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Using Integrative Leadership Skills to Establish a Program to Reduce the Likelihood of Chronic Pain Syndrome

By Patricia Dennis

For my final project on the Leadership Program in Integrative Healthcare at Duke, I wanted to leverage the assets of my organization to build a transformative initiative by collaborating with others from across our enterprise for the benefit of our patients, members and community.

HealthPartners is the largest consumer governed nonprofit health care organization in the nation – serving more than 1.5 million medical and dental health plan members nationwide. Our care system includes a multi-specialty group practice of more than 1,700 physicians, 50 primary care clinics, 55+ specialties, seven hospitals, 22 dental clinics, a 24 hour on-line clinic, plus several pharmacies and an institute for education and research. HealthPartners employs over 22,500 people, all working together to deliver the HealthPartners mission.

THE PROJECT

When I started the business plan process, I tapped several potential champions across HealthPartners who were already engaged in Integrative Healthcare practices, and looked to them for guidance in identifying the best opportunities for transformational change.

I held interviews with the leadership to understand the pain points in the delivery system and posed these questions: What things are we doing now in complementary care or integrative medicine?  Are there places in the organization that are already delivering this type of care?

Talking to the people who were already delivering such care was also helpful. With this group, I asked: If you were part of the Duke Program and had the opportunity to pick one meaningful project, what would it be? They highlighted their successes and where they saw a need.

We soon identified reducing the likelihood of Chronic Pain Syndrome as having great potential.

The opportunity to see the topic of Chronic Pain Syndrome from the standpoint of the patient, the primary care provider and from the health plan allowed us to approach the Triple Aim of Health, Experience and Affordability from each of those perspectives.  Tackling this issue from several perspectives while acting within our organization’s mission and vision provided a powerful focus and call to action.

DEFINITION OF CHRONIC PAIN SYNDROME

We defined Chronic Pain Syndrome as pain lasting more than 12 weeks accompanied by adverse impacts on coping with aspects of work, relationships and leisure, and in which emotional responses ranged from hopelessness to relentless searching for relief.

THE STAKEHOLDERS

In addition to the support from the HealthPartners CEO and executive leadership, the working team consisted of myself plus the:

  • Medical Director, Primary Care
  • Medical Director, Health Plan
  • Director, Behavioral Health and Resilience
  • Chief Improvement Officer
  • Director, Health Informatics
  • Health & Care Engagement Analyst – Research
  • Health & Care Engagement Sr. Integration Project Manager

THE PILOT

We began to evaluate data and put together a plan that would identify potential patients, and connect them with care services in our health system to improve their health.   We wanted to demonstrate that usual care combined with a comprehensive, person-centered model could reduce the likelihood of Chronic Pain Syndrome.

The idea of creating an intervention to reduce the likelihood of Chronic Pain Syndrome, rather than treating it after the fact, quickly took root as a prime method to impact change, not only for patients, but also for providers and for our health system overall.  We began to evaluate data and put together a plan that would identify potential participants through clinician referral or through claims identification, and connect them with care services in the system to improve their health and well-being.

We identified the following steps as being within our scope of work:

  • Identify and engage 20-30 patients of the health system who would participate in the pilot
  • Engage and train the physicians
  • Offer 6-12 weeks of telephonic sessions based on the biopsychosocial model
  • Teach the patients self-management for pain
  • Improve their coping capability
  • Coordinate the conventional and complementary care

The key transformational elements in our model were:

  • Identify and intervene early
  • Offer telephone-based patient education, support and guidance
  • Introduce complementary/alternative resources to physicians
  • Coordinate patients’ clinical and complementary care
  • Avoid non-evidence based diagnostics and treatment

RESOURCES

The resources for complementary care available for outpatients in the PCP setting through our system included modalities such as:

  • Acupressure
  • Acupuncture
  • Guided Imagery
  • Yoga
  • Massage Therapy (with an order for therapeutic massage)

We determined that the care coordination process would be best handled by licensed behavioral health (BH) professionals who had received chronic pain training.

  • BH professional contacts members/patients by phone
  • BH professional completes pain assessment, if not already completed by the physician
  • BH professional consults with primary care providers for patient specific guidance
  • BH professionals offer patients support and coordination with the providers

ELIGIBILITY

To be eligible, patients needed to be:

  • Between the ages of 21 – 65 years
  • Experiencing less than 12 weeks of pain
  • Experiencing mechanical/compressive or muscle pain
  • Identified by HealthPartners claims history and/or physician referral tool
  • Not extensively using opioids, experiencing post op pain, cancer pain or headaches/migraines

OBJECTIVES

Our objectives for the pilot were to:

  • Create a standardized and reliable process
  • Function as a coordinated team to offer comprehensive solutions to patients
  • Document ongoing progress
  • Share concerns and successes
  • Create a learning collaborative

TIMELINE

We established the following timeline:

  • August — October 2015: Pilot development
  • November — December 2015: Selection of pilot location, Socialization of pilot
  • January — February 2016: Claims identification of pilot members/patients, Clinician Training
  • March 2016: Begin participant outreach and engagement
  • June 2016 — July 2016: Pilot evaluation and recommendations for expansion

MEASURES OF SUCCESS

Being able to measure success is an important aspect of any pilot.  We identified three areas where we could have a measurable impact.

Patient Outcomes

  • Participant’s ability to cope with pain
  • Participant’s engagement in shared decision making
  • Participant’s follow through on care coordination

Care Delivery Outcomes

  • Consistency of practice patterns supported by evidence
  • Provider satisfaction

Process Outcomes

  • Participant satisfaction
  • Decreased referrals for diagnostics and less evidence based interventions
  • Affordability of overall care

Measurement will be done through surveys, scoring tools and claims data.

CHALLENGES

In the process of setting up the pilot, we identified several barriers:

  • Offering options for integrative medicine has not been a standard of care so primary care physician practice has varied
  • There were often competing priorities
  • Resource availability for health informatics analytics was limited
  • The primary care physicians were completing health improvement requirements
  • The nature of pain intervention varied
  • Pain treatment is a diffuse medical responsibility within many health settings
  • Patients want quick relief and for most, relief includes learning and practicing a variety of self-care activities
  • Due to the claims lag period, there is a short window to outreach to participants identified through claims

WHAT’S NEXT

  • Validate a new evaluation tool
  • Participate in the Samueli Chronic Pain Breakthrough Collaborative
  • Identify success patterns and failure paths
  • Develop modifications to the model
  • Spread the revised model to more clinics during the feasibility and extended pilot phases

While there have been challenges along the way, our team has been able to continue to refine and improve our approach ahead of the pilot launch which is currently underway. And while there are several important outcomes, most significantly, we believe we have a concrete plan that will identify and engage patients who are at risk for Chronic Pain Syndrome early on in their journey, altering their course to improve their health and well-being.

AUTHOR BIO

Patricia Dennis is the Senior Vice President, Health and Care Engagement at
HealthPartners in Minneapolis, Minnesota.

 

 

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