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  • UnitedHealthcare Announces New Pilot Program to Increase Access to Physical Therapist Services as Result of Collaboration With APTA

    This week, UnitedHealthcare (UHC) announced a pilot program in 5 states that will waive the cost of copays and deductibles for 3 physical therapy sessions for patients with low back pain (LBP) living in Connecticut, Florida, Georgia, North Carolina, and New York. The pilot, which could affect as many as 1 million enrollees, goes into effect July 1, 2019. Other states will join the program in 2020 and 2021.

    Specifically, the pilot will be available to UHC enrollees with new onset of LBP when receiving care from an outpatient in-network provider. This benefit change will not extend the enrollee’s physical therapy or chiropractic benefit maximum, and will apply only to services related to treating back pain. Enrollees must have physical therapy or chiropractic benefits remaining in order to use this benefit.

    UHC will send emails about the benefit change on a quarterly basis to enrollees in the 5 states as they gain access to the benefit. Information also will be included on myuhc.com in the enrollee’s benefit information under Rehabilitation Services - Outpatient Therapy and Chiropractic (Manipulative) Treatment.

    This pilot follows a multiyear collaboration between APTA, OptumLabs, and UHC that included publication of a study in the American Journal of Managed Care (subscription required). This study affirms that higher copays and payer restrictions on provider access may steer patients away from more conservative treatments for LBP, including physical therapy and chiropractic services. "Innovative modifications to insurance benefits," authors write, "offer an opportunity for increased alignment with clinical practice guidelines and greater value."

    "This type of collaboration between a professional association and a private insurer is key to advancing the essential role of the physical therapy profession in improving outcomes for patients," says Carmen Elliott, MS, APTA's vice president of payment and practice management. "APTA continues to advocate for benefit design that is validated by data and meets the needs of patients, providers, and payers.”

    The study's authors, which include APTA member Christine M. McDonough, PT, PhD, hypothesized that patients with LBP who had easier access to a wider array of providers and lower out-of-pocket costs would be more likely to first seek out conservative approaches such as physical therapist (PT) or chiropractic services.

    Researchers looked at 5 years of claims data from OptumLabs Data Warehouse for 117,448 adult patients to determine the relationship between health plan benefit design and patient choice of primary care physician (PCP) versus a physical therapist or chiropractor as the first-line provider for new-onset LBP.

    Patients were excluded if they were not enrolled 2 years before and after the onset of LBP with no prior diagnosis of LBP or back procedures, or if they had filled opioid prescriptions within a year of LBP onset. Included patients could not have had any neoplasm diagnosis in the previous year or recent LBP-related diagnoses, such as spinal fractures, that would require more intensive treatment.

    For the analysis, authors divided the patients into 2 groups: those who first sought treatment from either a PCP or a PT, and those who first sought treatment from either a PCP or chiropractor.

    Their findings include:

    Only 2.8% of the 82,052 patients in the PCP-versus-physical therapist group chose to see a PT first, while 31% of the 115,144 patients in the PCP-versus-chiropractor group chose to see a chiropractor first. The majority of patients had a point-of-service (POS) health plan, and approximately 30% had no copayment or deductible to meet.

    Fewer restrictions on provider access was associated with higher likelihood of seeking out physical therapy or chiropractic treatment. Compared with patients with a POS plan, patients enrolled in a preferred provider organization (PPO) plan—the least restrictive option—were 32% more likely to see a physical therapist first. Patients in exclusive provider organization (EPO) plans were 16% less likely than POS patients to see a physical therapist first. These findings were similar for choosing a chiropractor versus a PCP.

    Higher copayments decreased the likelihood of a patient seeing a physical therapist as first provider. Patients with a copayment over $30 were 29% less likely to see a physical therapist first than were patients with no copayment. This association was not evident for chiropractic.

    As deductibles increased, the odds of a patient seeing a PT first declined; this association was not consistent for chiropractic. Patients with a deductible between $1,001 and $1,500 were 19% less likely to see a PT first (as opposed to seeing a PCP) than were those who had no deductible, while patients in this level were more likely to see a chiropractor first. Patients with a deductible of $1,500 or more were 11% less likely to see a PT first and 7% less likely to see a chiropractor first.

    There were mixed results for consumer-driven health plans (CDHPs) such as health reimbursement accounts (HRAs) and health savings accounts (HSAs). Patients with HRAs were 16% less likely to see a PT first compared with patients without CDHPs, but they were slightly more likely to see a chiropractor first. Patients with HSAs were 25% more likely to see a PT first compared with patients without CDHPs. HSAs had no effect on the chiropractic group.

    "Our study has demonstrated that patients experiencing LBP are moderately responsive to network restrictions and cost sharing in their choice of entry-point provider," authors write. "Reductions in spending are not necessarily accompanied by improvement in value, particularly if patients bypass routine care that would prevent higher downstream costs."

