Reprinted with permission from Triad Healthcare, Inc.©2000, Triad Healthcare, Inc.
Baby Boomers and retirees are willing to spend more for a visit to a complementary health-care practitioner than they are for a visit to a traditional physician, according to a recent study underwritten by TRIAD Healthcare, Inc. What’s more, respondents say they return to normal activity faster following complementary treatment than they do with conventional treatment.
These are among the provocative findings from a recently released nationwide study of health-care attitudes and usage, focusing on complementary and alternative medicine (CAM). Sorelli B, a consumer health-care research firm in Glen Ellyn, Ill., surveyed a random sample of 407 Boomers and retirees in the fall of 1999, on behalf of TRIAD Healthcare, Inc. At 77 million strong, the Baby Boom generation is the largest, best-educated and most affluent generation in history.
More than 40% of the respondents say they think chiropractic and massage therapy (MT) benefits should become core components of their health plans.
The study found that consumers want the coverage, but even if the benefits are not available to them, they are ready to spend more for CAM services – specifically chiropractic care – than for traditional medical services. Users of chiropractic services say they are willing to pay more out of pocket for a visit to a chiropractor than for one to an allopathic physician.
Thirty-six percent of people who had gone to a doctor of chiropractic in the past 12 months say they would spend more than $20 out of pocket for a chiropractic visit, while only 32% of the same pool would pay that much for an MD or DO visit.
Return to normal activity appears to take less time under chiropractic and massage therapy care: 47% of those answering for chiropractic said they had returned to their regular activities within one day of treatment, as did 65% of those answering for MT. Just 37% of people who had seen an MD/DO reported this length of time for return.
The results of the study are far-reaching. According to the Journal of the American Medical Association, one in three adults uses some complementary and alternative therapy regularly, resulting in a $27 billion market. Perhaps even more significant, this report also estimated that the number of visits to CAM practitioners exceeded the number of visits to primary-care physicians between 1990 and 1997.
Employers are beginning to respond to the widening CAM spotlight. According to Medical Benefits, 19% of responding employers have reacted positively to employee requests, and now cover at least one type of CAM.
The following information is a portion of the executive summary of the Sorelli B study.
An Inside Look…
Consumer Demand to Drive Managed-Care Market
Chiropractic Economics’ Editor Tara Stultz recently caught up with Dr. Marino R. Passero to discuss the implications of the recently released, nationwide complementary and alternative medicine (CAM) study underwritten by TRIAD Healthcare, Inc. (see related article, page 34). Passero, COO of TRIAD Healthcare and senior vice president and officer of NCMIC Group, Inc.’s Board of Directors, also shared his views on the current state of managed care and the emerging trends.
Q According to the recent Sorelli B study underwritten by TRIAD Healthcare, nearly 75% of people responding believed their symptoms were diminished by chiropractic or massage therapy care, compared to 54% who answered the question positively for medical doctors. What are the implications of these results for chiropractors, and how can the information be leveraged to get the word out to both managed care organizations (MCOs) and potential new patients?
A Excellent question. The problem can be simply stated that as doctors of chiropractic, we have known empirically that people under chiropractic care received “other” benefits, such as a general feeling of well-being, increased energy, less sickness, greater capacity to work and less missed days of work. All of these were simply noted by the DC and the initial problem was treated – which was usually a neuromusculoskeletal problem. Now we understand that these types of patient surveys are valid, and as we begin to develop these surveys, the evidence will spur additional research studies that will validate the information gleaned by the type of survey done by Sorelli B. When industry and payors begin to understand that the health-care savings come in long-range thinking, not short-term cost-cutting, there will be a shift in the way they approach health maintenance.
Q According to the study, nearly 70% of chiropractic patients say they visit their DC for care other than what could be provided by their conventional physician. How can this information strengthen the chiropractor’s position when working with MDs for patient referrals?
How do these numbers fit into the growing movement toward complementary care?
A Many studies are demonstrating that patients are visiting their alternative providers for everything from prostatic cancer treatment alternatives, to the common cold. The fact is that so much of the public is now in the age grouping where they are positive toward the use of alternative care and not intimidated by the medical model. The information relative to medical deaths has caused an additional reservation among many people to view medical care as being high-risk and alternatives as having low risk.
Q The study found that about 60% of respondents would sign a petition to include chiropractic or massage therapy benefits in their insurance. Do you think insurance companies would be responsive to this type of input from policyholders? And, if so, how can the profession facilitate getting the information to MCOs?
A It is not a question of would they respond, but how. The entire process is “consumer-demand driven.” As chiropractors we should know that, because everything we have ever gotten has been advanced by the grassroots demand of the consumer. This is no different. The “patient bill of rights” is consumer-driven, and the changes will result – not because they are driven by a desire to change as much as they are driven by a desire to appease a constituency in revolt. Yes, the MCOs will respond to Congress, to state legislators… but mostly to consumers who will drive the system.
Q Looking at the big picture, what are your overall conclusions about the Sorelli B study and its implications?
