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Impact of a value-based insurance design for physical therapy to treat back pain on care utilization and cost

Authors Maeng DD, Graboski A, Allison PL, Fisher DY, Bulger JB

Received 28 February 2017

Accepted for publication 2 May 2017

Published 31 May 2017 Volume 2017:10 Pages 1337—1346


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr E Alfonso Romero-Sandoval

Daniel D Maeng,1 Anthony Graboski,2 Peiling L Allison,3 Dorothy Y Fisher,4 John B Bulger2

1Department of Epidemiology and Health Services Research, Geisinger Health System, 2Geisinger Health Plan, Danville, PA, 3United HealthCare Services, Inc., Milton, PA, 4Forward Health Group, Danville, PA, USA

To assess the impact of a value-based insurance design providing enhanced access to physical therapy (PT) for treatment of back pain on treatment patterns and cost of care.
Study design: A retrospective analysis of claims data obtained from Geisinger Health Plan (GHP). In April 2013, GHP began offering “PT bundle” – i.e., a bundle of up to five PT visits for a single one-time copay that can be renewed for another bundle of five PT visits – for its employer-based plan members with back pain.
Methods: A cohort of GHP members who were preauthorized for the PT bundle were compared against a contemporaneous cohort of GHP members who were preauthorized for PT under the standard per-visit copay arrangement between January 2013 and October 2014.
Results: Among the PT bundle cohort, the PT visit rate during the first 9 months since the PT preauthorization date had dramatically increased and then gradually decreased in subsequent months. The PT bundle was also associated with 29%–35% short-term reductions in emergency department visits and with 12%–20% reductions in primary care visits after 6 months. No significant impact on hospitalization or cost was observed.
Conclusion: Implementation of the PT bundle appears to have led to a change in the treatment pattern of back pain that is more consistent with the recommended guidelines to use more conservative management such as PT as the first-line treatment for back pain.

Keywords: back pain, physical therapy, insurance, utilization, cost of care

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