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PMI s and Holistic Medicine Provision
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Andrew Walton
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Oct 14, 2000 05:09 PDT
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HomeLatestHeadlines
Employers Need to Shape the Debate on Alternative Medicine Coverage
3/17/2000
By Christine Woolsey
Human resource directors, employee benefits managers and employer
purchasing coalitions must take the lead in discussions surrounding the
growing convergence between worksite wellness programs and complementary
and alternative medical treatments, according to a physician and
researcher from Stanford University School of Medicine.
There is growing interest in complementary and alternative medicine,
also known as CAM, from consumers and physicians alike, said Dr. Kenneth
R. Pelletier, director of the Complementary & Alternative Medicine
Program at Stanford University. "If you think alternative medicine is a
passing fad, you're wrong," he said during a March 15 seminar on CAM
benefits co-sponsored by the Chicago Business Group on Health.
The CBGH, an arm of the Midwest Business Group on Health, is an
80-member coalition of employers and healthcare providers in the Chicago
area. The Worksite Wellness Council of Illinois and Northwestern
Memorial Physicians Group also sponsored the CAM seminar.
"This is only the beginning of a groundswell trend," Pelletier said. "We
hear over and over that the single pressing issue employers face is
employee demand for CAM in their benefits structure." Unfortunately,
most employers do not know how to incorporate such benefits or how to
measure their efficacy or cost-effectiveness," he said.
CAM benefits typically include such treatments as chiropractic care,
acupuncture, nutritional therapies and mind-body therapies, such as
guided imagery, meditation and biofeedback.
While chiropractic and acupuncture services are becoming more widely
accepted by some healthcare payers, most other types of CAM benefits are
not covered by insurance. Pelletier and others attending the seminar
believe that should change, although they recognize the difficulty
employers have in making informed decisions about what to include in a
CAM benefits program.
Pointing to statistics on U.S. healthcare spending, Pelletier said large
employers have a stake in the CAM benefits debate. "In 1997, we crossed
the $1 trillion mark in medical expenditures per year. Healthcare
spending comprises 15.3% of our gross domestic product -- more than any
other nation."
Obviously, these rising costs have a direct impact on employers. In
fact, the average Fortune 500 employer spends 62.5% of its after-tax
profit to pay for medical care for employees, dependents and retirees,
Pelletier said.
Many employers were lulled into complacency when managed care and other
cost control initiatives dropped healthcare inflation to the single
digits. But now it's back up again in the double digits. "We're finding
the rate of increase is unchanged and we can look forward to major
increases in costs," he said.
The perplexing and aggravating thing about this increased spending is
the fact that the United States ranks near the bottom in health
outcomes. Greece, for example, "ranks higher and better than the U.S. on
every initially accepted measure of health on one-tenth of the
expenditures," according to Pelletier.
This discrepancy is, in part, why a growing number of physicians,
patients and researchers are embracing alternative medical treatments.
Research on the efficacy of such treatments is increasing, although it
is far from conclusive. Even so, stalwarts of the medical community,
including the highly regarded New England Journal of Medicine, are
adopting a new philosophy toward CAM treatments. "They are saying there
can't be two kinds of medicine -- traditional and alternative,"
Pelletier explained. "Basically, once something is proven to work, it
doesn't matter if it was considered an alternative treatment in the
past."
Stanford's Complementary & Alternative Medicine program is studying a
variety of topics surrounding CAM, including how it compares to
conventional medical treatments and its clinical and cost-effectiveness.
The program has also examined whether more managed care organizations
now routinely cover some portion of CAM expenses.
According to a 1997 Stanford study, 39% of 18 leading MCOs surveyed
offer some level of coverage for 16 to 20 CAM therapies, Pelletier said.
Another 22% offer some coverage for six to 10 such therapies. The most
common CAM benefit covered is chiropractic care, followed by
acupuncture, biofeedback, preventive medicine, massage and homeopathy.
These managed care companies cite a number of reasons why interest in
CAM benefits is surging:
• Limitations of the biomedical model in managing chronic disease,
• Patients' desire to take fewer medications and decrease side effects,
• Greater awareness of CAM from other cultures,
• The belief that disease is linked to the environment, nutrition,
emotional, lifestyle and mind-body issues,
• A medical director or senior executive's personal experience with CAM.
In addition, the survey found that the most influential factor in MCOs'
decision to pay for such benefits is consumer demand, followed by
purchaser demand. Market research, legislative mandates and demonstrated
efficacy ranked third, fourth and fifth.
However, Pelletier pointed out that Stanford's 1998 survey, not yet
released, indicates that consumer demand is the top reason MCOs are
offering CAM benefits and demonstrated efficacy now ranks 10th, down
from fifth place in the previous study. "That causes me great concern
because plans are now abdicating to consumers the responsibility to
weigh the efficacy and safety of CAM," he said.
Employers also should be alarmed by this trend, he noted, and the
business community must get involved in the debate. "The impact of
business coalitions and purchasing groups is enormous. When you make a
decision to cover something, you send the health plans scrambling. They
won't do the right thing unless you are an intermediary consumer."
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