KRAY KIBLER, Chief Operating Officer and Chief Financial Officer, Scrip Companies
CRAIG HOOD, Executive Vice President, Allegro Medical
The growth in the number and proportion of older adults in the United States has reached unprecedented levels, creating a number of issues for Baby Boomers, including a rise in chronic conditions, greater demand for pain relief, overuse of pharmaceuticals and high prescription expenditures. Combined with the looming physician shortage, the U.S. healthcare system faces the potential for longer waiting times and lower quality of medical care.
Seniors represent 13.7 percent of the United States population, about one in seven Americans.2 Almost 92 percent of older adults have at least one chronic condition, and 77 percent have at least two. Some type of disability, such as difficulty in hearing, vision, cognition and ambulation, was reported by 36 percent of adults aged 65 and over.
In the midst of these trends, Complementary and Alternative Medicine (CAM), the wide array of healthcare practices, products and therapies that are distinct from those used in conventional medicine, is expected to experience unprecedented popularity. CAM practices are diverse and include chiropractic, massage therapy, acupuncture, nutritional medicine, naturopathy, herbalism, Ayurveda, Reiki, laser therapy and electrotherapy.
CAM also includes a large and diverse group of orally or topically administered products such as herbal medicines, botanicals and probiotics that are widely marketed and readily available, often sold as dietary supplements.
CAM therapies emphasize the natural healing ability of the body and prevention versus the conventional approach of treating disease and its symptoms. A growing number of traditional healthcare professionals have begun to integrate CAM into their treatment programs for its proven benefits, including pain and injury prevention, post-surgical treatment and non-invasive pain relief. For instance, the Mayo Clinic has incorporated massage therapy into post-surgical treatment.
The Mayo Clinic has incorporated massage therapy into post-surgical treatment, and California now allows chiropractic services for reimbursement when they are provided in federally qualified health centers (FQHC) and rural health clinics (RHC) — further demonstrating the mainstream acceptance of chiropractic.
The purpose of CAM is to move patients toward complete wellness, helping them to discover and understand the hidden causes of health challenges, creating a customized and comprehensive treatment plan, and investing in healthy aging to achieve lower disability rates down the road.
PAIN MANAGEMENT IN AMERICA
Pain is the most frequent reason patients visit the emergency department (ED) — over 70 percent. A number of studies show that fewer than half of post-operative patients receive adequate pain relief, despite the fact that poor pain management puts patients at risk, creates needless suffering, and increases costs of care.
It is also well documented that certain populations, including seniors, bear the burden of chronic pain disproportionately. Given the high cost of pain in human lives, dollars, and social consequences, CAM presents an avenue for relieving pain across the healthcare continuum.
The goal of pain management is to improve a patient’s quality of life. Paradoxically, advances in medicine that have led to greater survival rates among patients with cancer, heart disease, HIV/AIDS, stroke, traumatic brain injury and many other diseases have increased the number of people living with chronic pain.
The physician shortage will aggravate the issue of pain management. Currently, there is a shortage of more than 13,000 physicians, with the expected shortfall to grow 10-fold within 12 years.
HOW CAM ADDRESSES ACCESS ISSUES
Licensed chiropractors, massage therapists, acupuncturists and naturopathic physicians continue to be sought after as accessible and cost-effective healthcare solutions. CAM providers are held to the same strict standards of quality as conventional providers including advanced education, licensure, credentialing, the delivery of evidence-based care, and accountability for outcomes.
CAM providers, especially chiropractors and naturopathic physicians, represent first-contact providers and maintain referral relationships with conventional medical providers when services beyond the CAM practice become necessary. Overall, the practice of CAM has risen dramatically in recent years. According to the National Institutes of Health, an estimated 18 million Americans receive massage therapy each year, while chiropractors treat more than 30 million people annually.
A National Institutes of Health study found that among insured patients with back pain, fibromyalgia, and menopause symptoms, those who use CAM have lower insurance expenditures than those who do not use CAM. The study noted that CAM therapies avoid high technology and offer inexpensive remedies. CAM providers in this study included chiropractors, licensed massage therapists, acupuncturists, and naturopathic physicians.
The results suggested that, because individuals with high disease burden typically drive the majority of claims expense, the potential for savings is much greater for CAM users. What’s more, the trend toward the integration of CAM into standard care will improve access to care for many Baby Boomers.
PAIN MANAGEMENT OPTIONS
Chiropractic: Chiropractic treatment of neck and back pain, which is common among aging Americans, provides more relief than over-the-counter drugs like aspirin and ibuprofen. In one
study, after 12 weeks of treatment more than half treated reported at least 75 percent reduction in pain compared with one-third in the drug group. A year later more than 50 percent of those treated with chiropractic reported significant decrease in pain. In contrast, the patients taking pain killers had upped their dosage during the same period.
Massage Therapy: Studies show that massage therapy increases endorphins and serotonin, chemicals that act as natural painkillers and mood regulators. Massage therapy also reduces levels of the stress hormone cortisol, and turns off genes associated with inflammation and its associated pain, which in turn relieves muscle soreness. Moderate to deep pressure massage can activate the vagus nerve which regulates heartbeat, helping seniors experience pain relief for a number of conditions. Studies also show that massage helps reduce anxiety, pain and nausea in cancer patients by 44 percent, and also raises the level of cancer-fighting white blood cells.
Acupuncture: Acupuncture has been shown to relieve a wide range of pain conditions that impact seniors, such as carpal tunnel syndrome, fibromyalgia, headache, low back pain, myofascial pain and osteoarthritis. One study found that during acupuncture trials for patients with chronic low back pain, only 15 percent of subjects who received genuine acupuncture treatment needed extra pain medication, compared with 34 percent who were receiving placebo treatments, and 59 percent receiving conventional therapy. Furthermore, long-term pain reduction was achieved more effectively in subjects who received either real or placebo acupuncture versus those who received conventional therapy.
