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  • Innovative Collaborative Effort Between APTA, United Healthcare, and OptumLabs Could Introduce Important Changes to Pain Management Policies

    What would happen if payers encouraged patients with low back pain (LBP) to explore low-risk treatments such as physical therapy by waiving copays for initial sessions? Thanks to a collaboration between APTA and the nation’s largest private health insurer, we may find out.

    Through its work with APTA, United Healthcare is identifying 10 markets for a pilot program that would employ a variety of policy changes to its pain management program, including the elimination of cost-sharing for an initial physical therapist (PT) visit, easier appointment scheduling for patients, and stepped-up public and physician education efforts emphasizing the benefits of early referral to a PT for pain. If successful, the pilot could help to transform the payment landscape in ways recommended in a recent APTA white paper on addressing the opioid epidemic through better pain management policies.

    The pilot accelerates the practical application of findings from a joint study by APTA, United Healthcare, and OptumLabs on the potential impact of early physical therapy and other nonopioid strategies to address LBP. That study paid particular attention to cost and downstream utilization associated with early physical therapy for LBP.

    The study was one of the topics covered during the 2018 Rothstein Roundtable at the APTA NEXT Conference and Exposition (see video dispatch below). During the Rothstein discussion, David Elton, senior vice president of clinical programs for OptumHealth, characterized the study's findings as ones that "confirm what we've seen"—that "good things happen" when physical therapy is used early in an episode of LBP.

    While not yet finalized for publication—something that could happen as early as fall of this year—the study's results were convincing enough to cause the insurer to move quickly toward the creation of the pilot program.

    "The collaborative work between APTA, United Healthcare, and Optum is an innovative approach that brings providers and payers together to work on truly transforming the health care system in ways that make a difference to patients," said Carmen Elliott, MS, APTA vice president of payment and practice management. "We are excited about the publication of the joint study and pleased for the opportunity to make real-world changes to improve patient access."

    According to United Healthcare, APTA chapter leadership in the 10 markets under consideration will be contacted to schedule webinars that provide an overview of the pilot.

    OptumLabs and OptumHealth are businesses of Optum. Optum and UnitedHealthCare are benefits and services companies of UnitedHealth Group.




    • Will this initiative cause optum and UHC to back off of the authorization requirements every 2-4 visits that required substantial paperwork for PTs or improve the extremely low reimbursement rates for Physical Therapists in private practices when compared to POPTS or hospitals.

      Posted by Jeremy Pittman on 7/11/2018 11:59 PM

    • To add to Jeremy's comment, it seems like they indeed see value in PT intervention as a cost effective way to manage pain, however between authorization/paperwork burdens and capitated payments ($65 eval and f/u treatment regardless of time spent) they then don't want to pay for it.....

      Posted by Jessica Dufault -> ?MS^=N on 7/12/2018 3:51 PM

    • With the extremely low reimbursement rates of UHC (lowest of all companies we contract with), we honestly can't afford to have an influx of patients with UHC insurance. We want to help all the patients we can,but we must stay viable. Reimbursement rates need to be considered during this "collaborative effort".

      Posted by Shay on 7/13/2018 10:44 AM

    • We know early injury management works: look how professional sports teams take care of their employees. The people deserve the same. We also need to screen better for comorbid mental health, addictions and stress to prevent pain chronicity. And, physical therapists should be reimbursed for wellness and lifestyle management, which should be a cornerstone modality as 85% of chronic disease and expense is preventable.

      Posted by John Lesh on 7/13/2018 4:29 PM

    • It’s really sad that as our representative body the APTA is working with UnitedHealthCare. How generous of UnitedHeathCare to waive $45 of the $70 they pay for PT for 1 visit. As a payor United has demonstrated time and time again they don’t value PT enough to reimburse at a market competitive rate. Way to go APTA. Let’s keep collaborating with companies that don’t value our services as much as their competitors.

