Spine Pain Care

In 2016, the national expenditure for low back and neck pain (spine pain) approached $380 billion. As expenditures have soared, patients with such pain report worse physical and social function, mental health, and ability to work. Overall, we are spending more and getting much less. CERC is seeking to identify a higher-value method of care delivery that lowers national healthcare spending and improves outcomes for patients with spine pain. 

Projects and Outcomes

Using a modified version of the validated STarT Back risk assessment tool, our team focused on three main addressable challenges in the current care of spine pain and recommended solutions:

  1. Spine pain patients are often over-treated, considering that 90% of improve spontaneously. Solution: Immediately triage patients at low risk of chronic spine pain into conservative care to prevent overtreatment of self-limited pain.

  2. Patients at high risk for chronic pain do not receive needed biopsychosocial treatment. Solution: Coordinate care for patients at high risk of chronic spine pain into a high-touch care pathway that addresses both physical and psychosocial risk factors.

  3. Care is disorganized and does not follow guidelines. Solution: Support patients and providers via shared decision-making tools for preference-sensitive procedures and decision-support aids during physician order entry.

A national clinical trial is underway in 32 clinics across Houston, Los Angeles, Phoenix, and Nashville. Blue Shield of California plans to incentivize adoption in California.


The pilot study found that patients reported meaningful levels of  improvement across all four key outcome measures: pain level, health status, disability and patient's sense of self-efficacy in managing their health problems.