What the Insurance Transition From “Sick-care” to “Well-care” Means for the Future of Back Pain Treatment

What the Insurance Transition From “Sick-care” to “Well-care” Means for the Future of Back Pain Treatment

How Tricare Cost-Sharing Requirement Waivers Are Encouraging Access to Long-Term Treatments

As part of our combined efforts to help patients find freedom from bodily pains like back pain, Tricare is allowing us to waive the cost-sharing requirement for the first three visits to our compassionate and knowledgeable physical therapists. The goal of this initiative is to encourage more use of "high-value" treatments for back pain. Understanding the difference between "high-value" and "low-value" treatment can help you understand how physical therapy is evolving with the new direction of healthcare.

Our physical therapists are passionate about helping patients find healing from their back pain with high-value care, and we hope these waivers through Tricare make this healing more accessible. High-value care is our main focus when it comes to back pain treatments, and Tricare is supporting us in this mission.

This shift towards high-value care is incentivized by the fact that increasing the value of healthcare improves patients’ quality of care and results, broadens patients' access to care, and reduces overall costs of care in the long run. In contrast, low-value care refers to treatments that are not proven to benefit some patients, can put them at higher risk of complications, can result in unnecessary costs, and might not be the best use of healthcare resources.

What Is High-value Care?

Not only does high-value care create ideal results for patients who are suffering from back pain, but it is more accessible for all parties involved. Although you might think high-value care is a vague term, there are some tangible aspects of back treatment that help define it. In 2017, the American College of Physicians released guidelines for treating back pain that have been widely endorsed.

Initial treatment recommendations for these guidelines include exercise, stretching, heat/ice, and motor control exercise. These active treatments are integral to the practice of physical therapy. As physical therapists, our goal is to help patients strengthen their muscles, often muscles associated with injury or pain. Physical therapy helps address pain, including back pain, helps heal scar tissue, and improves range of motion and overall function. These active, high-value care options work to accomplish all of this through a collaboration between the practitioner and the patient, both of whom are dedicated to improving the condition. 

What Is Low-value Care?

In contrast, low-value care includes "sick care" in which the patient seeking treatment is doing so in a more passive manner. We consider low-value care to include treatments like imaging before six weeks without red flag symptoms, surgery for non-specific back pain, opioids as the first or second-line treatment, and recommended bedrest. For many people, this would also include spinal injections. The nature of these treatments is that they provide temporary relief and require patients to meet a specific set of criteria in order to be eligible for them. These treatments are not meant to have a negative connotation by definition. For a small percentage of patients with back pain, they are the best approach. However, we recommend that most patients begin back pain treatment with routes that are more predictable and less invasive.

We care for the whole body of the individual at ProFysio Physical Therapy. At our practice, we never overbook or rush our patients. When you come to our clinic, you can rest assured that you will receive focused and individualized care, and you will have access to state-of-the-art technology. If those treatments can empower the suffering individual to be an active, passionate participant in their own healing rather than relying on passive treatments, that sets them up for long-term success and health. Our highly trained physical therapy team is aware of this and is enthusiastic about providing healing that can last a lifetime. Initiatives like this cost-sharing requirement waiver show that insurers are recognizing the value of this enduring care model. The shift is also further evidence of the solution-oriented future of physical therapy.

If you are suffering with back pain or other bodily ailments, you do not need to suffer alone any longer. Call the team at ProFysio Physical Therapy at (732) 812-5200 or contact us online and we would be happy to walk you through the best treatment route for you or help you understand your insurance options.

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