Agenda Item 9, Attachment 1 Page 1 of 31 Statewide Collaboration through Smart Care California: Low Back Pain Kathy Donneson Chief, Health Plan Administration Division Dr. Richard Sun Preventive Medicine and Public Health Physician Benefit Programs Policy and Planning March 14, 2017
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Agenda Item 9, Attachment 1 Page 1 of 31
Statewide Collaboration through Smart Care California: Low Back Pain
Kathy Donneson Chief, Health Plan Administration Division
Dr. Richard Sun Preventive Medicine and Public Health Physician
Benefit Programs Policy and Planning
March 14, 2017
Statewide Collaboration through Smart Care California: Low Back Pain | March 2017 Agenda Item 9, Attachment 1 Page 2 of 31
• Background
• Introducing Dr. Tobias Moeller-Bertram
• Lower Back Pain Findings
• Next Steps
Agenda
Statewide Collaboration through Smart Care California: Low Back Pain | March 2017 Agenda Item 9, Attachment 1 Page 3 of 31
Background
Low back pain is the single leading cause of disability worldwide
Global Burden of Disease 2010
Spine pain care accounts for $90 billion in direct cost annually in the US
Stanford Clinical Excellence Research Center
Statewide Collaboration through Smart Care California: Low Back Pain | March 2017 Agenda Item 9, Attachment 1 Page 4 of 31
Background | Low Back Pain (LBP)
Common and costly for CalPERS
$106.6 million in 2015
Smart Care California Prevent progression of acute LBP to chronic pain and disability
Introducing Dr. Tobias Moeller-Bertram
Dr. Toby Medical Director Desert Clinic Pain Institute
Agenda Item 9, Attachment 1 Page 5 of 31
CHRONIC LOW BACK PAIN: A Whole Patient Problem….
Requiring A Whole Patient Solution....
Tobias Moeller-Bertram, MD, PhD, MAS Desert Clinic Pain Institute
March 14, 2017
Agenda Item 9, Attachment 1 Page 6 of 31
PERCEPTION Agenda Item 9, Attachment 1 Page 7 of 31
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Agenda Item 9, Attachment 1 Page 8 of 31
CHRONIC VS RECOVERED BRAIN CIRCUITS
Visit 1 Visit 2 Visit 3 Visit 4
Apkarian 2013 data (Hashmi JA et al., "Shape shifting pain...")
Chronic
Recovered
Agenda Item 9, Attachment 1 Page 9 of 31
BEST TREATMENT MODEL? Agenda Item 9, Attachment 1 Page 10 of 31
Historically, management of patients’ pain was addressed by individual health care providers, usually a physician. However, the presence of pain affects all aspects of an individual’s functioning. As a consequence, an interdisciplinary approach that incorporates the knowledge and skills of a number of health care providers is essential for successful treatment and patient management.
Agenda Item 9, Attachment 1 Page 11 of 31
Interdisciplinary care involves the execution of the treatment plan concurrently. That is, disciplines involved in care will be engaged in parallel and in collaboration and not sequentially whenever possible.
The availability of interdisciplinary care is not solely the responsibility of team members, all stakeholder (institutions, people with pain, referring clinicians, and payers) need to support, encourage, and demand a comprehensive approach to pain management as it is in all of their best interests.
Agenda Item 9, Attachment 1 Page 12 of 31
• Although there are perceptions that opioid therapy for chronic pain is less expensive than more time intensive non-pharmacologic management approaches, many pain treatments are associated with lower mean and median annual costs compared with opioid therapy.
• Multimodal therapies and multidisciplinary bio-psycho-social rehabilitation-combining approaches (e.g., psychological therapies with exercise) can reduce long-term pain and disability compared with usual care and compared with physical treatments (e.g., exercise) alone.
Drug Abuse Screening Test-10 Alcohol Use Disorders Identification Test
CLINICAL OUTCOMES – SUBSTANCE USE Agenda Item 9, Attachment 1
Page 21 of 31
COST TRENDS OF COHORT
• Out of the 79 patients on both Adjusted Clinical Group (ACG) reports given by IEHP:
– 43 patients (54%) had a decrease in the Probability of High Total Cost.
– 34 patients (44%) had an increase in the Probability of High Total Cost.
– 2 patients (2%) remained the same.
Probability of High Total Cost
Increased
44%
Unchanged
2%
Decreased
54%
Agenda Item 9, Attachment 1 Page 22 of 31
$36,817
$19,671
$0
$10,000
$20,000
$30,000
$40,000
Pre-intervention Post-intervention
Total Cost of Care• 65 Total Members • Total Cost of Care = All claims (Rx and
Medical)
• Pre-intervention = 12 months before intervention
• Post-intervention = 6 months after intervention
• Intervention = Member engagement with COE
COST ANALYSIS Agenda Item 9, Attachment 1
Page 23 of 31
Vision: Ensure that members utilizing a high-level of opioids and suffering from severe, refractory chronic pain will receive a comprehensive, integrative and holistic treatment program focused on promoting patient self-efficacy, functional restoration, and wellbeing.
Goal: Develop a network of Pain COEs building on Desert
Clinic Pain Institute Model
IEHP'S APPROACH TO SCALING PAIN COES: TOTAL PAIN CARE (TPC) PROGRAM
COE = Center of Excellence IEHP = Inland Empire Health Plan
Agenda Item 9, Attachment 1 Page 24 of 31
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Desert Clinic Pain Institute
Agenda Item 9, Attachment 1 Page 25 of 31
COE sites will be evaluated on cost, utilization, patient outcomes and program engagement:
1. Cost Analysis/Return on Investment (ROI)
Total medical costs including pharmacy, facility, professional and cost of COE program