Spine Pain Care Model

National expenditures for back and neck pain have soared while patients with such pain report worse physical and social function, mental health, and ability to work. The prevalence of disability attributed to spine pain is also on the rise, as are deaths related to overdose of prescription opioid medications.  Overall, we are spending more and getting much less.

Given this unsustainable trajectory, CERC sought to identify a higher-value method of care delivery that lowers national health care spending and improves outcomes for patients with spine pain. Using a modified version of the validated STarT Back risk assessment tool, the team focused on three main addressable challenges in the current care of spine pain and recommended solutions.

·      Challenge:  Spine pain patients are often over-treated, considering that 90% of spine patients improve spontaneously.

        Solution: The immediate triage of patients at low risk of chronic spine pain into conservative care to prevent overtreatment of self-limited pain.

·      Challenge: Patients at high risk for chronic pain do not receive needed biopsychosocial treatment.

        Solution: Coordination of care for patients at high risk of chronic spine pain into a high-touch care pathway that address both physical and psychosocial risk factors.

·      Challenge: Care is disorganized and does not follow guidelines.

        Solution: Support for patients and providers via shared decision-making tools for preference-sensitive procedures and decision support aids during physician order entry.

Conservative forecasts show the care model could result in a net reduction in per capita spending for spine pain by 25%, or $21.5B in direct care costs. Taking into account lost productivity, savings could grow to over $70B annually.

Team: Sierra Matula, MD, MSHS, Lawrence Huan, MD, Arthur Wood, MD, Terry Platchek, MD, Donna Zulman, MD, MS, Arnold Milstein MD, MPH