HMO adds acupuncture to its benefits package
Growing demand for alternative therapies cited
The growing popularity of alternative medicine has led to what a California-based HMO calls the state’s "first wide-access acupuncture benefit package."This summer, Milpitas, CA-based Lifeguard Health Care will offer, at no additional charge, acupuncture coverage to its 86,000 members already participating in the supplemental chiropractic package provided through Lifeguard’s existing partnership with Landmark Chiropractic Independent Practice Association (IPA) of Sacramento.
The move "was really driven by outside forces," explains Mark Hyde, CEO and president of Lifeguard. "In our 1996 survey of brokers and employers, there was a strong desire expressed for acupuncture services, so we felt we should put it higher on the list [of services offered] than others. It was definitely customer-driven."
Landmark was encouraged by its own survey to make the move , says Kevin Buron, vice president of marketing.
His organization’s fall 1996 nationwide survey of HMOs "told us that alternative care was becoming part of the managed care environment. About 70% of the respondents indicated an increase in requests for alternative care. The health care plans were recognizing patient demand for these services and were at the point of beginning to offer them." (See our report on the Landmark survey, below.)
To assemble a network of acupuncture providers, Buron says Landmark will merge this summer with AcuNet, an Encino, CA-based IPA.
David Wells, DC, LAc, president of AcuNet says his IPA handles the credentialing of providers, ensuring that they meet National Committee for Quality Assurance standards for acupuncture. "We’re also involved in case management, reviewing every chart to determine the appropriateness of care," Wells says. "We conduct outcome studies and patient satisfaction surveys."
Wells sees a significant role for acupuncture in health care.
"We feel it’s an important complement to allopathic care or traditional Western medicine because it deals with conditions that are not as well-served, such as chronic pain, poorly defined conditions like HIV, or acute pain, and offers a non-invasive way of dealing with those conditions."
Traditional Chinese medicine, Wells explains, looks at and treats the whole person. "It can make a person feel more normal without knowing the specific pathogen," he says. "It also triggers a normal response from the brain to produce endorphins and neurotransmitters like serotonin, all of which stimulate normal function in the body. For example, if you are a substance abuser, it helps your brain produce hormones that make you feel normal, so you don’t crave the drug."
Some of the most common ailments employees seek acupuncture treatment for are lumbar and cervical pain, carpal tunnel syndrome, and tendinitis, says Wells.
Since managed care is known for its rigorous attention to outcomes and quality of care, does acupuncture have a sufficient track record in the United States to justify inclusion in an HMO benefits package?
Wells responds with a resounding yes. While there is no "global" study available on the efficacy of acupuncture, there are "single studies on single issues like cocaine, asthma, and chronic obstructive pulmonary disease," he asserts.
"There is not a broad-based study available showing economic benefit, but I believe we will have that within a few years," Wells adds. "Acupuncture enables people to get well on their own at a lower cost."
Wells cites the example of a typical lumbar disc patient. "An MRI costs $1,500, then you have meds, or surgery, which can cost at least 10 times as much," he notes. "On the other hand, most patients with acute lumbar disc pain respond favorably to acupuncture for under $500 and are back at work and functional." (See references, p. 78.)
Buron adds that Landmark will be selective in the types of treatment it offers and will concentrate on neuromusculoskeletal disorders.
"We’re looking at alternative care therapies that have demonstrated clinical effectiveness," he explains. "Medical directors are still very skeptical, and it’s our job to make them feel comfortable. To integrate acupuncture successfully you need good credentialing and utilization management but also clinical studies that demonstrate effectiveness."
While he’s enthusiastic about the new acupuncture benefit, Hyde does not anticipate a wave of new alternative therapies in the managed care arena.
"I don’t know that I see dramatic interest [in other therapies]," Hyde comments. "In the area of pain management, Western medicine has not been particularly successful, and chiropractic and acupuncture are specifically designed to address pain. But do I believe HMOs will become involved in herbal and massage therapies? No, I don’t think so."
Buron agrees. "In our HMO survey, there’s a pretty substantial drop-off [in demand] once you get past acupuncture and chiropractic," he notes. "Just look at the number of providers. In California there are about 10,000 chiropractors, and 2,000 acupuncturists. But there are only 1,200 providers in the country who practice natural healing."
[Editor’s Note: For more information on HMOs and acupuncture, contact: Mark Hyde, Lifeguard Health Care, 1851 McCarthy Blvd., Milpitas, CA 95035. Telephone: (408) 432-3600. Fax: (408) 383-4259. You also may contact AcuNet via their home page on the World Wide Web: http://www.acupuncture.com/mktplace/accunet.]
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