John Weeks’ August 2012 Round-up to include news headlines on the topic of integrative health care costs, coverage and employers
Key data for policy leaders published in Herman-Eisenberg systematic review of cost-effectiveness in CIM
A critically-needed review of all cost-effectiveness studies on complementary and integrative medicine (CIM) found 28 “high-quality studies,” according to lead author Patricia Herman, MS, ND, PhD. The review was global and covered the years 2000-2010. Herman, an economist and licensed naturopathic doctor, first engaged the project with David Eisenberg, MD with the Harvard School of Public Health, in 2008. The report is entitled “Are complementary therapies and integrative care cost-effective? A systematic review of economic evaluations.” In an interview published here Herman states: “I’m tired of this talk that there is no evidence for cost-effectiveness of complementary and integrative medicine. There is evidence. We need to move onto phase two and look at how transferable these findings are. We can take this evidence and run.”
Studies which found frank “cost savings” ranged from acupuncture for breech delivery and for low-back pain, to manual manipulation for neck pain, natural products for various conditions, and a study of the whole practice of naturopathic medicine for chronic low back pain. Those that were found cost-effective based on analysis of changes in quality adjusted life years included treatment in clinics of Oregon chiropractors, massage, Tai chi, Alexander technique, and numerous studies of adjunctive acupuncture treatment. A column on the topic is here: Review Finds Cost Effectiveness of Complementary and Integrative Medicine in More Than Two Dozen High-Quality Studies.
Comment: First, credit Herman, in particular, for the labor that this survey entailed. She personally read over 13,000 abstracts generated through key words searches. Second, why just 28 studies, globally, in 10 years? heck, this is an era in which many are obsessed with the awful cost situation. In fact, if one looks closely, one finds only 2 that are actually looking at the way whole person practitioners treat patients in the real world. This is a time to truly bemoan the fact that the NIH National Center for Complementary and Alternative Medicine has failed to comply with the real world, outcomes-plus-health services charge Congress gave the agency in 1998. Will the next decade bring more than this sparse yield. Regardless, as Herman says, those who say there are no cost benefits from CIM services should be muzzled. The comment field here shows, however, that the Polarizing Science Blogger naysayers cannot be convinced by evidence.
Washington Post touches on state decisions relative to chiropractic and acupuncture in essential benefits
The WonkBlog for the Washington Post included a September 22, 2012 piece called: “Is acupuncture an essential benefit? Weight loss surgery? Under Obamacare, states choose.” In California acupuncture is in. In Michigan chiropractic is in. Yet in Oregon “officials would leave both of those benefits on the cutting-room floor.” The article details other negotiations and decisions in other states: “That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost.” An Oregon administrator opined: “This being Oregon, where you have a school of chiropractic care, there was a lot of discussion about alternative medicine,” said Jeanene Smith, administrator of the Office for Oregon Health Policy and Research. “We felt that there was some benefit, but we didn’t exactly consider these to be absolutely essential.”
John Falardeau, policy lead for the American Chiropractic Association is quoted this way: “It’s a very big issue for us. We’ve been working hard with our state associations to make sure they’re at these meetings, to even get on the essential benefit advisory board.” All states must cover 10 broad categories, including “ambulatory patient services,” drugs, ER visits, preventive services and lab. A California Medical Association article on acupuncture’s inclusion begins: “The era of acupuncture’s existence as a practice on the margins of medicine appears to be inexorably drawing to a close.”
Comment: What is particularly notable in the Oregon decision is that the state also has a top acupuncture and Oriental medicine school and a top school of naturopathic medicine. Basic patient evaluation and management from members of the latter profession will likely be included under “ambulatory patient services” – after a lawsuit or two – if Section 2706 of the Affordable Care Act stays on the books. The section which requires non-discrimination among different disciplines, stays on the books. A brief below looks at efforts of massage therapists in Washington state to gain inclusion in that state’s plan. (Thanks to Kory Ward-Cook, PhD for the link to the CMA article.)
IHPC’s Wisneski speaks on integrative medicine to over 400 employers on CFO Magazine webinar
An initiative from CFO Magazine to educate chief financial officers of employers is called CFO Playbook. The program is described as “a series of educational Best Practice Webcasts, ebooks and events providing you with practical knowledge and insights from your peers.” On October 4, 2012, CFO’s readers had a chance to view a podcast which introduced a new idea. Perhaps “a pragmatic framework for implementing the solution” to the employer’s cost crisis in health care may be by looking at “how including integrative medicine treatment options in healthcare plans can give companies more control over their spending.” Long-time integrative medicine clinician, educator and policy leader Len Wisneski, MD, FACP, chair of the Integrative Healthcare Policy Consortium, was the featured guest. The session was organized by Wayne Miller of Nura Life Sciences and entitled The CFO Playbook on Health Care Cost Management.
Comment: Good for Miller to pull this together and get this audience thinking more deeply about how to create sustainable solutions through integrative approaches.
Employer group IHPM takes over global wellness initiative from World Economic Forum
The World Economic Forum, famous for its exclusive and pricey meetings at Davos, Switzerland, has handed off it’s health and wellness initiative to the Institute for Health and Productivity Management (IHPM). The IHPM sent a September 28, 2012 release entitled “Accelerating and Expanding Wellness Around the World: Transition of the Workplace Wellness Alliance from the World Economic Forum to IHPM.” The Forum’s initiative was led through their Workplace Wellness Alliance which provides “a platform for sharing best practices in workplace wellness.” IHPM, led by former National Business Coalition on Health CEO Sean Sullivan and vice president Deborah Love, has been a leading employer group in exploring complementary and integrative medicine as a means of enhancing health and productivity. IHPM is a former Integrator sponsor.