Oxford launches alternative medicine network

Program helps providers accept unorthodox Rxs

Oxford Health Plans discovered two years ago that one-third of its 1.9 million members were using alternative medicine services such as acupuncture, chiropractic therapy, massage therapy, naturopathy, and yoga. The problem: Many patients weren’t telling their regular physicians about the alternative treatments, and others were asking how they could get insurance coverage for the services. The solution: In 1997 Oxford became the first health plan in the United States to offer alternative medicine coverage.

Now the Norwalk, CT-based company that serves members in New York, New Jersey, Pennsylvania, Connecticut, New Hampshire, Illinois, and Florida is looking at ways to expand and improve the program that has, at least anecdotally, proved popular among members. Results from an outcomes study on the plan aren’t expected until 1999, but Oxford reports that members and physicians increasingly are asking for more information on alternative treatments and that referrals are strong, with 500 or more coming in each week just for chiropractors.

"People will go see an alternative medicine provider, and they won’t tell their doctor," says Kerry MacKenzie, Oxford’s manager of research and education. "We want to offer a safer, more structured environment for members to seek this type of treatment. We want to encourage communication between the alternative provider and the primary care physician."

To meet those goals, Oxford’s plan includes five components:

• a credentialed network of alternative medicine providers;

• an alternative medicine insured rider benefit that allows members to pay a co-payment when visiting participating providers;

• a mail order service that offers dietary supplements and natural products;

• educational seminars for physicians and members;

• ongoing research about alternative medicine.

So far, about 2,500 alternative medicine providers have been approved by the advisory boards set up for each specialty, including chiropractors, naturopathic physicians, nutritionists, massage therapists, yoga instructors, and acupuncturists. Providers must have a state license, have malpractice insurance, commit to continuing education, meet clinical experience requirements, and undergo a site visit evaluation. The credentialing process is redone every two years, says Hassan Rifaat, MD, Oxford’s director of alternative medicine.

Patients can choose a provider from Oxford’s list or be referred to one by their primary care physician. If their employer has purchased the alternative medicine rider — which generally adds 2% to 3% to annual premiums — the patient pays a co-payment. If not, the patient pays out-of-pocket based on a specially contracted rate that is generally 15% to 25% lower than the standard one. Patients also may order vitamins, herbs, homeopathic remedies, minerals, aromatherapy products, books, and videos at a discount through Oxford’s mail order catalog, Living Balance. An advisory board made up of physicians and specialists in dietary and herbal supplements oversees a supplier review process to ensure quality. The advisors also write articles for the catalog that explain the need for and proper use of certain items.

On the physician level, Oxford subsidizes the cost of attending seminars on alternative medicine, offers a series of interactive teleconferences with experts, and provides referral guidelines that help physicians learn more about the different areas of alternative medicine, the conditions they commonly treat, and contraindications to prescribing them.

"It’s a good idea that is long overdue," says Daniel Bonomo, MD, a general practitioner in Yonkers, NY, who refers patients to alternative medicine providers through Oxford. "Many patients use alternative providers and products anyway, so it’s better for the doctor to be involved and be able to give some guidance. The more I learn about alternative medicine, the more I see that it can be a non-toxic alternative for treating and preventing disease."

Bonomo has been prescribing various alternative medicine treatments for his patients for about one year and says he senses a growing interest in the field among his colleagues. "I think interest is broadening because physicians are seeing the need for integrating alternative treatments with what they’re already doing. I think the usage will just get bigger and bigger."

Rifaat says his goal is to get physicians to think proactively when it comes to alternative treatments, considering them as part of their treatment plan from the beginning instead of waiting for a patient to request a referral. To that end, Oxford plans to increase and improve its communication with physicians this year to help them learn more. Rifaat wants to be sure doctors know, for example, that government research has shown that chiropractic treatment within the first four weeks of lower back pain symptoms can be one of the only ways to improve the condition. He wants them to know that acupuncture can help allergy and asthma as well as nausea resulting from chemotherapy, and that massage therapy can improve flexibility and alleviate stress.

And perhaps more importantly, Rifaat wants physicians to know what negative interactions can occur between herbal supplements and prescription drugs and under what circumstances they should not prescribe alternative treatments. Once they start trying alternative treatments, he also wants physicians to develop relationships with alternative providers so they can offer integrated care for the patient. "I believe if the physician has more choices, that will lead to a more satisfied, healthier patient," Rifaat says.

Oxford also wants its patients to understand alternative medicine. This year, the company will step up its efforts to send alternative providers to employer sites to give demonstrations and explanations of their techniques.

To measure whether all of this effort makes a difference for patients, Oxford has asked researchers at Beth Israel Deaconess Medical Center of Harvard Medical School, home to one of the nation’s foremost centers of alternative medicine research, to conduct an extensive outcomes study. Not only will the study show Oxford how well its plan is working, but it will also be the first time researchers have had such a large group of patients in which to evaluate the utilization and effectiveness of alternative therapies, Rifaat says. The study, which began with patient telephone surveys in August, is looking at patterns of use, clinical outcomes, perceived effectiveness, cost, safety, and patient satisfaction. Written surveys will be sent randomly to physicians and patients in the spring. The second phase of the study will examine specific conditions in detail. The results are expected to be published in 1999.

[For more information on Oxford’s alternative medicine program, contact: Kerry MacKenzie, manager of research and education, or Hassan Rifaat, director of alternative medicine, Oxford Health Plans, 800 Connecticut Ave., Norwalk, CT 06854. Telephone: (203) 852-1442.]