Exempla Lutheran Medical Center, UnitedHealthcare and Anthem Blue Cross and Blue Shield have announced a pilot program focused on improving the treatment of back pain for Coloradans. The Colorado Low Back Collaborative (CLBC) pilot program is among the first of its kind in the nation and seeks to improve health care quality for patients and also lower costs.
The program will encourage physicians to explore all treatment options medically indicated and available to patients experiencing back pain, rather than immediately recommending surgery. The program leverages an innovative, evidence-based “decision tree” developed by the participating physicians that outlines optimal care processes, sequencing and timing of medical intervention to treat patients with back pain. The program also features a unique financial model that includes a “care management” fee paid to physicians to offset the additional administrative costs associated with providing more comprehensive and coordinated care for each patient. The program will involve more than 500 patients and 35 primary care physicians belonging to Lutheran Health Partners, a partnership between Exempla Lutheran Medical Center and its physicians. The pilot will run for up to 18 months and the results, based in part on patient outcomes, will be analyzed by the insurers and physicians.
“The evidence is clear that relief for low back pain is not always found at the end of a scalpel or in the operating room,” said Dr. Christopher Stanley, Senior Medical Director for UnitedHealthcare of Colorado, a UnitedHealth Group (NYSE: UNH) company. “Research has shown physical therapy and medication can often be better than surgery for treating many causes of back pain, often with fewer complications and lower expenses.”
Back pain affects tens of millions of Americans each year, according to the North American Spine Society (NASS). An independent national survey conducted by NASS found that 65 percent of adults experience back pain at least once a month. The U.S. currently spends almost $86 billion annually on treatments for spine problems, according to a study published in 2008 in The Journal of the American Medical Association.
Through the pilot, the participating physicians will receive an array of educational resources to help them evaluate treatment options for each patient. These educational resources have been developed based on numerous medical studies and guidelines recommended by physician-lead specialty organizations, including NASS. A component of the pilot also encourages patients to take a more active role in working with his or her physician to select the best treatment option available through the use of “shared decision-making tools,” which help patients understand the benefits and drawbacks of various treatments that might be medically appropriate.
A customized software program developed by Salvus Software, a Colorado-based health care software company, will be made available to the participating physicians, at their option, to help track and manage patients’ care in real time. After the completion of a patient’s care through the program, the physician will be eligible to receive a “care management” fee to offset the additional administrative costs associated with the program in relation to that patient.
Exempla Lutheran is participating in the pilot in part because it operates the Human Motion Institute (HMI), a leading orthopedic and spine care program located within Exempla Lutheran. Exempla Lutheran, through the Human Motion Institute, is designated as a Center of Excellence by The Joint Commission, a nonprofit organization that accredits health care organizations and programs.
“This is the start of our journey to improve patient care through the clinical integration of best practice evidence through a collaboration involving Exempla Lutheran Medical Center, physicians and health plans,” said Dr. Dave Munch, Chairman of the Board of Lutheran Health Partners. “This program gives physicians additional tools and options, with the goal of creating better outcomes for patients and lowering costs, through a whole-patient treatment model.”