ACO's Should Redirect Their Focus on Chronic Pain

Despite being the number one reason why people see their doctor, pain remains the “ugly step-child” to diagnoses like heart disease and cancer. Pain has always been considered just an annoying symptom of some more important problem like cancer, or arthritis, or coronary artery disease, or a disc herniation. Cure the anatomic problem and the pain resolves, as the thinking goes.

But, chronic pain is a disease itself, and a big and expensive one at that. Globally, 76.2 million people suffer from chronic pain due to permanent damage from previous injury or illness.  Pain affects more people than heart disease, diabetes, and cancer combined. Additionally, the annual cost of chronic pain in the United States, including healthcare expenses, lost income, and lost productivity, is estimated to be well over $100 billion. Furthermore, when pain is misdiagnosed and mismanaged, and I am sad to say that it often is, the stakes climb even higher and lives are lost. Last year, more than 16,700 Americans died of opioid overdose, and the costs of opioid abuse rose to more than $10 billion.  

These facts present a massive opportunity for any ACO to prove the value of population health principles by saving lives and saving money. While the transformation of America’s healthcare system will require thoughtful contribution and innovative thinking, a careful focus of energy to arenas where value-based care is needed the most and outcomes can be easily validated will be paramount in establishing credibility for creative change. With the extensive number of sufferers and the staggering costs of mismanagement, chronic pain is low hanging fruit for ACO’s wanting to show significant economic value in their operational strategies. Analytics and predictive modeling are the cornerstone of all population health strategies. Because of this, the universality and costliness of chronic pain and pain treatment are begging to be in the spotlight of large medical group ACO’s.  

Statistically, valid care management is the core of the ACO value-based care model. As the reimbursement paradigm shifts from maximizing volume to enhancing value, identifying large groups of patients in financial, social, and health challenged situations is necessary to offset the costs of other patients with unavoidable high-cost factors. Where better to apply value-based care principles than with patients in pain. Chronic pain patients have traditionally found the health care system difficult to access and navigate and should experience dramatically improved outcomes through the care management paradigm. 

Value-based care principles including data acquisition, predictive modeling, patient engagement, and multi-disciplinary care teams serve as the basis for improving pain treatment and for reducing opioid prescribing and abuse by presenting more valid, non-pharmacological treatment options.  This will improve physicians understanding of opioids’ physiological impacts, and provide patients with greater communications and insights into the co-management of their pain. These principles applied to chronic pain management and the opioid epidemic would pay extreme dividends to patients, providers, ACO’s, and the entire US economy. 

Seven in ten Americans feel that pain research and management should be one of the medical community’s top priorities, and most providers agree that pain treatment needs to be advanced. However, up to this point, little systemic or systematic progress has been made. Today’s treatment of chronic pain is disjointed, fragmented, and anecdotal.  The data and analytics that good care management can provide would support improved pain treatment algorithms and enhanced outcomes. This would further transform chronic pain and opioid management from its current, very reactive state to proactive care allowing full advantage of better pain relief, less opioid misuse and abuse, less opioid deaths, and significant cost savings for all. 

Success requires vision and a plan of action. The most critical first step is making sure your leadership team is in synch with both the problem and the opportunity. Changing organizational posture, opinions, and policies toward chronic pain is a top-down challenge. Strong, coordinated support from the top will ensure the proper processes, time, and resources are committed to patient, staff, and physician buy-in to this costly issue. 

The steps toward change and improvement are clear but not always simple when it comes to chronic pain and the opioid epidemic. Every organization must identify its known problems within both its patient base and its provider panel. Collective analysis of those issues will help to determine an effective and systematic approach to resolution. That “win” alone sends a message throughout your organization that positive options do exist to address this problem. 

The next step is to harness the data.  Effective analytics will use your own historical data to chart a new path based on predictive modeling combined with analysis of cost-effective options. With strong data, you are now armed to address payers involved in your patient treatment/payment paradigm. 

In the end, organizations that underappreciate the relevance of pain as the important modern-day health problem that it is will fail to reach their operational and financial goals. Organizations that begin with a keen understanding of the right ways to treat pain and how poor pain management jeopardizes the high performance of their network will ultimately enjoy the improved cost, quality, efficiency, and patient satisfaction that they envisioned.