Coverage for Integrative Pain Therapies on the Horizon

Pauline Anderson

November 16, 2018

BOSTON — Healthcare providers, policy makers, patients, insurers, and other stakeholders are making progress in ensuring better access to integrative pain management therapies such as yoga, acupuncture, and massage.

White papers from workgroups of the Integrative Pain Care Policy Congress should be available by the end of the year, Clayton Jackson, MD, president, Academy of Integrative Pain Management (AIPM), and clinical assistant professor of family medicine and psychiatry, University of Tennessee College of Medicine, Memphis, told Medscape Medical News.

The workgroups are focused on establishing an evidence base for integrative therapies and removing unnecessary regulatory and administrative barriers to accessing care, said Jackson.

The stakeholders held a day-long closed-door meeting here following Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018.

Reality Check

The current opioid crisis is a national public health challenge, but it's also viewed by those in the integrative pain management field as an opportunity to address another important issue.

"Patients and clinicians and public health policy makers are really being forced to confront the reality that we have a number of Americans who suffer from chronic pain," said Jackson.

"Those patients have inadequate access to proper resources for pain management. We can't just throw opioids at the problem; we have to acknowledge that many patients require multimodel treatment to achieve best symptomatic reduction and functional improvement," he added.

The meeting included representatives from 53 professional organizations, four patient advocacy groups, and two research consortia, as well as many from state legislatures and private and public insurers, said Jackson.

"The healthcare of over 100 million Americans patients was represented by the decision makers in the room," he said.

During the congress, representatives from the National Institutes of Health (NIH), the Substance Abuse and Mental Health Services Administration, veterans' groups, and other national agencies discussed federal efforts to support comprehensive integrative pain management. There were presentations from Medicaid, the Health Resources and Services Administration, the National Governors Association, and Indian Health Services.

Representatives from Massachusetts provided input on how that state strives for balanced pain management, and a panel discussion among public and private insurers addressed how to synchronize efforts to improve access to integrative pain management.

"Fortunately, we had a number of payer partners at the Congress. They're willing to cover services, provided there is an evidence base that these services do help and provided there are outcomes data measures they can use to compare apples to apples and oranges to oranges," said Jackson.

Evidence supporting integrative pain management approaches doesn't always meet the gold standard the US Food and Drug Administration (FDA) typically requires to approve drugs. The Congress is making headway in arriving at a consensus on the level of evidence needed for insurance coverage for these nontraditional approaches.

New Payment Models

At the congress, discussions have explored payment models that take into account the intersection between pain management, addiction, and behavioral health.

In addition to discussing new models of payment, meeting delegates are exploring ways that groups can collaborate to offer better care, especially for patients with chronic pain, said Jackson.

The goal of this year's conference was to move forward on work initiated at last year's inaugural meeting. Such work involves removing administrative and insurance coverage barriers to accessing care and educating clinicians and the public on best practices, said Jackson.

He stressed that healthcare professionals and the public should be aware that chronic pain management is "multidisciplinary and multimodel."

Jackson described the extent of current insurance coverage for integrative pain management therapies as "poor." Many pain patients can't afford the very treatments that might provide the most benefit.

"This is the whole reason for the congress's existence — so we can use the power of multiple patient advocacy organizations, professional societies, and others to say this is what we need," said Jackson.

Having all the stakeholders together in the same room "talking about solutions-oriented processes rather than challenge-based processes" makes it all the more possible to find "common ground," said Jackson.

"Everybody is under the same tent; everybody is working together and pulling in the same direction for what's best for patients," he said.

The white papers, which are expected to be published by year's end, should provide a solid framework for policy makers, said Jackson.

Academy of Integrative Pain Management (AIPM) Inaugural Global Pain Clinician Summit 2018. Integrative Pain Care Policy Congress, November 10, 2018.

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