Reflections on the Duke Integrated Pain Management Conference

By: Adam Seidner, M.D., M.P.H., CMO, The Hartford

On February 5th I participated in the Implementing Integrated Pain Management: Lessons from North Carolina Health Systems and Beyond conference at the Duke-Margolis Center for Health Policy. Participants came together to identify the current operational, financial, and regulatory barriers to and strategies to Integrated Pain Management (IPM) and develop strategies to overcome them.

About two dozen leaders bringing important stakeholder perspectives were in attendance to focus on North Carolina and beyond. The Alliance to Advance Comprehensive Integrative Pain Management was well represented with participation from many of its leaders and advisors. To give an idea of the breadth of the attendees, there were representatives from Duke University School of Medicine, Veterans Health Administration, Defense & Veterans Center for Integrated Pain Management, U.S. Pain Foundation, Stanford University School of Medicine, AmeriHealth Caritas North Carolina, North Carolina Medical Society Foundation, National Center for Complementary and Integrative Health, and many others. Those in attendance did not shirk their responsibility and they identified the ways to gain a better grasp on pain management.

The meeting goals were to identify principles and describe components of Integrated Pain Management programs; discuss challenges with implementing and expanding these models; and describe the factors that models must address to be successful and sustainable from a business perspective.

Overall, it was an excellent meeting bringing many stakeholders together to discuss various obstacles to delivering Integrative Pain Management. We reviewed Best Practices of Integrated Pain Management and what problems need to be solved. It was acknowledged that the prevailing approaches to musculoskeletal pain management are often unimodal, favoring pharmacological and procedure-oriented care to address the biological causes or contributors to pain. There is a need to recognize pain as a biopsychosocial condition with emotional, mental, behavioral, and biological components.

Common goals of IPM programs are to improve quality of life, manage pain, and optimize an individual’s function. Patient-centric models include building self-management techniques, managing comorbid conditions, and ensuring adherence to evidence-based practices.

Many medical disciplines manage chronic pain, including primary care providers, lack advanced training in the biopsychosocial model of pain management. In addition, clinicians are not properly trained to address cultural issues, biases, and their own beliefs about pain and IPM. There are cultural stigmas around pain and an underestimation of the magnitude of the problem and its impact on patients and their families.

Conference participants noted that evidence is needed to help patients avoid ineffective and unsafe treatments and ensure their safety. While non-pharmacologic pain management strategies may lower health care costs, providers need evidence to help them develop best practices. Reducing financial barriers to IPM care will be advanced by establishing a financial model that can support IPM modalities.

Health care organizations need to understand the potential costs of developing an IPM program. The group agreed that we need to find a way to pay for IPM services but payment for IPM services may not necessarily be the same for each program or modality. A mixed payment model is likely needed to ensure all services are properly reimbursed. While a bundled payment may cover the majority of services, underutilized services may require a fee-for-service reimbursement to ensure that its utilization is appropriate.

Overall, we should be encouraged that so many stakeholders have come together and are interested in how to move IPM forward. Partnerships between payer organizations and providers is necessary to explore the feasibility of alternative payment models. Providers should take into consideration their patient’s preferences and attitudes regarding various nontraditional treatments. Management can then be tailored to increase the likelihood of successful patient-centric pain management.

The Alliance to Advance Comprehensive Integrative Pain Management (AACIPM) will continue to work with stakeholders to answer many of the questions raised during the conference and find solutions to eliminate barriers to effect care. To that end, AACIPM is excited to welcome the Duke-Margolis Health Policy team that implemented this Roundtable meeting to participate in AACIPM’s Pain Policy Congress on May 13-14, 2020. This invitation-only meeting will convene key stakeholders, 100-125 leaders from 75 organizations and agencies, to level-set around this care and focus on action steps around shared priorities to advance quality pain management that keeps people with pain at the center of the model.