Consumers more and more are trying to take control of their own healthcare destinies. They are looking for more therapy alternatives so they can better manage their healthcare dollars.

"Patients are being thrust into the role of healthcare deciders," says William J. Lubin, DrPH, president and CEO of American WholeHealth Inc. "They are determining not only what kind of services they get and where they get those services, but they are also taking more financial responsibility for them."

With more of that responsibility falling to consumers, many managed care organizations are realizing that they must offer choices that until recently were not considered to be in the mainstream of healthcare coverage.

CAM benefits were once considered rare but are now becoming expected in the eyes of a public that is sometimes frustrated by the traditional healthcare delivery system. This means managed care plans should consider offering these benefits or risk losing members.

CAM, a $30 billion-a-year field, is defined as a group of diverse medical and healthcare systems, practices and products that are not considered to be part of conventional medicine.

According to the National Center for Complementary and Alternative Medicine (NCCAM), an agency of the National Institutes of Health, CAM services include prayer, natural products, deep breathing exercises, diet-based therapies and yoga. The most common CAM services are chiropractic, acupuncture and massage therapy.

A survey last year shows the growing popularity of CAM services.

Thirty-six percent of U.S. adults age 18 and older use some form of CAM services, according to the NCCAM survey. When prayer specifically for health reasons is included in the definition of CAM, the number of U.S. adults using some form of CAM rises to 62%.

"The findings confirm the extent to which Americans have turned to CAM approaches with the hope that they would help treat and prevent disease and enhance quality of life," said Stephen E. Straus, MD, director of NCCAM.

Employers, too, are increasingly eager to cover CAM services because of growing evidence that it helps reduce employee medical utilization and the overall costs of healthcare.

In a study released in October 2004 in the Archives of Internal Medicine, employees with chiropractic coverage had 41% fewer hospitalizations for back pain than employees without chiropractic coverage. They also had 32% fewer back surgeries and significantly lower utilization rates for CT/MRI scans and X-rays than employees without chiropractic coverage.

CONSUMERS DRIVE THE MOVE CAM services are more popular in some parts of the country than others. In some states, legislative bodies mandate CAM services. In the Pacific Northwest, for example, massage therapy and acupuncture have to be part of a benefits plan, while chiropractic services are mandated in 46 states.

Without question, consumers are the driving force behind the increasing popularity of CAM services.

"CAM has become part of the healthcare system because consumers have made it part of their personal healthcare system," says George DeVries, president and CEO of American Specialty Health, an administrator of CAM benefits. "If you survey most Americans, they will talk about their medical doctors and their hospitals, but they will also talk about massage therapy and their chiropractor."

Many patients have used some type of CAM service extensively for years. Now, they want those services to be coordinated with their overall healthcare plan.

"Consumers are spending money on these services, while also spending money on the traditional healthcare services," says Lubin, whose company manages networks of CAM providers and administers CAM benefits for health plans.

As with any form of medicine, CAM services are not for everybody. However, for a growing number of consumers they have become the preferred therapy.

"What we see is that a sizable percentage of [healthcare consumers] put their personal health into their own hands," said Edward J. Sondik, director of the National Center for Health Statistics.

For example, more patients with back pain are turning to massage therapy or chiropractic practitioners rather than going to a physical therapist or asking their physician for a prescription for pain killers.