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.
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.
Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email
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