    [Editor's note: McDonough is also the recipient of a 2015 Foundation for Physical Therapy Research Magistro Family Foundation Research Grant as well as a recipient of the 2009 New Investigator Fellowship Training Initiative in Health Services Research.]


    • Physical THERAPIST Services

      Posted by DOUGLAS M WHITE. on 6/25/2019 8:50 AM

    • How does waiving the copay affect the provider? It’s great to be first line for care but if the copay is not paid that significantly affects the ability to provide the service. I don’t know about other practices but UHC is already one of the lower paying insurers in my area and are now demanding authorization even with slotted visits. This requires more employee time and reduces our re- imbursement per visit.

      Posted by Theresa Palkovic on 6/25/2019 9:53 AM

    • So unfortunately this would seem that Consumers value Chiropractic care above that of a PT. Additionally, with all the research indicating that a patient would demo greater improvements by seeing a PT / Chiro in the acute stages of LBP, why are PCP still the first line of treatment who give medications for 6 weeks of wait and see before referral to the appropriate discipline?

      Posted by ANDREW harrison on 6/25/2019 10:00 AM

    • We are an out-patient PT practice in Ga. How can our in-network Cigna patients take advantage of this copay free service for their first three visits?. Are all Ga based PT Cigna providers automatically eligible? thanks, Angelo Rizzo PT,DPT, CLT 770 922 2420

      Posted by Angelo Rizzo on 6/25/2019 10:11 AM

    • I'm under the impression this means that providers will still be paid at their contracted rates for those visits. Please let me know if I am mistaken.

      Posted by Paul Weiss on 7/1/2019 5:00 PM

    • Allow me to make a prediction here. When dealing with UnitedHealthcare, we will come out the loser ... AGAIN. The questions that are not being asked and answered here include, will UHC pay PTs the deductible and co-payment or are we being asked to waive it as well or take a reduction? Another key question is, will they maintain at least the same reimbursement level. My guess is they will cut it ... AGAIN. UHC is already one of the lowest reimbursing insurance companies and one of the most problematic in terms of getting reasonable and timely reimbursement. They inevitably create bureaucratic barriers to reimbursement and are constantly maneuvering and scheming to find ways to deny or delay reimbursement. I certainly don't expect them to change that behavior any time soon. That'd be asking a leopard to change its spots. Try Googling "stock symbol UHC" and it will bring up a graph of UnitedHealthcare's historic share prices. Click on "Max" for the time period. Note the exponential rise in UHC's share price. Note how your reimbursement from UHC, on the other hand, is a steadily downward trending line. Note how the UHC CEOs and executive boards are getting filthy rich. Note how you are struggling more and more to obtain fair and reasonable reimbursement. Then ask yourself how we've allowed this to happen. My solution was buying a large block of UHC stock. That way, when I'm being screwed at the front end (as inevitably happens when dealing with UHC), at least I'm making some of that up at the back end. Another possibility is to actively promote to all your patients why they should NOT have UHC as their insurance company. Another possibility is boycotting them by not treating any UHC patients, explaining that treating them is a losing proposition. Another possibility is long term massive protests at the homes of the CEO and the members of the executive board. Instead, our organization is getting palsy- walsy with them. Does anyone else find that frustrating? I sure do!.

      Posted by Brian Miller on 7/13/2019 11:40 AM

    • P.S. Here's the compensation package for David S. Wichmann, CEO of UnitedHealth Group Inc. https://www1.salary.com/David-S-Wichmann-Salary-Bonus-Stock-Options-for-UNITEDHEALTH-GROUP-INC.html We've contributed towards a good part of his $18,107,356.00 compensation. Ditto with Stephen J. Hemsley who Forbes named as the highest paid CEO in the country in 2011. Ditto with William W. McGuire whose total compensation package came to 1.6 BILLION DOLLARS! At least he could have sent us a thank you note for contributing so generously to his retirement plan.

      Posted by Brian Miller on 7/13/2019 11:52 AM

    • Where can we find this information from UHC directly on their website since I can't locate it even though I know how to search a website very well?

      Posted by Rick Gawenda on 7/17/2019 5:57 PM

    • Nice post its very informative and helpful for us.

      Posted by Performance Physical Therapy & Wellness on 8/23/2019 12:33 AM

    • OPTUM/UHC and the entire physical therapy profession have known that "Physical Therapy First" works. Lowering/waving copays etc do lower musculoskeletal cost. OPTUM's own data showed this in 2015: https://1drv.ms/w/s!AlMdiQx4PFYo6jQFq0BHfzkYDfHg No need to reinvent the wheel.

      Posted by Stefan van Duursen -> =MYaCL on 9/2/2019 11:59 AM

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