A The implication of this study is simply to demonstrate that what the chiropractic profession has always known about the “spin-off benefits” is true. We now have the sophistication to quantify the information and to begin a new era of study that will have practical value, rather than simply an esoteric study that will require more study. The Sorelli B study, which some may criticize as being flawed or non-representative of the entire population, is actually quite statistically sound. …We need to continue to do more of these kinds of studies until the cumulative data become so pervasive that Congress, the scientific community and those in policy-making positions will begin to change the paradigm. The results of this study will benefit every segment of the profession. More of these studies will finally result in consideration of alternatives into the core benefit package, because they are cost-effective for the long term.
Q How are chiropractors’ roles changing within the managed-care environment?
A Chiropractors’ roles have changed from being totally excluded under the old primary-care physician (PCP) model, and now there is an opportunity to change the role from exclusion to inclusion. The inclusion will need to be based upon data, which can substantiate the cost and therapeutic effectiveness of chiropractic care. We are working on building that database in order to advance the model we are promoting.
Q What are the biggest changes you’ve seen in managed care during the past five to 10 years? What changes do you predict during the next five to 10 years?
A Predicting changes is impossible; the health-care industry is a moving, dynamic target. The program du jour is what is selling. Yesterday it was the staff model or PCP; today it is choice and CAM; tomorrow it hopefully will be quality and outcomes. TRIAD is poised to meet the quality model and is convinced that those who utilize the care (patients) and those who purchase the care (payors and employers) will eventually take a long-term view of healthcare and understand that the “wellness” issue may involve some up-front reduction of costs for care, reduction of disability, reduction in patient complaints, and increases in satisfaction and increases in outcome measures. The transition of what will happen to healthcare in general is anyone’s guess; however, the fact will remain that in the future, those who pay will demand value, and quality of the network will become ever-so important.
Q Is managed care becoming more cognizant of the importance of wellness/preventive care? What opportunities does this present for the chiropractor? In general, are managed-care organizations cognizant of the role chiropractors can play in wellness care?
A There is much talk of “wellness”; however, no one has defined what that term actually means. Wellness to one person is not the same as wellness to another. The managed-care organizations view mammography exams and immunization as wellness. Doctors of chiropractic view wellness in a totally different health-care model. Whether the health-care model will change to incorporate chiropractic concepts is a very difficult question to answer. TRIAD Healthcare is attempting to develop some data on our provider and patient population to help shed some light on that very question. The newly developed model of the doctor of chiropractic as the PCP was initially viewed with some skepticism; however, the preliminary data suggest otherwise. Only time and a few pilot projects, which will incorporate the “wellness” concepts that chiropractic espouses, will ultimately provide the information to support what chiropractic clinicians have known all along.
Q How does TRIAD’s set-up differ from the traditional HMO/PPO structures, and how is the approach to the medical model different? How do chiropractors and patients benefit?
A TRIAD’s model differs because it is not based upon a punitive approach to the provider. It is based upon clinical necessity, which is frankly the only clinically and legally defensible way to deliver care. Additionally, the proprietary matrix utilized by TRIAD is truly distinct in that it incorporates information not based upon numbers of visits or cost, but rather sound clinical parameters consistent with real-life encounters. TRIAD does not seek to limit care, nor does it seek to provide care that is not based upon sound clinical rationale. That is truly one of the most distinguishing characteristics that sets TRIAD apart.
TRIAD’s model is inclusive, and therefore any DC who qualifies can become a TRIAD provider. The TRIAD model truly reflects a quality of care issue that will eventually become standard. There is much talk about wanting quality, but the evidence suggests that only a few companies take this seriously. TRIAD is convinced that the value of the DC is important and the quality of care provided will enhance the bottom line for the employer, the payor, the patient, and ultimately, the provider.
Q How will chiropractors and MDs/DOs work together in the changing managed-care environment?
A Undoubtedly, there will be a necessary integration of medical and chiropractic physicians working together. How this model will ultimately play out will be interesting. The main issue, however, is how the entire delivery system will change. The doctor will ultimately become less significant as a central player in the health-care delivery, and a greater player as a health-care coach. Active care by the patient will become a very viable model for tomorrow. Doctors and patients will interact differently, and Internet access has changed the landscape forever.
Methodology
In September 1999, postcards were mailed to a random sample of 5,000 U.S. adults over age 35. Recipients were invited to participate in the study by phoning a toll-free number and requesting to be interviewed over the phone; they could also complete the questionnaire by fax or on the Internet; or could choose to be mailed a postage-paid questionnaire for completion.
A second set of postcards was sent to approximately half the original sample (2,500 people) in October 1999. The postcard reiterated the instructions of the first mailing. 407 questionnaires were completed and returned by the Oct. 31, 1999, deadline. Of these, 47 were completed by mail; six by fax; 29 via phone; and 325 on-line. Each respondent was paid $10 for his or her participation.
Fifty-five percent of respondents were women, while 45% were men. The “typical” respondent was a 50-year-old married woman with no children under the age of 18 living at home. This prototypical female has completed between 13 and 16 years of education and lives in a household where the average annual income is between $51,000 and $74,000. The average respondent does not work in the health-care industry.
