• Kathleen Carey, Omid Ameli, Brigid Garrity, James Rothendler, Howard Cabral, Christine McDonough, Michael Stein, Robert Saper, and Lewis Kazis.
• Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118. Email: kcarey@bu.edu.
• Am J Manag Care. 2019 Jun 1; 25 (6): e182-e187.

ObjectivesTo determine the association of health insurance benefit design features with choice of early conservative therapy for patients with new-onset low back pain (LBP).Study DesignObservational study of 117,448 commercially insured adults 18 years or older presenting with an outpatient diagnosis of new-onset LBP between 2008 and 2013 as recorded in the OptumLabs Data Warehouse.MethodsWe identified patients who chose a primary care physician (PCP), physical therapist, or chiropractor as their entry-point provider. The main analyses were logistic regression models that estimated the likelihood of choosing a physical therapist versus a PCP and choosing a chiropractor versus a PCP. Key independent variables were health plan type, co-payment, deductible, and participation in a health reimbursement account (HRA) or health savings account (HSA). Models controlled for patient demographic and clinical characteristics.ResultsSelection of entry-point provider was moderately responsive to the incentives that patients faced. Those covered under plan types with greater restrictions on provider choice were less likely to choose conservative therapy compared with those covered under the least restrictive plan type. Results also indicated a general pattern of higher likelihood of treatment with physical therapy at lower levels of patient cost sharing. We did not observe consistent associations between participation in HRAs or HSAs and choice of conservative therapy.ConclusionsModification of health insurance benefit designs offers an opportunity for creating greater value in treatment of new-onset LBP by encouraging patients to choose noninvasive conservative management that will result in long-term economic and social benefits.

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