Want an example of better care and lower cost? Read this report by Chereen Langrill, communications coordinator for SELECT Medical Network, in which she describes our efforts to improve care for patients with back pain in a way that saves them thousands of dollars by avoiding surgery when conservative measures will work just as well.
This report illustrates several of our strategies in practice: shared decision-making and patient-centeredness, team-based care, and care coordination. The Center for Spine Wellness is just one more way that St. Luke's is Taking Care Forward!
The purpose of the SELECT Medical Network of Idaho’s back program is to standardize a process of care for patients with back pain.
The program includes not only better standards for how people and providers can manage back pain — sometimes without a clinical visit – but also a focused resource that can apply subject matter experts when a higher level of care is needed. This focused resource is the Center for Spine Wellness, or CSW.
Idaho was identified as a significant outlier in the numbers of spine surgeries performed, and providers and local insurers agreed to study what was happening and attempt to identify the reasons.
CSW began as a pilot program to provide a coordinated, evidence-based and multidisciplinary team approach to managing back and neck care as an alternative when the group decided to create a center that could standardize a care process, measuring how well people and providers followed that process and, most importantly, ensuring that there was a defined way to follow meaningful outcomes in those patients that received care in more cost-effective ways.
The program initially received many referrals from area emergency departments, but now the bulk of patients seen and treated by the CSW are self-referred or referred by their employer or primary care provider. The CSW can see patients with back pain from a variety of sources, but its primary focus is to meet the needs of those patients that need extra help.
The CSW continues to refine the process for the conservative management of back pain. Dr. Vic Kadyan and Dr. Rodde Cox, two local physical medicine and rehabilitation physicians, lead this clinical integration initiative within SELECT. They head up a multidisciplinary work group, including participants from physical therapy, orthopedic and neurosurgery, occupational medicine, and primary care, focused on developing and implementing treatment recommendations, patient and provider education materials, and measurable standards.
The initial CSW site is located in Boise, but the center is expanding to cover southwestern Idaho with sites soon to be available in Magic Valley and in the western Treasure Valley. CSW standardized recommendations, treatment algorithms, patient education materials, and other tools are available for use in a provider’s office, and many of the educational materials and self-help tools will be available to people in their homes or workplaces.
In addition, patients may be referred (or may self-refer) for initial evaluation, development of a patient-centered care plan, measurement of meaningful outcomes, and further treatment and follow-up in partnership with referring providers.
Why is it important?
Back pain is fifth on the list of common reasons that cause people to see a physician. About 90 percent of adults experience back pain in their lives. Back injuries are the top reason for a work-related claim, and half the working population experiences back pain each year. These national statistics are consistent within Idaho.
What’s the challenge?
Back pain is a very personal thing. No one wants to be in pain, and having back pain affects a great deal of people’s lives. It is difficult to walk or go about normal activity when every movement causes pain.
Because of this, and because people in our region are used to managing back pain with medical intervention, the culture in our region seeks medical attention earlier and at a higher intensity than in other areas of the country.
Our challenge is to transparently address needs concerning the management of back pain in a way that is effective yet efficient. And we have many stakeholders to convince that we can demonstrate that there is a better and safer way of bringing this value to people in our region.
What’s the goal?
CSW continues to grow, with projected patient volumes increasing to more than 150 new patients monthly for the next fiscal year. As communication of the success of the pilot phase occurs, we expect to see additional involvement from other providers and employers.
Data collection to measure outcomes from treatment, including regular physical and mental component scores, will continue, and we are working with our payer partners to obtain data concerning the value that this program brings to participants. As the center grows and patient volumes increase, this data will be used to modify treatment guidelines to further develop care.
How will it make a difference for patients? What changes will they see?
Patients will eventually choose their preferred delivery method. It might be an interactive web-based program that allows them to customize their symptoms, lifestyle, and other factors to help make an informed decision. For other patients, it may be an office visit that follows outcome-based treatment recommendations. Some patients ultimately still may need a surgical intervention.
Patients, working with their providers and using transparent outcome information, will see a clear path to a care management plan that best fits their needs through shared decision-making, and will see our efforts toward team-based care with providers working as a coordinated team.
What are the next steps?
A spine wellness symposium, scheduled for Oct. 5 in Boise, will familiarize providers with how to standardize patient care. Treatment recommendations and other helpful tools will be shared with SELECT providers at the symposium and will soon be available electronically.
The symposium is also the official kickoff of the clinical integration program, and gives providers an opportunity to learn more about the initiatives and goals that are part of our efforts toward clinical integration, such as shared analytics and shared decision-making.
Like clinical integration itself, the back program aims to align providers and insurers across Idaho in order to provide better care. In May, the Center for Spine Wellness was recognized by the Blue Cross of Idaho as a Center of Spine Excellence Program, affirming the program’s team-based approach to care as providers work together to find the best solutions for patients.
What’s the measure of success?
Patient data is the best barometer for success, and early data shows improvement in the standardization of back pain management.
In the first six months of 2013, the Center for Spine Wellness treated and conservatively managed more than 200 new patients using the new guidelines established through the initiative.
In addition to offering flexible yet standardized treatment recommendations, the center continues to measure patient outcomes through standardized and comparable tools such as the Short Form 36, which quantifies both mental and physical outcomes, and the Oswestry Disability Index, which follows patient functionality.
Finally, the center is focused on ensuring that its processes deliver value based upon outcomes and cost-effectiveness.
Editor’s note: This is the third installment of a 10-part series introducing clinical integration initiatives that St. Luke’s is involved in.
Clinical integration is a term used to describe health care providers working together in an interdependent and mutually accountable fashion to pool infrastructure and resources. By working together, providers develop, implement and monitor protocols, “best practices,’ and various other organized processes that enable them to furnish higher quality care more efficiently than could be achieved working independently.
St. Luke’s Health System is a participating provider in the SELECT Medical Network of Idaho, Inc. SELECT is a network of healthcare providers in southwest Idaho that is focused on a coordinated model of care delivery focused on providing enhanced quality and better value to individuals, employers, and insurers.
In keeping with the clinical integration effort, 10 initiatives were developed for 2013 to help establish the standards of enhanced quality meant to help create a new vision for health care.
The initiatives are:
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.