Reducing barriers to integrative care

By Nancy Gahles

Thinking outside the traditional Congressional box, U.S. Representatives Jackie Walorski (R-IN), Ron Kind (D-WI), Grace Meng, (D-NY), and Darin LaHood (R-IL) introduced a bill that would allow access to integrative care while reducing costs and empowering the consumer.

On March 27, the representatives introduced a bill, H.R. 6199, the Restoring Access to Medication Act, which will improve access to care and help families afford the medications and other healthcare products they need. The bill will also empower patients to self-care through self-pay mechanisms.

The perennial obstacle to workable integrative care models has been reimbursement. The loggerhead has always been insurance reimbursement. This bill puts payment into the hands of the healthcare consumer. Utilization of Health Savings Accounts (HSA) and Flexible Spend Accounts (FSA) is the disruptive innovator we have been waiting for.

“For millions of Americans, HSAs and FSAs are critical tools to pay for health care, but currently they can’t be used to buy over-the-counter medications,” Rep. Walorski said in a press statement.  “Restoring this eligibility and expanding it to feminine hygiene products would improve both access and affordability. This is a bipartisan, common sense way to lower costs and give consumers control over their healthcare.”

From my perspective, the innovation is not only in giving consumers access to use their pre-tax dollars, which they have invested in either HSAs or FSAs, to purchase over the counter (OTC) medicines, but it is in allowing feminine hygiene products to be considered as a part of healthcare. The natural corollary to self-care is prevention. Women are the family consumers of healthcare. In my experience, women visit doctors more frequently than men do. Women bring the children to the doctor more frequently than men do. Women bring their husbands and fathers to the doctor or identify their need to go.

“Millions of people rely on over-the-counter medicines each and every day and this bill would greatly help Americans afford these types of medications,” Rep. Meng said in the statement. “For years I have been fighting to add menstrual hygiene products to the list of HSA-FSA eligible items, and I’m proud to continue championing that effort in this new legislation. There is no reason to prohibit individuals from using their HSA-FSA funds to pay for menstrual products. They are basic and essential items and adding them to the list of eligible expenses would go a long way toward making these products more affordable and accessible to women.”

Health Savings Accounts are essential tools individuals and families use to receive quality healthcare needs at an affordable cost, Rep. LaHood said.

“Many Americans rely on OTC medicines to meet their basic healthcare needs and this bill will ensure OTC medicines can be purchased through HSAs,” he said. “As we work to expand access to care while reducing costs, this bill takes an important step to do just that and is a win for working families across the country.”

Over 22 million Americans utilize HSAs and over 33 million contribute to an FSA. HSAs are attached to high-deductible insurance plans. These plans are being offered very frequently now by employers. As healthcare premiums soar, so do deductibles. Cost sharing, co-payments, and co-insurance are transferred more heavily upon the policy holder. Therefore, the disciplines within the integrative care models are not being accessed as they should or could be to achieve best outcomes.

Recently, on March 6 a meeting of the Congressional Integrative Health and Wellness Caucus was held in Washington, D.C. Rep. Walorski is a co-chair of the Caucus. One of the presenters, Susan Luria, director of University Hospital’s Connor Integrative Health Network in Cleveland, Ohio, illustrated the barrier that exists to accessing models of care, specifically with non-pharmacological treatment options.

“Our health system has a program with the belief that optimal health could best be achieved by a combination of traditional medicines and complementary therapies and support of patients to achieve lifestyle choices and behaviors that support their health,” she said.

These therapies include chiropractic, acupuncture, massage, yoga, music, and art therapy.

“It helps people take care of themselves and it provides physicians with tools to take care of their patients,” said Luria.

Another presenter, Casey Seenauth, ND, staff physician at the Riordan Center for Regenerative Medicine in Tempe, Arizona, discussed barriers to access.

“Even though there is evidence that these modalities are effective, they are largely unavailable,” Seenauth said. “There seems to be an issue of insurance companies not covering these treatments, so patients have to pay out of pocket and others are not able to afford the treatments.”

Complementary and alternative modalities are already accessible and able to be deducted from HSAs and FSAs. They include:

• Acupuncture
• Aromatherapy
• Ayurvedic medicine
• Homeopathy
• Nutritional consulting
• Traditional Chinese Medicine
• Chiropractic
• Massage
• Naturopathy

The how-to is that the person, patient, or policy holder submits the receipt for services to your plan administrator. In my personal practice experience, chiropractic and homeopathy are always allowed. The caveat is that an unrecognizable service may be questioned by the administrator. It is always advised that the modality or discipline be either licensed or national or state certified for legitimacy. Submitting a receipt on a letterhead with the practitioner’s credentials and license number is advised. If this does not suffice, you may be asked for a letter of medical necessity from a physician. Obamacare required a letter of medical necessity. This bill removes that requirement.

The bill before Congress builds on this by doing exactly what its name implies, restoring access to medications and modernizing health savings accounts. Should the bill become law, patients will be able to fill the prescriptions of any of these providers for OTC medicines that they prescribe. For instance, homeopathic remedies are classified as OTC medicines. Vitamins, herbal supplements, and other dietary supplements are not.

The tributary to the sea change is that when you begin to educate the consumer to the fact that they can afford to purchase healthcare and its products from their own savings accounts without the authorization of their insurance company, they experience a sense of freedom. The authors intended to give women power to purchase their feminine hygiene products to begin self-care and prevention, thus decreasing healthcare costs. Restoring access to medications like homeopathy, that treats the whole person suffering from menstrual disorders, mood disorders, and postpartum depression, among a myriad of other female issues, is an entry point to raising consciousness.

As a person becomes accustomed to using their own healthcare savings accounts for the integrative services that team care models are using, the barriers to access and insurance involvement disappears. The person allocating the monies to their HSA and FSA becomes knowledgeable about how much they have available to spend in a year. They also preview their healthcare needs to manage existing conditions and prevent new ones from arising.

I suggest that a practitioner provide a space on their intake forms providing information on whether the person has an HSA or an FSA. In my practice, I include a short consult with my office manager. Things to ask are, what is the amount you can invest, and have you funded your account?

According to their diagnosis and treatment plan, we lay out a financial forecast for them and advise them how much our treatment protocol will cost them. We do the same for self-pay patients, so that they do not dismiss the care as unaffordable.  

For the integrative team care model to flourish, personal empowerment, education, and motivation is necessary. It’s up to the practitioner or healthcare center to debunk the myths and empower the persons they are serving. Work with our lawmakers as well by supporting this bill and others to serve as a foundation for our progress. Align ourselves with the sea change afoot and the groundswell it will bring.