Insurance Coverage for Acupuncture

PROJECT SUMMARY
The proposed study will examine insurance coverage for acupuncture therapy using both quantitative and
qualitative methods, with the long-term goal of running interventional studies focused on insurance design that
can improve access to safe and effective pain care. After decades of reliance on prescription opioids for chronic
pain, the recent and widespread reduction in opioid prescribing is a welcome change. However, it is critically
important that patients with chronic pain conditions like chronic low back pain (cLBP) have access to safe,
effective, and affordable pain care. Acupuncture is an evidence-based treatment alternative for patients with
cLBP, but its insurance coverage is inconsistent, making acupuncture cost prohibitive relative to other forms of
pain care. Our first aim will measure trends in acupuncture use among a cohort of patients with cLBP using a
national sample of claims data, then examine characteristics of patients who use acupuncture and identify other
forms of pain care that they use in conjunction with acupuncture. We focus on patients with cLBP because it is
one of the most common complaints cited by patients who engage in acupuncture; it is also the most common
indication covered by insurers, including Medicare. In our second aim, we will evaluate the role of insurance
design on acupuncture use, specifically the impact of cost sharing like copays, coinsurance, and deductibles,
which have been shown to affect health care utilization at large and pain care in particular. A third aim will
contextualize the claims-based findings with qualitative interviews with insurers and pain care providers,
including acupuncturists, who will help us develop and refine an insurer-driven interventional study to encourage
patients to engage in evidence-based pain care, like acupuncture therapy. While there are myriad ways to
improve access to pain care, this project focuses on the role of insurance design and cost sharing. In terms of
career development, this grant will support a training platform that will allow the candidate to reorient from
behavioral health services research to acupuncture, pain care, and integrative health services research. An
interdisciplinary mentorship team will oversee the following training goals: (1) Carefully review the research on
the role of integrative medicine in comprehensive pain care, with a focus on acupuncture. (2) Develop an in-
depth knowledge of the role of insurance coverage in pain care and identify empirical strategies to study how
insurance design affects acupuncture use. (3) Learn how to conduct qualitative research that complements the
candidate's strengths in health economics and claims-based research. (4) Build a knowledge base in
interventional study design to propose a follow-up study that involves insurer-driven randomized trials that test
whether alterations to insurance design affects the use of acupuncture. Through the training and research
activities proposed in this K01, the candidate will become an expert in insurance coverage for acupuncture, gain
a skillset in qualitative methods and interventional study design, and begin working toward her goal of translating
research into actionable changes in policy or practice to support patients with chronic pain.

Grant Number: 5K01AT011776-04
NIH Institute/Center: NIH
Principal Investigator: Molly Candon