September 18, 2017
Musculoskeletal pain affects more Americans than diabetes, heart disease, and cancer combined. More than 100 million Americans suffer from chronic pain, according to the Institute of Medicine of The National Academies,1 and the annual incremental cost of health care due to pain ranges from $560 billion to $635 billion in the United States, according to the American Pain Society.2
Treating this pain can be expensive and, too often, ineffective. Only 5 percent of people suffering from back pain need surgery,3 and up to 80 percent of the people who had surgery have a reoccurrence of back pain within two years of first reporting the problem.4 Diagnostic imaging is increasing, but less than 1 percent of all imaging scans find the problem. The Journal of Orthopedics & Sports Physical Therapy notes that the rate of lumbar spine magnetic resonance imaging in the United States is growing at an alarming rate.5
As the requests for imaging have increased, so have the use of opioids. In 2012, 259 million prescriptions were written for prescription opioids—enough for every adult American to have his or her own bottle.6
And the result has been an expanding opioid epidemic.
Since 1999, the rate of overdose deaths involving opioids nearly quadrupled. According to the CDC, 60 percent of all drug overdoses are opioid-related.7
“Providers often order imaging studies to justify narcotic prescriptions; further concern is that imaging overutilization, meaning redundant and excessive testing, will result after ‘work-ups’ are completed by primary care physicians and often again by orthopedists and other specialists,” said Mitchell Ceylan the vice president of clinical program development and management at HealthHelp.
What’s needed is a new approach to pain management: a multidisciplinary approach.
A Multidisciplinary Approach
Traditionally, the health plan approach to managing treatment options and utilization management has been procedure-driven. A multidisciplinary approach to pain management is protocol-driven. It starts with an assessment request by the physician, has guidelines for treatment, a rules engine, and provider communication. This approach implements and expands the current program to a more comprehensive and integrated musculoskeletal program that improves patient care and outcomes.
This protocol-driven program design has the following components:
- Risk assessment via an algorithm for cervical and lumbar pain that uses The Oswestry Disability Index
- Diagnostic imaging
- CT, MRI
- Medical management
- Arthroplasty, laminectomy, discectomy, and so forth
- Knee, hip, shoulder, wrist
- Physiological treatment
- PT, OT, yoga, aquatics, stretch, and so forth
- Patient education
- Behavioral and psychological support
By implementing a multidisciplinary and integrated musculoskeletal program, health plans have the following opportunities:
- Identify high-risk patients early and send them to early interventions (medical versus surgical intervention)
- Identify low-risk patients and ensure they participate in alternative therapies, medical management, and so forth
- Identify appropriate multidisciplinary treatment pathways (i.e., PT/OT with joint injection)
- Reduce redundant diagnostic procedures (including eliminating repeat studies and helping to ensure study success)
- Identify opioid addiction in prescription patterns
For payers, this approach offers decreased downstream complications and emergency-room visits and reduced redundant imaging and unnecessary and repeat procedures.
Health plan members get the benefits of reduced unnecessary radiation exposure and reduced unnecessary downstream follow-up treatments and procedures. Also, they benefit from improved diagnoses accuracy through appropriate testing and the potential to identify prescription or illicit drug abuse and gain an opportunity for recovery.
Providers, meanwhile, benefit from the opportunity to collaborate with other physicians on the best tests and procedures for their patients, to help ensure optimal outcomes.
A Path to Reduced Opioid Abuse
Another benefit of this approach is the opportunity to decrease opioid dependence.
Reducing unnecessary and repeated pain-imaging scans can help reduce opioid dependence through identifying plan members who have had imaging performed by primary-care physicians without new clinical diagnoses. If a patient is “doctor shopping” through receiving multiple pain-imaging scans from various doctors, this approach notifies the ordering physicians of the patient’s behavior and recent scans, which can encourage the provider to withdraw the scan request.
The multidisciplinary, collaborative approach is HealthHelp’s approach to musculosketetal benefit management. The company’s comprehensive pain and musculoskeletal program provides a fully integrated pain, spine, musculoskeletal, and orthopedic implant program for managing chronic pain and bone and joint health. Outcomes from HealthHelp’s pain and musculoskeletal program include the following:8
- Over 400 percent ROI.
- Over 12 percent of spine surgery requests withdrawn after consultation.
- Increased appropriate use of physical therapy with proven improvement in patient outcomes.
- Significant overall decrease in surgical interventions and implants.
- Greater consumer engagement via effective member-centric health and wellness and incentive programs.
- Specific decrease in low-back pain-related spinal interventions.
- Improvement in quality and safety for members thus qualifying for 85 percent MLR requirement under ACA law.
Minimize Pain and Abuse
The current approach to assessing and treating musculoskeletal pain is ineffective—and it has resulted in an opioid epidemic.
HealthHelp’s multidisciplinary approach, including an assessment, guidelines for treatment, a rules engine, and provider communication, has a proven effect on minimizing pain and minimizing abuse.
Further, HealthHelp’s collaborative approach works with members’ physicians to determine the best form of diagnosis or treatment—a method highly preferred by network physicians at payer health plans that meanwhile saves payers valuable health care resources.
For more information, visit healthhelp.com/pain-management/ or contact HealthHelp at 800-405-4817.
1 “Relieving Pain in America,” The National Academies of Medicine, 2011. https://www.nap.edu/read/13172/chapter/2
2 “Chronic pain costs U.S. up to $635 billion, study shows,” Science Daily, September 11, 2012. https://www.sciencedaily.com/releases/2012/09/120911091100.htm
3 “The truth about back surgery,” Good Housekeeping, October 14, 2009. http://www.goodhousekeeping.com/health/a18687/back-pain-surgery/
4 “Acute low back pain,” Michigan Medicine, University of Michigan, January 2010. http://www.med.umich.edu/1info/FHP/practiceguides/back/back.pdf
5 “Appropriate use of diagnostic imaging in low back pain: A reminder that unnecessary imaging may do as much harm as good,” Journal of Orthopaedic & Sports Physical Therapy, 2011. http://www.jospt.org/doi/full/10.2519/jospt.2011.3618?code=jospt-site
6 “Opioid painkiller prescribing,” Centers for Disease Control and Prevention, July 2014. https://www.cdc.gov/vitalsigns/opioid-prescribing/
7 “CDC guideline for prescribing opioids for chronic pain – United States, 2016,” Centers for Disease Control and Prevention, March 18, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
8 “Comprehensive Pain and Musculoskeletal Program: Including Spine and Orthopedic Implant Management,” HealthHelp. http://www.healthhelp.com/pain-management/