Coordinated Care in Health Systems
It’s Time to Make it the Norm
Chronic pain is a massive problem in the United States, affecting one in five adults. Given the scale, treating chronic pain effectively should be a top priority for health systems. However, most systems do not offer diverse options for care that are proven effective.
This gap disadvantages patients and ultimately increases cost. In a new policy paper, the Center for Innovation and Policy (CHIP) at Northwestern Health Sciences University offers recommendations for health systems to implement innovative, coordinated care models that improve care and reduce cost.
The U.S. Chronic Pain Problem
One in five adults’ reports having chronic pain. * It is likely that every American knows someone experiencing reduced quality of life, opioid dependency, or depression and anxiety due to pain. Nationally, chronic pain accounts for $560 to $635 billion in direct medical costs, lost productivity, and demand for disability programs. Specifically, spinal pain is the largest contributor to healthcare spending among 154 health conditions.
The conventional management of neck and back pain is not only disjointed, it exacerbates the problem. Systems commonly employ low-value diagnostic and treatment procedures that contribute to the high cost of care without showing meaningful results. Lack of coordinated care in our health systems can lead to delayed use of guideline-concordant interventions. This increases cost and risk of chronicity.
Complementary and Integrative Healthcare for Chronic Pain
It is widely accepted that conventional management of common neck and back pain is not ideal and that evidence-based complementary and integrative healthcare (CIH) interventions should be used to treat pain. The American College of Physicians, VA, and Department of Defense, and the CDC all recommend CIH interventions—including chiropractic care, acupuncture, and massage therapy—for back pain.
Hospitals are required to provide non-pharmacologic pain treatment modalities in compliance with Joint Commission standards.
The Solution: Coordinated Care in Health Systems
Given the strong evidence against conventional pain management, and for CIH interventions, the solution is clear. We must integrate chiropractors, acupuncturists, massage therapists, and other CIH providers into health systems. Increasingly, this is happening. As CIH providers enter hospitals, health systems, VA medical centers, and community health centers, the research backs them. Advantages include:
- Effective Pain Management: Hospitals incorporating massage therapy and acupuncture have reported improved pain management and decreased anxiety in post-operative, cancer, and emergency department patients.
- Coordinated Care: Including CIH providers in health systems facilitates communication with the potential to both improve clinical outcomes and increase patient satisfaction.
- Right Provider for Right Service: Utilizing CIH providers is also shown to decrease wait times and help triage care, allowing specialists to put their focus where it is needed most.
- Decreased Total Cost of Care: Implementing services from licensed acupuncturists, massage therapists, and chiropractors reduces total costs of care, and would better position health systems in alternative payment models with private and public insurers.
The Barriers to Implementing Successful Care Models
With research this strong, what is holding health systems back from implementing effective coordinated care models?
Illogical financial incentives encourage the use of expensive diagnostic tests and treatment procedures that are often of low therapeutic value. Insurance coverage gaps, high co-pays, and artificial restrictions on visits discourage patients from using CIH interventions.
In addition, health system administrators and physicians may be unfamiliar with the training and scope of practice of CIH providers. This may create apprehension and reluctance to refer patients who might otherwise benefit from non-pharmacologic therapies.
Looking to the Future: Innovative, Effective Systems for All
In Minnesota and the surrounding region, we are seeing cause for optimism. Allina Health, Hennepin Healthcare, Fairview Health, Essentia Health, and other organizations have incorporated CIH providers on-site in hospitals and clinics, signaling that the future of healthcare will be integrative. Still, availability does not meet current needs or address the growing burden of health caused by spinal pain.
The utilization of CIH services continues to increase and expand into new settings. Health systems and other organizations have opportunities to implement innovative care models that improve care and reduce cost. NWHSU strongly supports this movement. You can read our full list of recommendations in our policy paper: Incorporating Integrative Health Providers in Health Systems.