Insurers move from ‘sick care’ towards ‘well care’

TRICARE, the health care program for uniformed service members, has decided to waive the cost-sharing requirement of up to three visits to a physical therapist for low back pain. They’ve said that the goal is to encourage more use of “high-value” treatments for low back pain.

TRICARE tells us in their summary of this demonstration what they mean by high vs low-value care: “Increasing the value of health care refers to improving patients’ quality of care and outcomes, improving patients’ access to care, and reducing overall costs of care. In contrast, low-value care refers to interventions that: are not proven to benefit patients; may harm patients; result in unnecessary costs; or waste health care resources.”

Well Care

High-value care leads to better outcomes, is easy to access and is cheaper for both patients and insurers. Physical therapy fits into this category, but looking at other high-value treatments helps us start to see a theme. In 2017 the American College of Physicians released widely endorsed guidelines for treating low back pain.

Initial treatment recommendations include exercise, stretching, tai chi, yoga, progressive relaxation, heat or ice, cognitive behavioral therapy, and motor control exercise. These are all active treatments, where the practitioner and the patient are working together to improve, and physical therapy can delivery many of the physiologic benefits of those treatment recommendations.

This is “well care”.

Sick Care

In contrast, low-value care tends to be “sick care” where the patient is a passive participant. TRICARE puts imaging before six weeks in the absence of red flag symptoms, surgery for non-specific low back pain, opioids as the first or second-line treatment, and bedrest in the low-value category. Spinal injections also fall in this category for most people.

This isn’t to say that imaging, surgery, or injections are always bad. For a small percentage of people with back pain, they’re the right treatment. But, most people should start with treatments that have the best outcomes for the lowest cost. If those treatments tend to focus on putting the person in pain in power to actively participate in their care rather than making them dependent on someone to “heal” them, that’s even better.

Physical therapists know this and have been providing care that fits this model for years.

TRICARE’s demonstration that waives cost-sharing clearly shows that insurers are recognizing the value of this type of care and that they are actively moving in this direction. It also further substantiates that highly skilled doctors of physical therapy, like the team of doctors of physical therapy at ProFysio, are the provider of choice for movement disorders and should be the first line defense for low back pain and other conditions like it.

It’s worth noting that you do not need a medical doctor’s prescription to begin physical therapy. As a direct access provider in the State of New Jersey, if you are having pain or limited movement you can call ProFysio or schedule online without a prescription today.  We even offer complimentary in person or telehealth consultations. 

Call ProFysio today to get rid of pain and get back to what matters most to you.

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