Chiropractic teams with National Association of Worksite Health Centers for greater visibility

Continued outreach to employers, benefits consultants and advisors required to broaden understanding of how chiropractic care lowers health care costs, improves employee performance and increases retention

With the right data and tools, employee health benefit brokers and consultants have the ability and willingness to advise clients to expand access to chiropractic services and integrate doctors of chiropractic (DCs) into worksite health centers to lower health care costs, improve employee performance and increase worker retention, according to an advisory roundtable convened by The National Association of Worksite Health Centers (NAWHC), in collaboration with the Foundation for Chiropractic Progress (F4CP).

The roundtable was held during open enrollment season on Dec. 1 in Scottsdale, Ariz., to measure benefit consultants’ knowledge and understanding of chiropractic care’s overall business impact from a cost, revenue and human resources perspective. Advisors determined that many brokers and consultants, as well as their employer clients, still require further education and assistance from the chiropractic profession to understand how enabling employees to visit DCs for neuromusculoskeletal pain and lack of mobility can benefit their health as well as the company’s bottom line.

“Chiropractic care continues to make strides in awareness and endorsements among health benefits advisors, but some still lack adequate knowledge of the abundant recent evidence demonstrating how our care is fully aligned with employers’ missions, values and financial goals,” said Sherry McAllister, DC, president of F4CP. “Disseminating compelling and timely data of the positive ROI of chiropractic care is essential, but so is sharing evidence of how DCs can be easily and effectively integrated into multidisciplinary care teams for maximum benefit, such as within a worksite health clinic.”

Survey Results Reveal Knowledge Gaps

Working in conjunction with the F4CP, the NAWHC convened the roundtable based on findings from last year’s F4CP roundtable (held in San Francisco, Calif.) that concluded that DCs need to prioritize benefit advisors and consultants through education about the efficacy and cost-savings of chiropractic care. Consultants and brokers hold tremendous influence over employers on health benefit design and worksite clinic services, advisors said, and need to be a priority.

Larry Boress, executive director of the NAWHC, moderated the consultant roundtable which included some of the nation’s largest health benefit advisor firms. He presented the results of an NAWHC survey of the participating consultants, “The Use of Chiropractic Services by Employer Health Centers and Benefit Plans.” The findings, which were directional, though not statistically significant, revealed that a majority (60%) of responding consultants still hesitate to recommend chiropractic services to their clients, including 20% who do not recommend the services. The reasons given for not recommending chiropractic care include concern with integrating a DC into the clinical team and uncertainty about how to evaluate a DC’s performance. Other reasons for not recommending chiropractic care included:

• Unsure how to educate business leaders on matters such as evaluating the DC’s quality of care, outcomes and financial ROI
• How to explain the differences between physical therapy and chiropractic
• Concerns about overuse by employees that would increase costs
• Perception that chiropractic care would be additional “free” services at no cost to the employee

What is encouraging is that 40% of benefits advisors surveyed do recommend chiropractic services and another 40% are considering it. Similarly, 100% of benefits consultants answered that they believed a DC should be part of the care team and not only an ancillary offering.

Chiropractic Leaders Share Supporting Clinical Evidence

Kicking off the roundtable, Dr. McAllister delivered an informative presentation about a less discussed, but important topic for understanding the value of chiropractic care titled “Training and Education of Today’s Doctor of Chiropractic.” Consultants were enlightened about the breadth and depth of DCs’ extensive clinical training to evaluate, diagnose, treat and manage neuromusculoskeletal disorders, particularly of the spine, using non-pharmacological, nonsurgical approaches to care and rehabilitation.

Dave Elton, DC, vice president of Musculoskeletal R&D of Optum Labs (a subsidiary of UnitedHealth Group) then shifted the discussion to economic and financial topics with his presentation: “Return on Investment, Value Proposition and Opportunity for Growth.”

Dr. Elton highlighted findings from a series of studies currently posted to the medRxiv pre-print server while proceeding through peer-review at a variety of clinical journals. His research team found when DCs are the first provider seen by an individual with low back pain or neck pain they are the most likely to deliver guideline-concordant care and were associated with the lowest total episode cost of any type of health care provider. One of Dr. Elton’s most recent studies shows that no matter when a DC becomes involved in an episode of low back pain, they are the type of health care provider most likely to resolve the low back pain.

Among doctors of chiropractic (DCs), physical therapists (PTs) and licensed acupuncturists (LAcs), individuals with low back pain initially seeking treatment from a DC are most likely to receive one to three visits, are associated with the lowest total cost and have the lowest rate of exposure to pharmaceuticals or imaging. At all levels of visit frequency, DCs delivering chiropractic manipulative therapy were associated with the lowest median episode cost compared to PTs and LAcs.

