Abstract ID: 3513

Primary Topic: Integrative Health and the Underserved
Secondary Topic: Health Services Research/Cost Effectiveness

Conducting and translating research for policy-makers: A case study of acupuncture coverage by Vermont Medicaid and Blue Cross Blue Shield
Robert Davis, MS; Remy Coeyteux, MD, PhD., , Winston-Salem, NC, United States

Late Breaker: No

Overview

Results from the “Acupuncture for chronic pain in the Vermont Medicaid population” trial will be presented in a symposium format in order to expand the discussion to include strategies that may enhance the likelihood that research will have policy impacts. The story begins with the opioid crisis and brings together a diverse set of Vermont stakeholders, including state legislators, health care and insurance officials, the medical community, the Licensed Acupuncturist workforce, and a population of underserved Medicaid patients who suffer from chronic pain. The format will provide attendees with a deeper context and insight into the unique challenges, constraints and rewards of working in a pragmatic, policy-oriented and politicized research environment.

Rationale

This symposium aims to stimulate thinking and provoke action by integrative medical providers and researchers in the health services/public policy arena. It is important because it will provide a rare example of a US-based pragmatic, prospective intervention trial with patient centered and qualitative outcomes. The population studied is an underserved group. The design was optimized for generalizability to the Vermont health care environment in order to inform health care policy decisions. Our discussion will extend beyond the trial design and results to include the unique challenges and opportunities encountered during this project. Attendees will also benefit from a description of our successful effort to challenge and educate Vermont BCBS officials regarding their incomplete and erroneous assessment of the state of the evidence regarding acupuncture for the treatment of chronic pain.

Objectives

We aim to:

  • Remind attendees about the continuum between explanatory and pragmatic trials and the importance of matching each element of the design with the research question being asked.
  • Inform attendees about the effectiveness of acupuncture in a Medicaid population of chronic pain patients in the domains of pain intensity, pain interference, sleep disturbance, fatigue, anxiety, depression, physical function, and social isolation.
  • Provide attendees with potential strategies for translating and contextualizing existing data and research evidence into formats of use for both expert and non-expert health care policy decision-makers.
  • Provide attendees with insight into the opportunities that were created when a crisis disrupted the usual health care status quo.

Methods/Session Format

The session will be conducted using a presentation and discussion format, encouraging feedback, questions and discussion from the audience.

Remy Coeyteux will introduce and moderate the session, including the discussion with the audience.

Robert Davis will report the study results and events that occurred.

Outline

(90 minutes total)

Background: Opioid crisis and Vermont Act 173 – mandated BCBS report and Medicaid pilot study described below (10 minutes)


Blue Cross Blue Shield VT report to legislature about acupuncture for chronic pain. Rebuttal of report and discussions, relationships and policy changes that ensued. (10 minutes)


Acupuncture for chronic pain in the Vermont Medicaid population – study (40 minutes)

    • design and rationale – challenges and constraints
    • results
    • ensuing policy changes

Discussion (30 minutes)

    • challenges working with the state bureaucracy to get the study started
    • evolution of relationships with Medicaid and BCBS officials
    • loss/turnover of key Medicaid officials during the study due to election of new governor
    • importance of contextualizing evidence, risks, and benefits of acupuncture with opioids and other analgesic medications when considering policy decisions
    • self care and biopsychosocial benefits of acupuncture as demonstrated by our data and other literature fit well with National Pain Strategy recommendations