After years of suspicion and hostility, some health insurers are discovering that nontraditional medicine can save them money. Staid giants like Mutual of Omaha are covering chiropractic care (most states leave them no choice). Prudential now pays for acupuncture. The Seattle-based Group Health Cooperative of Puget Sound will soon cover midwife-assisted home births. And a handful of adventurous networks are offering people everything from herbs to homeopathy for minor ailments. Skeptics worry that the new permissiveness could hurt consumers by encouraging useless or even dangerous medical practices. But the current trend would be hard to reverse. People like Liane Buchanan represent a huge potential market–and as the insurance industry is now discovering, it doesn’t cost much to give them what they want. As one HMO executive puts it, “Three visits to a chiropractor are a lot less expensive than an MRI or back surgery.”
No one has done more to advance the trend than Dr. Dean Ornish, founder and director of the Preventive Medicine Research Institute in Sausalito, Calif. Two years. ago, after Ornish published data showing that a lifestyle-based regimen could not only prevent heart disease but reverse it-without drugs or surgery–Mutual of Omaha agreed to run a two-year study in which several hundred subscribers would try his $5,500 program as an alternative to more invasive treatment. Instead of reporting to hospitals for $15,000 angio-plasties or $40,000 bypass operations, 200 volunteers have since immersed themselves in a structured, yearlong effort involving exercise, meditation, group support and a strict vegetarian diet.
At the start of the study, critics predicted that patients would abandon the regimen, saddling the company with hospital bills on top of Ornish’s fees. But 95 percent of the participants have stuck with Ornish’s low-tech program, and only one has required surgery. Mutual of Omaha estimates it has already saved $6.50 for every dollar it has spent. And because heart patients often require repeated operations over the years, company officials say Ornish’s approach could eventually save them up to $20 on the dollar. Fifteen other insurance companies are now trying Ornish’s program -and hospitals around the country are sending teams to Sausalito to learn how to administer it. Frank Sebron isn’t surprised. When the 50-year-old Nebraska policeman started the Ornish program in late 1993, he’d been through angioplasty and was taking two drugs at a cost of $214 a month. He was still too sick to chop wood. Today, his arteries are nearly clear, his cholesterol is down and his diversions include long-distance bicycling. The cardiologist who used to talk about buying Sebron some time now tells him, “We’ll grow old together.”
Ornish’s program has won such broad acceptance that it hardly qualifies as alternative anymore. But the trend doesn’t stop there. Sharp Health Plan, a 16,000-mem-ber HMO in southern California, now offers subscribers an eight-session wellness course designed by Dr. Deepak Chopra, the best-selling author and ubiquitous promoter of India’s ayurvedic healing system. And other insurers are creating entire benefit packages for people interested in alternative care. The most ambitious of these plans-known as Prevention Plus and Wellness 2-were launched two years ago by American Western Life (the company that insures Liane Buchanan) and now boast several thousand subscribers in five Western states. Members pay what they would for a standard, managed-care plan, and they get the same access to MDs and hospitals. But their choice of primary-care physicians includes naturopaths and other non-MDs. And for specialized care, they can turn not only to neurologists and cardiologists but to experts in reflexology (a healing system based on foot massage), rolfing (which stresses body alignment) and other unconventional practices. Members even qualify for mail-order discounts on shark cartilage (which enthusiasts take in the hope of warding off cancer) and echinacea (a flower thought to boost the immune system) from the company’s Purple Coneflower health-food store in Foster City, Calif.
When American Western Life (AWL) launched its new plans, it was trying to control an epidemic of costly, unnecessary treatment. During the previous decade, doctor visits and drug prescriptions had increased roughly fivefold. Hospital stays – many of them prompted by adverse reactions to prescription drugs – had surged just as dramatically. Besides offering lower-tech treatment options, the new plans force every enrollee to work with a physician to identify personal risk factors (smoking, stress, obesity) and to devise strategies for managing them. Participants also agree to call a hot line for advice on self-care before scheduling office visits with any provider. The impact is already evident. Last year 77 percent of the hot line’s 5,600 calls came from people who expected to schedule office visits, but only 55 percent ended up requiring them.
The danger, of course, is that people who need meditation or surgery will get garlic oil instead. Promoting wellness is one thing, says Dr. John Renner of the National Council on Health Fraud, but steering people to unproven therapies is quite another. Most companies still refuse to pay for treatments they deem experimental, and those that offer unconventional care usually charge extra for it, reasoning that rolfing and reflexology should complement standard treatment, not replace it. AWEs alternative practitioners are the first to concede that they don’t have all the answers. If a child has an earache and a 104-degree fever, says naturopath Nancy Welliver, that child will get antibiotics, not herbs. Yet Rennet is probably right to worry. As insurance companies race to cut costly services – and to embrace what’s cheap and popular – the standard of care could decline. Few experts would quarrel with Liane Buchanan’s decision to try herbs and enzymes before resorting to surgery. Unfortunately, the margin for error isn’t always so wide.
Their benefits may be unproven, but alternative remedies are often cheaper than traditional treatment. Here are some rough comparisons:
CONDITION CONVENTIONAL TREATMENT ALTERNATIVE TREATMENT Heart Bypass surgery 1 yr. diet-and-lifestyle disease therapy $30,000 to $40,000 $5,500 Gout Benemid Freeze-dried burdock $30.60 for 100 capsules $9.50 for 90 capsules Migraine D.H.E. 45 Ginkgo biloba $10.26 per injection $6.98 for 30 capsules Middle-ear Full course of Celcor Warm garlic oil infection $65.00 $3.75 Hay fever Decongestant Seldane Freeze-dried nettles $103.80 for 100 capsules $9.50 for 90 capsules
