Insured patients are generally covered under a range of benefits provided by HMOs, EPOs and PPOs. In addition to cost, these plan types differ in their provider access limitations.
HMOs and EPOs are the most restrictive, limiting access to only network providers and requiring referrals from primary care providers (PCPs) to specialists. PPOs are less restrictive, with a wider range of providers and out-of-network cost sharing options. Point-of-service (POS) plans tend to be somewhere in the middle, with the largest portion of insured enrolled in these plan types.
A study in the June 2019 issue of the American Journal of Managed Care looked at the association between health insurance benefit design and patient choice of conservative care. The observational study looked at 117,448 patients with new-onset low back pain using claims data from the OptumLabs Data Warehouse.
Researchers compared the likelihood of seeing a PCP first vs. a DC first vs. a PT first. The POS plan was used as a reference point.
Patients were 14 percent less likely to begin care with a DC under an EPO plan and 28 percent less likely to begin chiropractic care under a HMO plan compared to patients in POS plans; but 21 percent more likely to initiate care with a DC under a PPO plan.
Interestingly enough, there was "little association between co-payment and choice of a chiropractor first." And patients with deductibles of less than $1,500 were actually slightly more likely to choose a DC over a PCP. Patients with deductibles over $1,500 were 7 percent less likely to see a DC first.
PTs showed a greater likelihood to be chosen over PCPs under PPOs and HMOs, with 16 percent lower odds under an EPO. But PT-initiated care proved very susceptible to the negative financial pressures of co-pays and deductibles.
The researchers conclude, "modification of health insurance benefit designs offers an opportunity for creating greater value in treatment of new-onset LBP by encouraging patients to choose noninvasive conservative management that will result in long-term economic and social benefits."
Just as significant as the above conclusion is the publication in which the study appears. The American Journal of Managed Care is a peer-reviewed publication read by health care stakeholders across a variety of platforms. It also touts itself as “the leading journal dedicated to issues in managed care.” As such, this study may be an important step toward improving patient access to chiropractic care within insurance plans. Stay tuned. ?
Editor’s Note: For background on OptumHealth’s changing attitudes toward chiropractic care, read “Putting Spine Care in the Right Hands” in our March issue.
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
