September is when health costs and health care coverage options for the coming year pop up on your agenda. It's a great time to examine whether the benefit packages your health plans offer cover some medical practices that, ultimately, could keep employees healthy at lower cost to you.

Sita Ananth I'm talking about complementary and alternative medicine, or CAM. This category takes in everything from acupuncture, massage, and chiropractic care to herbal supplements, yoga, and biofeedback. It's also more popular than you might think: 36% of adults surveyed in 2002 by the Centers for Disease Control reported using some form of CAM treatment, up one quarter from just five years earlier. CAM most often was used for back or neck pain, head and chest colds, joint pain or stiffness, and anxiety and depression. CAM practitioners received 629 million patient visits in 2002, or 60% more than all primary care visits combined. CAM makes particular sense for the construction supply industry for several reasons:

Many CAM therapies are perfectly suited (and have a solid record of success) for treating a number of ailments found in lumberyards, including chronic pain, back pain, osteoarthritis, cardiovascular disease, and diabetes.

CAM therapies and practitioners focus their patients on prevention, wellness, and personal responsibility.

CAM treatments are generally lower cost than traditional medical care and often are a lower-risk option than what a physician or hospital may suggest. This is a boon for employers looking to stretch their limited benefit dollars.

In a 2004 article published in the Archives of Internal Medicine, researchers found that employees with chiropractic coverage, as compared to those without, incurred a 41% reduction in hospitalizations for back pain and a 32% reduction in back surgeries. In addition, those with chiropractic coverage incurred 37% fewer CT/MRI scans for back problems and got 23% fewer X-rays.

Some dealers already are thinking nontraditionally with regard to their workers' health. As ProSales reported in July ('¿Habla de Seguridad?' page 63), Hayward Lumber in Monterey, Calif., gives Pilates-based strength training at the start of each monthly safety meeting; company president and CEO Bill Hayward demonstrates various poses and encourages employees to exercise daily. And Central Valley Builders Supply in St. Helena, Calif., offers yoga classes to its yard crews.

Health plans generally offer a few types of coverage. One is a rider, where the employer can choose to purchase coverage. A second is an embedded benefit, which is available to all plan members. In either case, adding CAM could result in an additional premium, member co-pay, and limits on visits in addition to the need for referral by a primary doctor. The third coverage type involves a discounted fee-for-service plan, where the insurer has negotiated discounts for members for certain services. In this case, there is no need for pre-authorization or visit limits.

Scott Marber of Consensus Health suggests you consider the following if thinking of including CAM practitioners with your plan:

Are the providers credentialed by the plan?

What is the role of the physician? Is a referral needed?

What are the treatment guidelines?

Are there continuing education requirements for CAM providers?

While even more research is needed to link the specific cost savings to employers, it is clear that CAM therapies, offered in conjunction with usual medical coverage, can offer benefits such as increased job satisfaction, lower stress, lower turnover, and happier people.

–Sita Ananth, Project Director, Complementary and Alternative Medicine at Health Forum, American Hospital Association. [email protected]