A monthly round-up of the latest news, events and topics in integrative healthcare policy from John Weeks.

Examination of Tennessee Blue Cross Blue Shield data finds 20%-40% lower costs for LBP patients who see chiropractors first 

“Starting with Chiropractic Saves 40% on Low Back Pain Care.” So runs the headline in a November 16, 2010 release from the American Chiropractic Association (ACA). The study itself, by a team that includes well-known health services researchers Michael Finch, PhD and Christine Goertz, DC, PhD, carries a less effusive title: Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer. The researchers found the following “practical applications” from the examination of records from 85,000 members of Blue Cross Blue Shield of Tennessee: 

  • “For low back pain, care initiated with a chiropractor (DC) is less costly than care initiated through a Medical Doctor (MD). Paid costs for episodes of care initiated with a DC are almost 40% less then episodes initiated with an MD. 
  • “Even after risk adjusting each patient’s costs we found that episodes of care initiated with a DC are 20% less expensive than episodes initiated with an MD.” 

The analysis, carried out in 2006, was funded through a grant from the ACA. ACA president Rick McMichael, DC, shared with the Integrator that “we think this is a very strong study, with major implications.” He attributes the outcomes to chiropractic medicine’s “more conservative approach” and how chiropractors “get in there and partner with patients” to move them toward health. The study, says McMichael, “demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”
McMichael shared that the project with the Tennessee Blues plan began “some years ago” through an ACA House of Delegates member who shared that he thought the ACA might be able to access the insurer’s data. Said McMichael: “We always have feelers out to get access to data. We’re happy to put our approaches and services to the test.” As another example, he points to the HMO Illinois cost saving data via Alternative Medicine Integration Group, an
Integrator sponsor. 

Comment: At the time of my interview with McMichael, the study had not yet produced or received much mainstream media attention, other than this online Medical News link. I am reminded of comments by integrative cardiology researcher Eileen Stuart, RN, MS, PhD, regarding the reception of her scientific offerings at cardiology meetings. Stuart’s research, published in top journals, had found significant benefits of a program she developed at Harvard with Herbert Benson, MD that combined natural health measures for heart patients: “I always have a few doctors come up after and ask about the program. If these outcomes had been due to a drug, the doctors would have been flocking around me.”

Imagine what kind of media coverage we would see from a press release like this: “New drug shown to save 20%-40% on treatment of conditions that costs nation $50-billion annually.” It doesn’t help that ACA was the study’s backer, suggesting potential bias. Yet one wouldn’t think BCBS Tennessee would be interested in scamming the public on behalf of chiropractors. Better dead than red, I guess. Drug medicine uber alles   


Comparative care plus comparative cost: Spine article offers additional data on relative effectiveness of chiropractic treatment
Within days of learning of the article noted above on
comparative cost of chiropractic treatment, reader Wayne Bennett, DC sent notice of a favorable publication on comparative treatment outcomes. A team of 2 DCs and 2 Medtronic-affiliated MDs report in the December 2010 Spine that: 

” … compared to family physician-directed usual care, full clinical practice guideline-based treatment including chiropractic spinal musculo-therapy treatment is associated with significantly greater improvement in condition-specific functioning.”   

See The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.


Paper reviews strategies for economic evaluation in CAM
The Use of Economic Evaluation in CAM: An Introductory Framework is a useful 24-page discussion article recently published in the open-access
BMC Complementary and Alternative Medicine.  The authors note that “in order for CAM to be extensively considered in health care decision-making there is a need to expand the evidence-base for these medicines and therapies and for the CAM research community to further incorporate economic evaluation into research priorities (alongside developing a broader health services research agenda).” They explore complexity issues, arguing that using a Markov model approach could be useful. The authors conclude with this statement: “Whether examining the use of CAM alone or as an integrated component of contemporary health care provision, further consideration of economic evaluation as a research tool is required. This paper provides an impetus for those interested to pursue such a worthy goal.” 

Comment: The same journal recently published an analysis in South Korea of collaborative care for low back pain using acupuncture, using a “Markov model.” The authors concluded that “acupuncture collaborative therapy for patients with chronic LBP may be cost-effective if the usual threshold is applied. Further empirical studies are required to overcome the limitations of uncertainties and improve the precision of the results.” (Thanks to Mitchell Stargrove, ND, LAc for the heads-up on the evaluation paper.) 


Economic burden of chronic disease
Reader Michael Cronin, ND, recently sent a link entitled “An Unhealthy America: The Economic Burden of Chronic Disease. The site was created some time ago through the Milken Institute. It may prove a useful reference for some readers.

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