of reimbursement policies is needed to expand coverage for nonpharmacologic treatments, and reduce or remove copayments and deductible costs. Recent examples of payment reform include Oregon Medicaid covering a range of nonpharmacologic approaches for painful musculoskeletal conditions, 33 and Medicare announced in January of 2020 that they will cover acupuncture for chronic LBP. 34,35 United Healthcare has started to roll out plans with $0 copays for first three visits to chiropractic care and physical therapy for LBP.…”

Section: Discussionmentioning

confidence: 99%

Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers

Roseen

Conyers

Atlas

et al. 2021

The Journal of Alternative and Complementary Medicine

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Background: In April 2017, the American College of Physicians (ACP) published a clinical practice guideline for low back pain (LBP) recommending nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic LBP.Objective: To assess primary care provider (PCP)-reported initial treatment recommendations for LBP following guideline release.Design: Cross-sectional structured interviews.Participants: Convenience sample of 72 PCPs from 3 community-based outpatient clinics in high-or low-income neighborhoods.Approach: PCPs were interviewed about their familiarity with the ACP guideline, and how they initially manage patients with acute/subacute and chronic LBP. Treatment responses were coded as patient education, nonpharmacologic, pharmacologic, or medical specialty referral. PCPs were also asked about their comfort referring patients to nonpharmacologic treatment providers, and about barriers to referring. Responses were assessed using content analysis. Differences in responses were assessed using descriptive statistics.Key results: Interviews were completed between December 2017 and March 2018. Of 72 participating PCPs (50% male; mean years of practice = 13.8), over three-fourths indicated being familiar with the ACP guideline (76%-87% at 3 clinics). For acute LBP, PCPs typically provided advice to stay active (81%) and pharmacologic management (97%; primarily nonsteroidal anti-inflammatory drugs). For chronic LBP, PCPs were more likely to recommend nonpharmacologic treatments than for acute LBP (85% vs. 0%, p < 0.001). The most common nonpharmacologic treatments recommended for chronic LBP were physical therapy (78%), chiropractic care (21%), massage therapy (18%), and acupuncture (17%) (each compared with 0% for acute LBP, all p < 0.001). The cost of nonpharmacologic treatments was perceived as a barrier. However, PCPs working in low-income neighborhood clinics were as likely to recommend nonpharmacologic approaches as those from a high-income neighborhood clinic.Conclusions: While most PCPs indicated they were familiar with the ACP guideline for LBP, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.

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Section: Discussionmentioning

confidence: 99%

Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers

Roseen

Conyers

Atlas

et al. 2021

The Journal of Alternative and Complementary Medicine

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“…Bohm 17 Dorr and Townley 26 Eaves et al 24 Heyward et al 1 Bohm: back pain, joint pain, neck pain most common (private and public insurance coverage) 17 Dorr: chronic fatigue syndrome (FL), lower back pain with poor functional prognosis (OR), frequent emergency room visits (RI) for state Medicaid programs 26 Eaves: neck and back pain 24 Heyward: lower back pain (public and private insurance coverage) 1 CA: California; FL: Florida; RI: Rhode Island; OR: Oregon; HMO: health maintenance organization.…”

Section: Healthcare Setting Provider Type and Coveragementioning

confidence: 99%

“…The primary barriers reported by providers regarding insurance coverage for acupuncture included credentialing challenges and reimbursement difficulties, particularly for non-physicians. Licensed acupuncturists in the study by Eaves et al 24 identified challenges with credentialing, low reimbursement rates, obtaining reimbursement, and increased patient no-shows as barriers in the implementation of Oregon's Medicaid coverage for acupuncture. Parkman 20 identified physician discomfort with acupuncture and a lack of physician referrals as additional barriers.…”

Section: Barriers From the Provider And Patient Perspectivementioning

confidence: 99%

A scoping review of acupuncture insurance coverage in the United States

et al. 2020

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Background: Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. Methods: We utilized the Arksey and O’Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. Results: We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. Conclusion: We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.

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“… 51 The current opioid crisis has put pressure on policy makers to manage pain with effective non-opioid treatments, and examples of acupuncture reimbursement for lower-income, younger adults by Medicaid are emerging. 52 , 53 Some younger adults with private insurance already have an acupuncture benefit, e.g., Kaiser Permanente Washington covers acupuncture. 20 Once payment policies are in place in a wider range of plans, evidence-based dissemination strategies can inform health system leaders, PCPs, and patients about acupuncture’s appropriateness for LBP.…”

Section: Tailoring Dissemination Strategies For Younger and Older Adultsmentioning

confidence: 99%

The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain

Roseen

Purtle

Zhang

et al. 2021

Glob Adv Health Med

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Background Dissemination research is the study of distributing information and intervention materials to a specific clinical practice or public health audience. Acupuncture, a healthcare practice involving the stimulation of certain body points, often with thin needles, is considered an evidence-based treatment for low back pain (LBP), but is underutilized in the United States. Body: We will use the example of acupuncture for LBP to identify opportunities to leverage dissemination research to increase utilization of acupuncture. Deficits in the awareness or knowledge of acupuncture may limit its adoption by patients and other stakeholders. Thus, we summarize methods to gather data on stakeholder awareness and knowledge of acupuncture for LBP, i.e., audience research. Engaging multiple stakeholder audiences (e.g., health system leaders, primary care providers, patients), is needed to generate knowledge on promising dissemination strategies for each audience. Audience segmentation is important for identifying population subgroups for whom adoption of acupuncture may require a more intensive or tailored dissemination strategy. To illustrate potential audience ‘segments’, our research discussion focused on developing dissemination strategies by age (i.e., older adults – those age 65 years or older, and younger adults – those under age 65 ). This decision was prompted by Medicare’s recent policy covering acupuncture for chronic LBP. We leverage current knowledge of barriers and facilitators of acupuncture use to discuss how further tailoring of dissemination strategies might optimize adoption of acupuncture in both groups of adults. Experimental study designs could then be used to compare the effectiveness of such strategies to increase awareness, knowledge, or adoption of acupuncture. Conclusions: Conducting dissemination research may improve awareness and knowledge of acupuncture, and ultimately the adoption of acupuncture in biomedical settings. We anticipate that the concepts highlighted in this manuscript will also be helpful for those disseminating information about other complementary and integrative health approaches.

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Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain

Cited by 13 publications

References 37 publications

Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers

Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers

A scoping review of acupuncture insurance coverage in the United States

The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain

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