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Denise Henry Consumer demand and legislative mandates are drawing once hush-hush alternative treatments nearer to the healthcare mainstream. A national study released in March by Landmark Healthcare, a Sacramento, Calif.-based alternative care company, shows 67 percent of managed care organizations offer at least one type of alternative care. Chiropractic care and acupuncture are the most common offerings, at 65 percent and 31 percent, respectively. When asked why they cover alternative care, 38 percent of HMOs that do said member and employer demand guided their decision. Another 38 percent said they acted upon mandates or legal requirements. HMO involvement in alternative care will likely gain momentum, according to the survey. In the next two to three years, one-third of HMOs surveyed say they’ll add acupuncture, acupressure, massage therapy, and vitamin therapy. More widely offered HMOs’ policies on alternative treatments vary widely. Aetna U.S. Healthcare offers a direct access discount program to members, enabling them to seek alternative therapies including massage, vitamins, and acupuncture at discounted costs through Aetna’s contracts with various health providers. "We’re giving members greater access at affordable fees. We’re also being responsive to plan sponsors and what they’d like to see for their members," said Prudence Carter, MHA, RN, an HMO patient manager for Aetna. Aetna also offers employers a chiropractic rider and may provide the same option for acupuncture. "We’re not forcing our members into providing something they may not want, but we’re leaving the option open," said Bobby Pena, public relations manager for Aetna’s Western region. At PacificCare of Texas, members can receive coverage for chiropractic treatments upon primary care physician referral. The HMO, however, does not characterize chiropractic as an alternative treatment, a view shared by 43 percent of HMOs surveyed for the Landmark study. Meanwhile, in Washington, PacifiCare members receive alternative care as a state-mandated benefit. "Our goal is to always offer the right care in the right place, and we put that in the hands of trained medical professionals who can make the best determination for their patients," said PacificCare spokesperson Tony Salters. Learning about other options While alternative medicine has yet to receive 100 percent acceptance by HMOs, its greater availability gives both patients and their health providers more freedom in their healthcare decisions, experts say. "There’s great interest among healthcare providers, particularly nurses, in learning about and providing patients with complementary and alternative therapies," said Merla Hoffman, MSN, RN, president of the American Holistic Nurses Association and a certified health touch practitioner instructor. "While we have reduced prices with HMOs, they’ve taken away our choices. If they’re willing to give people back more choices and control over their health care, their health will improve, and that will save in the long run." Often, traditional health care and Western medicine do not meet everyone’s needs, said Ann Ingram, MSN, NP, RN, chair of the National Alliance of Nurse Practitioners. "People want to try other modalities to achieve optimum health care." Although not everyone agrees on alternative medicine’s effectiveness and appropriate use, its potential value is still being explored. Healthcare providers continue to examine alternative medicine as a complement to traditional medicine. "Full integration is not quite there yet, but the door is open as health plans and physicians look at the value of alternative care," said Debbie Enigl, RN, Landmark Healthcare’s director of quality management. "It’s not necessarily a matter of alternative medicine used by itself but sometimes in combination with other modalities. It’s a blending of better health care and outcome for patients." The bottom line HMOs disagree about the effect of alternative care on the bottom line. Of those surveyed for the Landmark study, half said alternative care benefits either produce savings or don’t add cost, while the other half said alternative care adds to costs. But as a preventive care measure, some healthcare providers believe alternative medicine can’t help but reduce some costs. "If HMOs would focus on prevention and promotion, we would see less money spent on critical illnesses," said Robin Potter-Kimball, RN, immediate past president of the Oklahoma State Nurses Association. "If we could cover pedicures and manicures for diabetics, for example, we could save so much money with fewer amputations. If we could pay for something simple, it’s remarkable what we could do." |
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