CIPM Practice Examples
Repository of Resources Concept (this will evolve through additional stakeholder input)
The Alliance to Advance Comprehensive Integrative Pain Management (AACIPM) is a multi-stakeholder collaborative, bringing together views and expertise from important constituents of the pain care community – healthcare providers, people with pain, public and private payers, purchasers of healthcare, government agencies, federal medicine, policy experts, policy makers, non-governmental organizations and patient/caregiver advocates. Our country is in a time of change and innovation in pain management, as many stakeholders are responding to an increeased emphasis on providing safe, high-quality, evidence-informed, individualized pain care.
As efforts to combat opioid misuse and overdose continue, we must not overlook the fact that some of the roots of the opioid epidemic lie in inadequately managed pain. Today, 50 million Americans suffer from untreated pain, half of whom are living with pain that significantly impairs their ability to go about their daily lives. This includes over 22 million people who are still employed and trying to manage their symptoms. Chronic pain negatively affects a person’s quality of life, and has also been shown to impact social environments and mental health. Patients need access to safe and effective treatments to manage their pain.
Comprehensive Integrative Approach to Pain Management
The focus of comprehensive integrative pain management (CIPM) is to bring together the evidence-informed practices in conventional medicine with the evidence-informed practices of integrative health and medicine, using them in a complementary and integrative manner that considers both the best available evidence and the values of the person with pain. Often, we see pain management bifurcated with a focus on only one part of the full toolbox of treatments (e.g., non-pharmacological versus pharmacological). There are millions of people living with acute, subacute and chronic pain and the exact same approach is not appropriate for everyone. We must coalesce around a common foundation for the evidence-based and value-driven options needed for a comprehensive and whole-person focused approach to pain management.
There is wide agreement that a person-centered and coordinated approach to pain management is the best kind of care. This approach makes the best possible use of a range of evidence-based treatment options such as physical therapy, acupuncture, cognitive behavioral therapy, nerve block injections, massage therapy, medications, and chiropractic and osteopathic manipulation. Shifting the treatment approach from one that relies heavily on a compartmentalized view of the person with pain to an individualized solution will result in better outcomes for people living with pain.
Why Do We Need a Repository of Clinical Examples?
There is not a resource we have found that includes a comprehensive compilation of clinical examples of pain management that are focused on evidence-based and value-driven care.
One of the keys to expanding access to quality pain management is a consensus on how to define or measure effective pain care—especially its impact on overall function, sleep, mood, stress, and activity. More clarity is required about the causes and mechanisms of chronic pain, and what outcomes define successful prevention and treatment.
There is a demand for a larger and more readily accessible toolbox of high quality, affordable, low risk, whole person-focused and evidence-based options for pain management. There is also demand from many stakeholders looking for this approach to care to understand where it can be found and specific details about how it is being provided, such as insurance coverage, value-based payment models, patient-reported outcomes measurements, outcome data, tools used for care planning (e.g., risk stratification), core competencies of healthcare providers involved, use of telehealth services, and more. This gathering of resources would answer many questions and build awareness about an evidence-informed comprehensive integrative approach to pain management.
How Will AACIPM Develop This Repository?
Recognizing the lack of a consensus model, AACIPM will gather information through surveys and discussions among its participating organizations. AACIPM will convene a workgroup of expert stakeholders to create the initial plans for repository infrastructure while also determining the cost and feasibility for this significant undertaking. There must be strong agreement across the engaged stakeholders—people with pain, health care providers, public and private payors, purchasers of healthcare, government agencies, federal medicine, researchers, patient/caregiver advocates, policy experts and policymakers – that this repository is needed and useful.
What is the Concept for This Repository of Clinical Practice Examples and Other Relevant Resources?
Our concept is to create a repository of clinical practice examples illustrating existing ways to deliver comprehensive, interdisciplinary, multimodal, integrative pain care. As available, this repository will include information about structure, function, core competencies of healthcare providers, outcomes, and coverage, to inform stakeholders about different existing models. Qualitative analysis of the information gleaned in this process will be undertaken with the goal of producing information about common core components of a successful CIPM practice, as well as about additional services that some practices have found important in producing desired outcomes. This analysis will also identify gaps in available outcome data, evidence of treatment efficacy, insurance coverage, and availability of healthcare personnel needed to operate a high-quality CIPM program. The end goal over time is to share CIPM business models that practices can adopt, and payers and purchasers can recognize as clinical practices that are worthy of coverage.
Other Relevant Resources: AACIPM is curating information, such as relevant studies, tools, and recent guidelines and systematic reviews for pain care. There can be an overwhelming amount of information to sift through, which sometimes involves conflicting recommendations, so compiling resources with helpful explanations will provide additional clarity for people with pain, healthcare providers, payors, and others. AACIPM supports implementation of important past work (e.g., National Pain Strategy and National Federal Pain Research Strategy), and the May 2019 published report from the HHS Best Practices Pain Management Task Force. The HHS report was legislatively mandated through the Comprehensive Addiction and Recovery Act (CARA) and included a wide list of stakeholders in the task force. There are important recommendations in this report that require continued attention to implement, and bringing together resources in one place to assist with increasing access to whole-person focused pain management is very important.
Modifications in AACIPM’s Focus
In 2019, AACIPM core activities included facilitation of a Facilities Assessment Standards Development Committee to address the gap in standards for CIPM. The charge for the committee was to create certification standards for clinical treatment facilities that provide comprehensive integrative pain management (CIPM) to patients with high-impact chronic pain, along with a survey methodology to be used in assuring that a clinic meets those standards. The overall purpose for developing this process was to ensure consistency and high value pain care for people living with high impact chronic pain by holding CIPM treatment programs throughout the country to minimum standards and measurable outcomes, and to assure third party payers that those CIPM treatment facilities that maintain the accreditation standards will produce the desired outcomes for chronic pain care.
There was interest in this effort but difficulty getting traction around an agreed upon model based on changes in the environment of pain management and innovation by providers, payors and purchasers of healthcare in response to opioid misuse and overdose challenges. By the end of 2019, AACIPM’s Advisory Committee decided that, based on the current state of pain management, it would be the best use of resources to build a repository of CIPM practice examples. In order to be most useful in practical terms, this repository will be developed with input from key stakeholder groups including people with pain, public and private payors, purchasers of healthcare, policy experts, government agencies, federal medicine, researchers, and regulators.
Why Is AACIPM Leading This Process?
With increased demand for policies that promote overall health, including evidence-based pain management that include the range of pharmacological and non-pharmacological care based on individual needs, we are in a time of change. Innovative ways to better manage pain and whole person health are being piloted and implemented, for example, the Veterans Health Administration, Duke University, private payers (policy change example to address co-pay barriers), and self-insured employers, and investors are interested in supporting these kinds of efforts. As we are in a period of change and innovation in how comprehensive, interdisciplinary, integrative pain care is being paid for, it is important to focus on standards and outcomes in our discussions so that people with pain can rely on quality care and providers can be incentivized to provide quality care connected to consistent outcomes. And valid outcome measures for pain management should be utilized.
The role that AACIPM will play is to bring together public and private payers, purchasers of healthcare, providers, patients and researchers to share existing and emerging better CIPM practices and outcomes data as available so that it can be synthesized and shared more widely among more stakeholders.
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