KEY ISSUES IN ADDRESSING PAIN MANAGEMENT FOR AGING AMERICANS
The population of Americans aged 65 years or older during the next 25 years is expected to reach about 72 million. By 2030, older adults will account for roughly 20 percent of the U.S. population.
During the past century, a major shift occurred in the leading causes of death for all age groups, including older adults, from infectious
diseases and acute illnesses to chronic diseases and degenerative illnesses. More than a quarter of all Americans and two out of every three older Americans have multiple chronic conditions, and treatment for this population accounts for 66 percent of the country’s healthcare budget.
The cost of providing healthcare for one person aged 65 or older is three to five times higher than the cost for someone younger than 65. Although the risk of developing chronic diseases increases as a person ages, the root causes of many of these diseases often begin early in life. Practicing healthy behaviors from an early age and getting recommended screenings can substantially reduce a person’s risk of developing chronic diseases and associated disabilities.
Overuse and abuse of pharmaceuticals
For decades, the most important tool in a health toolkit was the prescription pad, with an emphasis placed on treating an illness rather than focusing on prevention and treating the whole body. Hundreds of thousands of the nation’s seniors misuse prescription drugs, including painkillers, anxiety medications and other pharmaceuticals for treating a number of conditions from joint pain to depression.
Doctors are prescribing highly addictive drugs to older patients at record levels, according to a USA TODAY examination of government data. The impact,as measured in overdose deaths, ED visits and admissions to treatment programs, is considerable. Studies project that the number of seniors misusing pharmaceuticals will keep growing, fueled by the aging Baby Boomer population. Among the most common prescriptions given to older patients are opioid pain relievers and benzodiazepines, the psychoactive medications, such as Xanax and Valium, often used for anxiety. According to data from IMS Health, which tracks drug dispensing for the government, the 55 million opioid prescriptions written in 2013 for people 65 and over marked a 20 percent increase over five years — nearly double the growth rate of the senior population.
The average number of seniors dependent on prescription pain relievers in the past year reached an estimated 336,000, up from 132,000 a decade earlier, according to data from the Substance Abuse and Mental Health Services Administration (SAMHSA). Annual ED visits by people 65 and over for pharmaceutical complications climbed more than 50 percent during that time, and the rate of overdose deaths among people 55 and older, regardless of drug type,
nearly tripled from 1999 to 2010, to 9.4 fatalities per 100,000 people, according to the Centers for Disease Control and Prevention.
The economic impact of medication-related problems in persons over the age of 65 is as much of an issue as Alzheimer’s disease, cancer, cardiovascular disease and diabetes. Medication-related problems are estimated to be one of the top five causes of death in that age group, and a major cause of confusion, depression, falls, disability and loss of independence.
Rising cost of pharmaceuticals/drugs
Fifty percent of seniors take eight or more prescriptions on average. Top contributors to the cost trend among Baby Boomers include diabetes (28.3 percent), rheumatological (14.6 percent), and asthma and chronic obstructive pulmonary disease (COPD) drugs (14.3 percent), according to the 2010 Medco Drug Trend Report. Medco also found that as many as 75 percent of insured Americans in the Baby Boomer group are currently taking at least one medication for a chronic condition, and more than half are regularly taking three or more drugs. A 30-day supply of six of the 11 name-brand drugs that Medicare beneficiaries use the most cost more than $250 each.
CAM: EXPLORING ALTERNATIVES
CAM’s growing popularity highlights a path for improving conventional medicine and mitigating the three-pronged challenge of cost, access and quality. Fortunately,U.S.medical schools are developing CAM course work, and managed care organizations are providing some coverage for CAM therapies. A study by Harvard Medical School researchers, looking at trends over the past half-century, indicates that CAM will play a role in the U.S. healthcare system for the foreseeable future.
The study examined trends in the use of 20 different CAMs, covering everything from acupuncture to yoga, among representative socio-demographic groups across the continental U.S.
The findings show that:
- Most of CAM therapies have steadily increased in popularity since the 1960s
- Of those respondents who had tried an alternative therapy, almost 50 percent were still
using it 11 to 20 years later
- Most CAM therapies are used–at least in part–as preventative measures or as part of a regular fitness program
- Demand for CAM is likely to grow.
HEALTHCARE WORKERS LEADING THE WAY IN THE CAM ADOPTION
Baby Boomers’ willingness to adopt innovative services is likely to hasten progress in patient- managed technology, such as mobile health, and reform in pain management approaches. The shift toward CAM will become exponential, especially given that many CAM approaches are no longer considered “alternative” for healthcare workers, the majority of whom use some form of CAM for themselves.
In fact, 76 percent of healthcare workers use CAM, compared to 63 percent of the general population. What’s more, healthcare providers, including doctors and nurses, were more than twice as likely to have used practitioner-based CAM, and nearly three times as likely to use self-treatment with CAM, during the prior year than support workers.
An increase in the number of chiropractors, massage therapists and acupuncturists has sparked an industry focused on providing high quality CAM equipment, supplies, life-enhancing products and the latest technology for consumers and businesses. Such medical developments and techniques are poised to change the face of healthcare.
At the same time, Baby Boomers are re-examining their priorities and taking better care of themselves, following basic health principles, such as exercising, eating whole foods, getting plenty of sleep, avoiding tobacco, sun exposure and stress, and increasingly turning to CAM as an important part of their overall healthcare. This fundamental behavioral shift will help to curb reliance on costly conventional medical care and improve overall pain management. To meet this coming upsurge in demand for real healthcare value, fully integrated CAM providers and CAM insurance benefits will play a critical role.
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