An Integrated Approach to Chronic Pain

Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health,¹ demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.

Since 2012, Rhode Island Medicaid "Community of Care" enrollees suffering from chronic pain have participated in an integrated chronic pain program administered by Advanced Medicine Integration. Longtime readers will recall that for nearly two decades, AMI has been coordinating chiropractic and integrated care services in various states to help address the chronic pain epidemic in a community-based, integrated fashion.^2-3

AMI's integrated chronic pain program is designed to "reduce pain levels, improve function and overall health outcomes, reduce emergency room costs, and through a holistic approach and behavioral change models, educate members in self-care and accountability."

The program features holistic nurse case management with referrals to CAM providers including chiropractors, massage therapists and acupuncturists; and patient education including stress-reduction tips and more.

According to AMI, Community of Care enrollees "have significant economic challenges as well as bio-psycho-social disorders." CoC enrollees, as might be expected, tend to make more visits to emergency rooms compared to other patients.

Here are some of the key findings from the pilot program thus far (2012-2015), showing average per-enrollee improvements post-referral into the AMI integrated chronic pain program compared to pre-referral for enrollees with at least 12 months pre-referral data and 12 months post-referral data. Note that these improvements are also significant compared to the control group, consisting of CoC members who did not enroll in the AMI chronic pain program.

• Rx Scripts: Prescriptions declined from a whopping 70.42 pre-referral to 25.97 post-referral.
• Opioid Scripts: Opioid prescription use declined from 7.69 pre-referral to 1.10 post-referral.
• ER Visits: Emergency-room visits, a major issue for CoC enrollees, declined from 7.57 visits pre-referral to 2.98 visits post-referral.
• Total Claims Costs: Average pre-referral claims costs approached $20,000 ($19,456.59) per enrollee pre-referral; post-referral, claims costs declined to $14,150.76, including CAM costs.
• Patient Satisfaction: According to a third-party survey of program participants, 92 percent "agree or strongly agree their CAM provider reduced their pain level"; 82 percent "believe their quality of life has improved by participating"; and 96 percent "would recommend the program to friends or family suffering from chronic pain or fatigue."

For background on AMI and the Rhode Island pilot program, read "Integrative Health Care for a Medicaid Population: Interview With Alan Post, DC," in our Aug. 15, 2013 issue.⁴ According to Dr. Post, the pilot program is ongoing and expansion beyond the initial patient population is under consideration.

References

1. Advanced Medicine Integration Group, L.P. Presentation to Rhode Island Department of Health, November 2016.
2. Vivo M. "Chiropractors as Primary Care Providers." Dynamic Chiropractic, June 4, 2007.
3. "AMI Model Working in Florida: Functional Improvements, Reduced Utilization Costs by Medicaid Patients." Dynamic Chiropractic, April 22, 2008.
4. "Integrative Health Care for a Medicaid Population: Interview With Alan Post, DC." Dynamic Chiropractic, Aug. 15, 2013; reprinted with permission from Health Insights Today, Nov/Dec 2012.