Experts agree; insurance companies must change their patient incentives to eliminate another Opioid crisis.

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There is growing evidence that insurance companies and doctors are responsible for the current opioid crisis.   60 minutes covered this in their three-part investigation showing that drug companies willfully supplied new businesses with opioids that addicted thousands of people in Florida.   Some doctors profited handsomely from their prescriptive practices, while others just wanted to help.  Some of those doctors lost their licenses and others were jailed for their role in this fiasco. More evidence is showing that in order to resolve chronic problems such as neck and back pain, we need to avoid drugs and surgery.   The evidence also supports the idea that the way we move is responsible for why many of us hurt. Most people visit their medical providers for painful conditions first, although this is changing as more people visit chiropractors as their first course of care for back and neck pain and other musculoskeletal conditions.   We know that methods employed by chiropractors and physical therapists have a much higher level of satisfaction especially when the medical provider refers to a chiropractor and co-manages the patient. On the other hand, insurers have made medication use cheaper than getting some type of rehabilitation for years now, incentivizing the usage of drugs as a primary way of getting relief.   Drugs used to be less expensive however, as their cost has gone up and we have an Opioid crisis as a result, the overall cost to society is growing.  While drugs dull the pain, the truth is, that most painful problems in the body have a mechanical origin.  Inflammation is not usually a disease in most otherwise healthy people.  Usually, there is a mechanical problem that the medical establishment failed to understand properly due to a lack of holistic training in body mechanics and how the fascial system works in conjunction with organs, muscles, bones, nerves and joints. If you visit a medical provider for diffuse pain, it is likely that you will get prednisone to reduce inflammation.  If the patient feels better, regardless of how their problem manifested itself, the provider is likely to believe the patient has had their problem resolved.  Patients have been taught to believe this as well. If you have swelling in one or both legs, it is likely they will give you a water pill which may reduce the swelling, but will not affect a mechanical problem in the leg that may be causing the swelling.  There is also the side effect of a loss of potassium which can become a problem if you do not add potassium supplementation while taking the pill.  Many people who have bad hips and knees owe this to pain management that medicates instead of understanding the mechanical problem causing the symptoms.  A multi-billion dollar business has been built on replacing joints damaged by medical pain management over the years. Some of these folks after hip or knee replacement ended up in chronic pain requiring pain management for the rest of their lives, an industry reliant on opioids such as fentanyl.  Medically, we must change the way we think according to a recently published article in the Daily News, if we ever want to solve the Opioid crisis or any other crisis caused by substituting drugs for appropriate care of painful conditions. Simply reducing the use of Opioids and exchanging it for another pain killer is not the answer, but a gateway to higher medical costs and more mechanical problems as we age.

Insurers right now are the problem.

A patient may get a prescription for pain for a relatively low copayment of $10 dollars, yet the medication may cost $350 dollars and resolve nothing. The patient may eventually "feel better" and never realize that their problem is just chronic because of the way they are used to feeling.  On the other hand, visiting a chiropractor or a therapist may have a copayment of $50 per visit which is not compatible with rehab requiring a few visits a week.  Patients are incentivized with low copayments to take drugs for mechanical problems by insurance carriers. The rehabilitation and resolution of a condition that is properly understood may save joints from damage years later, affecting the overall wellbeing of a patient.  Future visits for other painful conditions may have been prevented had the problem been properly addressed years earlier.  The administration of medication may relieve pain now, however, the problem may have resulted in the need for a hip or knee replacement years later because the patient thought their stiffness and pain was a normal part of aging. Osteoarthritis is a problem that develops, and what we see on the x-ray is a history of dysfunction, and the arthritis is the result, rather than a normal result of aging. Medication and pain management has driven the opioid crisis while forcing up healthcare costs.  A foot problem that was properly addressed with foot orthotics in a young adult may have prevented a knee problem, a shoulder problem, a back problem, a hip problem, and a neck problem. Mechanical preventative care is essential for many adults, yet, this is something that insurance companies do not cover. Chiropractic physicians and other types of healthcare providers who do physical medicine have the ability to improve and restore function to painful areas, without the use of drugs and surgery.   The piecemeal approach of seeing a primary doctor and then being referred to three specialists, as if the body is built this way has also driven costs up. The nonholistic approach to care has different physicians looking at you from a point of view, rather than looking at you.  This has driven the sales of medications since it seems that every specialist will write a script for something. We are made of systems, not of independent parts. This is especially true of the musculoskeletal system which requires the provider to personalize the care to the patient to resolve a problem.  We are all different, from different genetic backgrounds and we all have different body styles as explained in the book Cheating Mother Nature, what you need to know to beat chronic pain. Insurers, who understand the seriousness of the opioid crisis has not changed these policies that favor taking a pill instead of resolving a problem with the right provider.  In addition to high copayment and out-of-pocket costs for chiropractors and therapists, they have also created tiered systems that further discriminate against provider groups such as chiropractors who cost more because Horizon Omnia has made the large hospital systems cheaper to go to because they are tier 1.  They would like the public to believe they are saving money when they are using more expensive and less effective forms of care because of perverse financial incentives. Insurers such as Aetna have just made this worse by having providers pre-certify their patients beginning next year for care.  This overreach from Aetna is not going to save money but may result in fewer provider choices.   The real cost drivers are drugs, hospital systems, and overuse of tests.

How insurers can fix this right now

  1. Visits for chiropractic and rehab should have a low copayment of $10 dollars, while drugs for pain should have a much higher copayment.
  2. Should encourage patients to have preventative musculoskeletal care.
  3. Promote physical fitness.
  4. Have primary care physicians refer shoulder, knee and most joint problems to chiropractors and other therapists first, instead of placing them on medication or referring them to an orthopedic surgeon which is likely to increase chronicity and increase costs with surgeries that may not have been the best option for the patient.
  5. Allow providers to manage their patients, without trying to micro-manage them with pre cert programs which make patient rehab more difficult and overly complicated.