Nonpharmacological Pain Relief for Health Plan Members

January 21, 2022

WholeHealth Living | Quality Time

Pain Relief through the Ages

Article was written by WholeHealth Living

From a child’s skinned knee to the arthritic pain of old age, pain has always been a fact of life ­– and so have the methods to treat it. The Egyptians stimulated nerves with electric fish, and the Chinese inserted needles for the same effect. Leeches, opium, and chloroform are no longer in a doctor’s bag – and that’s because the methods we seek are ever-evolving. Physical medicine and integrative health solutions are playing an ever-growing role in the future of wellness and pain management.

Integrative health benefits represent the future

The largest market opportunity for integrative benefits for insurers will always be Medicare Advantage and Medicare Supplement plans – mainly because seniors consume the most healthcare. But shockingly, the oldest millennials are only 25 years from buying Medicare plans.

The future belongs to millennials. Currently, the largest living generation, by 2025, millennials will account for 75 percent of the American workforce and will assume leadership positions across all industries. For health plans, this is the future.

U.S. Census Bureau data finds that Gen Zers and millennials (ages 25 to 40) have the highest uninsured rates among adults, contributing to the younger generations being more likely to use alternative medicine. Health plans building a bridge to the future must include integrative health benefits in their vision.

In a 2021 survey, 55% of consumers reported using at least one form of alternative medicine or natural remedy to treat a health problem. Demographics keep pushing this number higher: 44% of Baby Boomers use alternative medicine compared to 67% of Gen Z.1

Despite the growing demand for alternative medicine, some health plans are not keeping up. Nearly a third of Americans have had trouble getting their health insurance to cover alternative medicine treatments. Most consumers (66%) want to see these types of treatments covered by their insurer.2

WholeHealth Living® – Physical medicine and integrative health solution for health plans

WholeHealth Living® from Tivity Health® is helping health plans bring nonpharmacologic and alternative therapies to their members through its managed network of physical medicine and integrative health benefits. WholeHealth Living identifies, builds, contracts, credentials, and manages a network of licensed practitioners. The network includes chiropractors, acupuncturists, massage therapists, and naturopathic practitioners.

The WholeHealth Living network connects mainstream medicine with the integrative practitioner community by offering turnkey integrative benefits solutions.

The opioid crisis spurs CMS to cover acupuncture

The wall between conventional and alternative care had held firm for decades until two years ago when The Centers for Medicare & Medicaid Services (CMS) finalized its decision to cover acupuncture for Medicare patients with chronic low back pain. It might seem ironic that an 8000-year-old therapy hadn’t gathered sufficient evidence until now, but the wall cracked open for a different and more urgent reason: the opioid crisis.

Some 70,630 people died from a drug overdose in 2019 alone.3 Given the scope of crisis, CMS said it is now keenly focused on fighting the opioid epidemic, including by supporting access to pain management “using a safe and effective range of treatment options that rely less on prescription opioids.”

“We are dedicated to increasing access to alternatives to prescription opioids and believe that covering acupuncture for chronic low back pain is in the best interest of Medicare patients,” said CMS spokesperson Kimberly Brandt in a statement. “We are building on important lessons learned from the private sector in this critical aspect of patient care. Over-reliance on opioids for people with chronic pain is one of the factors that led to the crisis, so it is vital that we offer a range of treatment options for our beneficiaries.”4

CMS chose to cover acupuncture after examining coverage policies of private payers and after assessing potential benefits and harms in light of the opioid public health crisis. CMS found considerable variation in what was covered and the number of visits to acupuncturists allowed by private payers. Yet, a large number did provide at least some acupuncture coverage.

CMS now supports access to pain management “using a safe and effective range of treatment options.” Yet, Medicare does not include massage therapy or naturopathic medicine as a required benefit. Also, Medicare only covers chiropractic care as a treatment for “spinal subluxation,” meaning your spine is out of line. But why not the full range of alternative treatments for pain?

Encouraging nonpharmacologic treatment of pain

In 2017, the American College of Physicians (ACP) released guidelines encouraging nonpharmacologic treatment of chronic low back pain (LBP). These guidelines recommended spinal manipulation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, biofeedback, and more. Unfortunately, few health plans cover the treatment of low back pain in this comprehensive manner.

In an analysis of health plan coverage for nonpharmacologic treatment of low back pain, the study published in Global Advances in Health and Medicine (2019) found that nearly all state-based coverage policies failed to cover chronic pain management and multidisciplinary rehabilitation. Fewer than ten states covered acupuncture, massage, and biofeedback, and forty-six states covered chiropractic.5

Even worse, the study found 27 states that had wording that excluded treatments deemed complementary, alternative, holistic or nontraditional.

The study recommended: “States should increasingly aim to enact policies that reflect safe, evidence-based, and efficacious treatment options in an effort to address the alarming rates of chronic pain as well as substantial societal costs.” The authors concluded, “Better [Essential Health Benefits] coverage of non-drug therapies may be a strategy to mitigate the opioid crisis.”

Clinicians like the Musculoskeletal Institute at Dell Medical School encourage staff members to work in multidisciplinary teams to manage pain and other conditions. The back-pain team includes spine specialists, chiropractors, physical therapists, and social workers. Patients or insurers make a single up-front payment each year for non-emergency musculoskeletal issues, such as osteoarthritis, chronic shoulder pain, and carpal tunnel syndrome.

In 2018, the Joint Commission, an organization that accredits hospitals, began requiring them to offer pain treatments that do not include opioids; among the approaches that the Commission recommended were meditation, music therapy, acupuncture, chiropractic, osteopathy, and massage.6

“The strongest evidence to date”

Mainstream medicine is backing integrative pain treatments because the “evidence” argument is changing. A 2018 study enrolled 750 active-duty military personnel with back pain. Half received standard care (medications, self-care, and physical therapy), while the other half received standard care plus up to 12 chiropractic treatments.

After six weeks of treatment, those receiving chiropractic care reported:

  • Reduced pain
  • Less disability and more improvement in function
  • Higher satisfaction with their treatment
  • Less need for pain medicine

The study found “the strongest evidence to date that chiropractic care is safe, effective, and results in high levels of patient satisfaction and perceived treatment benefit, thus strengthening our knowledge regarding this conservative non-drug option for low back pain.”7

WholeHealth Living offers effective methods to address your members’ pain

Tivity Health’s WholeHealth Living program offers a turnkey solution for health plans that addresses their members’ pain, reduces the cost of expensive treatments, decreases members’ reliance on opioids, and allows members to return to a life they love. Payers nationwide are offering access to the WholeHealth Living network of chiropractors, acupuncturists, massage therapists, physical therapists, occupational therapists, speech therapists, and naturopathic practitioners.

The program is backed with nearly 30 years of clinical and operational expertise. It is delivered through Tivity Health – the same company that offers SilverSneakers® – the nation’s most recognized and respected fitness program specifically designed for older adults. In this critical area of health care, the WholeHealth Living team bridges the gap between specialty practitioners, health plans, employers, and the broader medical community to improve clinical outcomes, create savings, and enhance member satisfaction.

3. U.S. Department of Health & Human Services –