UnitedHealthcare Combats Opioid Crisis with Non-Opioid Benefits
Physical therapy and chiropractic care can prevent or reduce expensive, invasive spinal procedures, such as imaging or surgery, to reduce opioid use and cut costs.
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- UnitedHealthcare (UHC) is combatting the opioid epidemic and high healthcare costs with new physical therapy and chiropractic care benefits to prevent, delay, or in some cases substitute for invasive spinal procedures.
“With millions of Americans experiencing low back pain currently or at some point during their lifetimes, we believe this benefit design will help make a meaningful difference by improving health outcomes while reducing costs,” said Anne Docimo, MD, UnitedHealthcare chief medical officer.
Lower back pain is in part responsible for sustaining the opioid epidemic and also increases healthcare costs.
Although opioid overdoses fell by two percent from 2017 to 2018 and a legal battles aim to hold pharmaceutical companies accountable, there is no end in sight for the opioid epidemic. Industry professionals are still grappling with the balance between cutting opioid prescriptions will working to reduce patient pain.
Common conditions such as low back pain bolster the epidemic’s presence, with clinicians still prescribing the opioids against best practice recommendations. According to a recent OptumLabs study, 9 percent of patients with newly diagnosed low back pain are prescribed opioids and lower back pain currently contributes 52 percent to the overall opioid prescription rate.
In addition to boosting opioids distribution, alternative, invasive lower back pain treatments can significantly impact healthcare spending.
It is not new information that physical therapy and chiropractic care are effective, lower cost alternatives to spinal imaging or surgery. However, payers are still in the process of adopting the method.
To counteract the high-cost, high-risk potential of using opioids to treat back pain, UHC created a benefit that does not rely on medication or technology but rather on physical therapy and chiropractic care.
The benefit allows eligible employers to offer physical therapist and chiropractor visits with no out-of-pocket costs. Members who already receive physical therapist and chiropractic care benefits under UHC’s employer-sponsored health plans and who have maxed out their visits will not receive additional visits under this benefit.
However, for those who still have visits to use and who choose physical therapy or chiropractic care over other forms of treatment, the copay or deductible for those visits will be waived and they will receive three visits at no cost.
UHC has high expectations for the fiscal and physical impacts of this benefit.
According to UHC’s analysis, the health payer expects that by 2021, opioid use will decrease by 19 percent. Spinal imaging test frequency and spinal surgeries will be reduced by 22 percent and 21 percent, respectively. In addition to these specific goals, UHC hopes to see a decrease in the overall cost of spinal care.
The same OptumLabs study demonstrated that UHC’s expectations are not without precedent.
The study looked at the correlation between out-of-pocket costs and patient utilization of noninvasive treatments. Researchers discovered that members whose copay was over $30 were a little under 30 percent less likely to choose physical therapy as opposed to more invasive treatments.
An American Journal of Managed Care study in June 2019 found that patients with high deductibles, typically over $1,000, were less likely to visit physical therapy.
Eligible employers may be brand new or renewing their membership. They must be fully insured and over 51 or more employees strong. The benefit is currently available in Connecticut, Florida, Georgia, New York, and North Carolina.
However, UHC plans to expand the benefit from 2020 into 2021. By the end of this expansion period, the benefit will also be available to self-funded employers and organizations with an employee population between 2 and 50. The benefit will span ten states, primarily in the southeast.
“This new benefit design may help encourage people with low back pain to get the right care at the right time and in the right setting, helping expand access to evidence-based and more affordable treatments,” said Docimo.