      Posted by Mike on 7/13/2018 5:12 PM

    • Collaborating with United Healthcare is a bad idea ... BAD ... VERY BAD! Please name me one instance where any interaction with this rapacious corporate overlord has ever benefited anyone but them and especially their CEO. Read the histories of William McGuire and Stephen Hemsley. I don't know who the new CEO is but he's sure to be another in a long line of corporate expropriators of provider and patient wealth. Dealing with them is like entrusting a python to take care on your 6 month old infant. Someone will wind up being eaten alive and, hint, it won't be the python..

      Posted by Brian MIller on 7/18/2018 10:47 PM

    • These collaborative issues for solving access to effective and efficient treatment in Healthcare reinforces why UNIVERSAL HEALTHCARE IS NEEDED and IS THE ANSWER to providing effective; efficient treatment approaches with good outcomes that is ACCESSIBLE AND AFFORDABLE TO ALL. When will the UNITED STATES OF AMERICA wake up to the CRISIS of providing AFFORDABLE HEALTHCARE AND STOP WASTING VALUABLE FINANCIAL RESOURCES . GREED AND INDIVIDUALISM TO HEALTHCARE RESOURCES has not provided a sustainable ; effective and efficient path to resolving the ONGOING HEALTHCARE EPIDEMIC/CRISIS IN THE UNITED STATES OF AMERICA. Anne Kenny P.T.

      Posted by Anne Kenny on 8/2/2018 7:42 PM

    • The article did not explain the waiving the co-pay clearly. Does this mean that insurance companies are paying the co-pay for the patient? Or, does this mean that PT clinics are being paid less by foregoing the co-pay collection for treating patients? The co-pay is at least 50% to 70% of the cost of the visit for PT in today’s market. If the latter is true, why would the APTA work collaboratively to financially punish Physical Therapists? Eric

      Posted by Eric on 8/30/2018 11:56 AM

    • We considered joining as a provider for UHC but the payment is to low for the amount of time that it cost our clinics to provide a quality PT visit. You can apply for a specialty status but was told you were to work on the regular contract and then after a year they decide if they will pay you slightly more. UHC is a large provider of coverage for people in our area and we just don't want to minimize the quality of physical therapy treatment by having patients in and out of the door in 20 to 25 minutes as other clinics around plan when they are seeing a UHC patient.. Maybe UHC should spend more money on quality healthcare and less on advertising that they do.

      Posted by Glenn Guilbeau PT on 8/31/2018 6:31 AM

    • We must look at the positive finding from this study. Earlier referral to PT is better for the public and reinforces that PT is an effective and more cost effective intervention. The time to negotiate better reimbursement is as this is shown to reduce costs. Virginia Mason Hospital System showed this was true in 2005 reducing their cost of treatment for acute low back pain by 60%. One of the outcomes of that observational study (because the hospital system lost money because reduced utilization of MRI, employed physiatrists and surgical suites used for epidurals) was that PT was REIMBURSED AT A HIGHER RATE. That is the ONLY time in my 33 years of practice that insurance companies INCREASED PT reimbursement. Now, the big effort is to get PTs to be even better at treating acute LBP avoiding the use of MDs when unnecessary. And, don't think this is only about UHC. If it is true for UHC it is true for other insurance companies. If other insurance companies push their customers to early PT intervention, this will continue to increase the demand. Although market forces don't work in health care, this is a step in the right direction.

      Posted by Herbert Silver -> >JX^D on 9/1/2018 11:38 AM

    • Why in the world would the APTA work with UHC!!!!!!! It is just down right insulting. Are they trying to help or hurt the profession!

      Posted by Marice on 9/17/2018 9:44 PM

    • Sounds great! Too bad UHC/optum reimburses at a rate our clinic can not accept. If clinics accept the rates other insurers will follow. The death of private practice. What ever came of vision 20/20 APTA?

      Posted by Thomas Nelson -> @JP^D on 10/31/2018 5:18 PM

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