Chiropractic care is a unique piece of whole person care, and chiropractors are in a valuable position to ensure the delivery of services are appropriate and effective for patients.
Why is low back pain care important?
Low back pain can be frustrating for both patients and clinicians. There is often no single cause for the pain that can be “fixed” with one approach to treatment. Back pain is the leading cause of disability worldwide, and has been shown to be a significant risk factor for suicide.
The complex diagnostic process, coupled with patient demands, can result in imaging studies, referrals, opioid prescriptions, and therapies that are inconsistent with current guidelines, as well as dissatisfied patients who never do get effective pain relief.
How does chiropractic care help with low back pain?
Research shows that spinal manipulation may relieve pain and improve function in people with acute low-back pain. The addition of chiropractic treatments to patient care has also been shown to reduce the use of pain medications. Patients also report a higher satisfaction with their treatment.¹
¹Should you see a chiropractor for low back pain? - Harvard HealthWhat is the LBP measure?
The low back pain imaging opportunity will apply the HEDIS “Use of Imaging Studies for Low Back Pain” (LBP) metric, applying chiropractor attribution. The LBP measure represents the percentage of adult patients [seeing a chiropractor] with a new low back pain diagnosis (i.e. no diagnosis for 180 days previous) and without an imaging study in the following 28 days. Please review HEDIS specifications for details and exception/red flag conditions.*
Imaging for Low Back Pain is one of the Healthcare Effectiveness Data and Information Set (HEDIS) measures used by The National Committee for Quality Assurance (NCQA). NCQA is an accrediting agency that uses standards and guidelines to provide a road map for improvement to health plans.
*How does the LBP measure differ from the HEDIS measure?
What is the reward opportunity?
If a region achieves the opportunity for calendar year 2025, a Value-Based Reimbursement of 5% is awarded for a payment cycle of 9/1/26-8/31/27. The BCBSM approved amount is increased by 5%. This may be earned in one of two ways:
Over the past 20 years, Blue Cross Blue Shield of Michigan has evolved our payment processes to incentivize value over volume. We maintain specific base rates while offering new revenue opportunities through increased incentive payments to health care providers who demonstrate success in delivering care and managing patient health on a population basis.
Value-Based Reimbursement payments offer the opportunity for PPO providers to earn greater than the standard professional fee schedule, based on achieving goals related to high-quality performance, and paid on BCBSM PPO commercial professional claims.