Selecting a DC or PT for care, however, does not need to be a binary decision. Both clinicians practicing collaboratively on a team in worksite health clinics accelerates employee health recoveries while lowering overall health care costs, according to a presentation from Dan Lord, DC, medical director of Crossover Health Medical Group, which operates worksite health clinics across the country for major corporations, including some of the largest technology firms in the world.

Dr. Lord’s presentation, “Experience of a Chiropractor in Worksite Centers,” shared how Crossover’s integrated and holistic care services, such as primary care, mental health, physical therapy, chiropractic, health coaching and care navigation yield positive clinical outcomes and financial results such as:

• Decreased utilization of imaging
• Decreased referral to specialists, ER visits
• Decreased utilization of higher-cost PT service when clinic includes DC on the team

Dr. Lord also noted how the chiropractic landscape is changing, including how DCs are increasingly thought of as members or contributors to clinical teams focused on neuromusculoskeletal conditions. The introduction of digital musculoskeletal solutions/apps is also a new element in chiropractic and vary greatly in quality and features, according to Dr. Lord, who notes that the digital tools are best for self-care and self-reporting.

Robb Russell, DC, assistant VP & clinical chief of staff, SCU Health, presented the latest guidelines from the American College of Physicians recommending noninvasive approaches such as spinal manipulation and massage. Ironically, primary care physicians wrote the guidelines but often don’t follow them while DCs are far more adherent to the recommendations, Dr. Russell noted. He concluded his presentation with a call to action for benefits consultants to transcend their current role as just a vendor and experts on health plan offerings, but rather as trusted advisors who can help deliver employee well-being. Chiropractic care can help them in that goal by educating employers on its advantages:

• Cost-effective: Lower cost care while preventing the need for more expensive services
• Clinically effective: Better symptom management and more improved function than other types of care
• Guideline concordant: Most conservative care pathway and associated with the least amount of health risk and cost
• High net promoter score of 92%: Overall higher satisfaction among patients than other healthcare providers

Educational Opportunities for DCs

According to the NAWHC’s survey results, DCs can play an important role in educating health benefits brokers and consultants to encourage them to recommend chiropractic care to their clients. Specifically, the following were some of the most frequent questions, concerns and misconceptions that the surveyed community had about chiropractic:

• What do you look for when hiring a DC?
• How does a medical director manage a DC?
• Chiropractic equipment not conducive to worksite clinics, i.e., a chiropractic table consumes too much space in worksite clinic to deliver other services, such as acupuncture/PT
• Finding a chiropractor whose philosophy and approach are broad enough to meet the needs of a large population
• Chiropractic techniques and approaches vary greatly, which raises concerns about care quality consistency when changing doctors
• Understanding the need of the population and the current spend
• Ensuring patient out-of-pocket spending is always applied to their deductible, even for chiropractic care sought inside the worksite health clinic
• Lack of standardized process for integrating DCs into a clinical team
• Understanding when to recommend a PT vs a DC for pain management
• The clinical and financial ROI of adding a DC to a worksite clinic
• Earning buy-in from other doctors to refer to DCs

Judging from these questions and other NAWHC survey results, considerable knowledge gaps persist among health benefits brokers and consultants about chiropractic care and DCs. The overriding sentiment of the practice leaders who presented at the roundtable is that knowledge sharing and advocacy by DCs and other experts are essential on a local level to expand care access, improve employee outcomes and reduce the employers’ benefit premium costs, loss of productivity and turnover.

“Health benefits brokers and consultants have considerable influence over employer decisions concerning the types of care they should include among their health benefits,” said the NAWHC’s Boress. “These roundtable events are important on a national level for helping consultants understand how and why chiropractic care needs to be part of benefit design, but DCs within the community can play a role in engaging these advisors and sharing timely and accurate information so that company leaders make optimal decisions for their employees and their businesses.”

About the National Association of Worksite Health Centers
The National Association of Worksite Health Centers (NAWHC) is the nation’s only non-profit organization focused on assisting public and private employers and their vendor partners in developing and getting the greatest return from their onsite, near-site, shared and virtual health centers, onsite pharmacies and wellness centers.

NAWHC offers educational programs, networking opportunities, resources, benchmarking and support for those interested and involved with worksite health centers. NAWHC serves as a clearinghouse of information on worksite health centers and the marketplace, providing educational programs, resources, benchmarking surveys, and employer case studies. To learn more, visit www.nawhc.org.

About Foundation for Chiropractic Progress
A not-for-profit organization with over 29,000 members, the Foundation for Chiropractic Progress (F4CP) informs and educates the general public about the value of chiropractic care delivered by doctors of chiropractic (DC) and its role in drug-free pain management. Visit www.f4cp.org/findadoctor; call 866-901-F4CP (3427).