PROJECT SUMMARY The proposed study will examine insurance coverage for acupuncture therapy using both quantitative and qualitative methods, with the long-term goal of running interventional studies focused on insurance design that can improve access to safe and effective pain care. After decades of reliance on prescription opioids for chronic pain, the recent and widespread reduction in opioid prescribing is a welcome change. However, it is critically important that patients with chronic pain conditions like chronic low back pain (cLBP) have access to safe, effective, and affordable pain care. Acupuncture is an evidence-based treatment alternative for patients with cLBP, but its insurance coverage is inconsistent, making acupuncture cost prohibitive relative to other forms of pain care. Our first aim will measure trends in acupuncture use among a cohort of patients with cLBP using a national sample of claims data, then examine characteristics of patients who use acupuncture and identify other forms of pain care that they use in conjunction with acupuncture. We focus on patients with cLBP because it is one of the most common complaints cited by patients who engage in acupuncture; it is also the most common indication covered by insurers, including Medicare. In our second aim, we will evaluate the role of insurance design on acupuncture use, specifically the impact of cost sharing like copays, coinsurance, and deductibles, which have been shown to affect health care utilization at large and pain care in particular. A third aim will contextualize the claims-based findings with qualitative interviews with insurers and pain care providers, including acupuncturists, who will help us develop and refine an insurer-driven interventional study to encourage patients to engage in evidence-based pain care, like acupuncture therapy. While there are myriad ways to improve access to pain care, this project focuses on the role of insurance design and cost sharing. In terms of career development, this grant will support a training platform that will allow the candidate to reorient from behavioral health services research to acupuncture, pain care, and integrative health services research. An interdisciplinary mentorship team will oversee the following training goals: (1) Carefully review the research on the role of integrative medicine in comprehensive pain care, with a focus on acupuncture. (2) Develop an in- depth knowledge of the role of insurance coverage in pain care and identify empirical strategies to study how insurance design affects acupuncture use. (3) Learn how to conduct qualitative research that complements the candidate's strengths in health economics and claims-based research. (4) Build a knowledge base in interventional study design to propose a follow-up study that involves insurer-driven randomized trials that test whether alterations to insurance design affects the use of acupuncture. Through the training and research activities proposed in th...