In a year-long Medicaid demonstration program in Rhode Island, acupuncture (along with other complementary care services such as chiropractic care and massage therapy) was offered to individuals with chronic pain and at least 4 emergency room visits in the previous 12 months. The program relied on a holistic nursing triage program that helped refer individuals to complementary services that may help better control their pain. The program resulted in an 86% reduction in opioid prescriptions and a 63% reduction in overall prescriptions. Further, the number of emergency room visits decreased by 61%, and the average total cost of care decreased by 27%. These findings suggest that implementing care using specialized triage staff can significantly improve pain outcomes, reduce reliance on prescription medication, reduce ER utilization, and reduce total healthcare spending.

In an Oregon-based Medicaid demonstration program, expanding Medicaid coverage of acupuncture for back pain increased utilization from 0.3% to 5.6%. However, this program also demonstrated that despite increased patient access to care, other structural barriers to implementation persisted, such as the administrative burden imposed on providers, which made reimbursement difficult. Further, those who utilized newly covered services were not representative of the general Medicaid population, underscoring the need for targeted interventions to minimize health disparities in care utilization and chronic pain burden.

Acupuncture is offered at several, but not all, U.S. Department of Veterans Affairs sites, with the full cost of care covered by the Veterans Choice program. In a single year of implementation, 185,000 acupuncture treatments were provided across the subset of “Whole Health” system sites. Implementing this program required a culture shift to ensure referrals to acupuncturists were taken up when appropriate. The successful adoption and scaling of the Whole Health system relies heavily on interprofessional training offered by the VA. These trainings are available at the local level and promote interprofessional knowledge to bolster familiarity with various treatment options and to boost provider confidence in using CIH approaches, including acupuncture, when appropriate. Research on the Whole Health model suggests that providers are satisfied with training, and as a result, CIH utilization has increased. This structural shift towards the Whole Health model was also supported by the VA’s Acupuncture Evidence Map, which helped to communicate treatment efficacy and appropriateness to VA providers. Further evidence demonstrates that veterans engaged with CIH approaches were able to significantly reduce opioid intake relative to those who did not engage with CIH care.

Acupuncture is also becoming more widely available at Federally Qualified Health Centers across the United States, which serve underserved communities that may otherwise face financial or other structural barriers to treatment.

More recently, the integration of acupuncture services into an acute care setting, such as an emergency department, has demonstrated feasibility, acceptability, and patient satisfaction, alongside meaningful improvements in acute musculoskeletal pain outcomes.

Integration of acupuncture across these care delivery settings is an example of implementation that effectively broadens access for medically underserved populations and serves as a model for broader adoption in additional settings.

In one study examining the implementation of an inpatient acupuncture service to treat pain, it was reported that some providers and care recipients lacked an awareness of acupuncture as a pain management option, particularly when to introduce acupuncture into the treatment regimen. This study emphasizes that while there may be interest in integrating acupuncture services, adequate educational resources are essential for implementation. Care recipients and providers need to know when acupuncture may be an appropriate treatment option and how to refer or access acupuncture services. Client-facing educational materials may include written or visual information guides that succinctly describe when acupuncture may be appropriate. Provider-facing educational materials should emphasize the evidence base for acupuncture and interprofessional training to support confidence in referring to and communicating with acupuncture providers.

Acupuncture can be delivered in limited ways through telehealth services. Acupuncturists are trained to help virtually evaluate health needs, discuss integrated pain management options including pharmaceutical interventions and lifestyle changes, and counsel individuals on self-administering needless acupuncture, also referred to as acupressure. The practice of acupressure involves applying pressure to specific points of the body to elicit similar therapeutic benefits without the need for a physical acupuncturist or sterile medical equipment. Further research is needed to better understand efficacy and compare it with face-to-face acupuncture, but the format of care delivery shows promise for adapting acupuncture methods to improve access to care via telemedicine.