Low Back Pain Implementation Collaborative

May 2022

The Washington Health Alliance’s Low Back Pain Implementation Collaborative (Collaborative) is continuing to make progress on its mission to “advance the market to improve the value of care for all patients with low back pain in Washington state.” The Alliance appreciates the commitment of the Collaborative’s 30 participants across all stakeholder groups who are working together to make significant progress on this important initiative:

Aetna Proliance Surgeons
American Physical Therapy Association Regence BlueShield
Aon SEIU 775 Health Benefits Group
Association of Washington Cities Seattle Metropolitan Chamber of Commerce/Business Health Trust
Bloodworks Northwest Teamsters
City of Seattle The Boeing Company
Confluence Health UFCW 21
Davis Wright Tremaine UW Medicine
Dr. Robert Bree Collaborative Virginia Mason Franciscan Health
Kaiser Permanente Washington Washington Acupuncture and Eastern Medicine Association
King County Washington Health Benefit Exchange
MultiCare Health System Washington Optum Care
Point B Washington State Chiropractic Association
Port of Seattle Washington State Health Care Authority
Premera Blue Cross Washington State Department of Labor and Industries

 

In a recent survey, participants reported on the actions they are taking to reduce low-value and increase high-value care for patients with low back pain.

Health plans reported:

  • Setting up telemedicine visits as a first stop for triage
  • Directing members to a 24-hour nurse line
  • Providing education to members on how to self-manage pain
  • Improving an on-line member portal
  • Providing more non-surgical care options
  • Implementing prior authorizations for advanced imaging and surgery

Health care providers reported:

  • Educating primary care providers about care center options
  • Instituting baselines to understand the prevalence of low-value care
  • Tracking calls to primary care clinics to find out how many result in an Emergency Department or Urgent Care visit
  • Referring patients to care options sooner
  • Reviewing, updating, and developing patient education materials
  • Considering how equity is reflected in care for those with low back pain

Health care purchasers (employers and union trusts) reported:

  • Informing members on the difference between acute and emergent low back pain
  • Considering bundled payment models to allow for more integrated services
  • Incentivizing the first point of contact to be with a primary care provider, rather than the Emergency Department
  • Promoting health coaching program options to members
  • Informing members with a history of chronic low back pain of free treatment options
  • Tailoring benefit design to evidence-based treatment recommendations

Health care allies reported:

  • Building awareness of the problem of inconsistent treatment for low back pain
  • Creating purchasing and payment standards that use consistent care quality metrics
  • Supporting the use of shared decision making including pain education, self-care, and effective triage
  • Working towards producing information videos and investing in educational tools for all stakeholders; health care consumers/patient, providers, purchasers, and plans

During its most recent meeting on April 26th, the group considered various opportunities and recommendations to improve the care delivered to people with low back pain with the Collaborative’s advisors:

  • Dan Cherkin, PhD, Affiliate Professor in Family Medicine, University of Washington; Director of Research, Osher Center for Integrative Medicine; Emeritus Senior Scientific Investigator, KP Washington Health Research Institute;
  • Mark Fendrick, MD, Director, Center for Value-Based Insurance Design; Professor, Internal Medicine, School of Medicine and Professor, Health Management and Policy, School of Public Health, University of Michigan, is also a project advisor;
  • Andrew Friedman, MD, Section Head of Physician Medicine & Rehabilitation, Virginia Mason Medical Center; Chief of Physiatry, Virginia Mason Franciscan Health; Clinical Assistant Professor, Department of Rehabilitation, University of Washington; and Chair, Industrial Insurance Medical Advisory Committee, Department of Labor; and
  • Joshua Liao, MD, MSc, FACP, Associate Professor Medicine; Associate Chair for Health Systems, Department of Medicine; Adjunct Associate Professor, Health Systems and Population Health.

The Collaborative is supported by the Arnold Ventures’ Provider Payment Incentives Portfolio. Contact Alliance Director of Purchaser Strategies Denise Giambalvo for more information on the Collaborative.

 

April 2022

Progress on Working Together to Improve Low Back Pain

As we continue with the Washington Health Alliance’s Low Back Pain Implementation Collaborative, all of the stakeholders, purchasers, health plans, and health care professionals are identifying ways they can work together to improve the value of health care provided to all of those with low back pain in Washington state.

As we have learned from our expert advisors, catching low back pain within the first three months is critical to both alleviate unnecessary doctor visits and improve the likelihood that the patient’s symptoms can be appropriately treated.

Another important foundation to improve low back care is education, both for providers and patients. Providers are more likely to get the best outcomes when they have the right tools to triage the patient and direct them down the right pathway. Patients also benefit from education because they can learn about care options and ways they can help themselves. In the case of low back pain, long periods of bed rest can prevent recovery and there is truth to the saying, “motion is lotion.”

We are excited to be working on this important project, supported by Arnold Ventures’ Provider Payment Incentives portfolio, and look forward to sharing more news of our progress.

 

March 2022

It is estimated that 80% of Americans will have some form of back pain in their lifetime, but not all of them will receive high quality health care to address it. As early as 1985, studies showed the benefits of motion in the healing process and speculation that “help will come in the next decade from a collaborative effort from politicians, industrial leaders and engineers, physicians, psychologists, and biomechanicians.”

Several decades later, that still has not happened. “[B]arriers to optimal evidence-based management include widespread misconceptions of the general public and health professionals about the causes and prognosis of low back pain and the effectiveness of different treatments, fragmented and outdated models of care, and the widespread use of ineffective and harmful care.”

According to Washington Health Alliance data, approximately 72,000 people with low back pain received more than 140,000 low-value services an at estimated cost of nearly $10 million in 2020. In addition, a recent review of social determinants of health across 17 countries showed important associations between gender, race, ethnicity, education, occupation and socioeconomic status and low back pain.

The Alliance’s Low Back Pain Implementation Collaborative (Collaborative) is working to change that, with the official launch held last month. There are 29 participant organizations representing all stakeholders working together with the mission of “advancing the care for all patients with low back pain in Washington state.”

A post-launch survey indicated that all participants in the Collaborative felt the orientation with advisors and breakout sessions was relevant to the needs of their organization and several indicated that they are looking forward to developing a plan in which each stakeholder understands their role in reducing medical waste and to supporting equity and reducing health disparities in the treatment of low back pain.

The Collaborative is supported by the Arnold Ventures’ Provider Payment Incentives Portfolio. For more information on the Collaborative, please contact Alliance Director of Purchaser Strategies Denise Giambalvo.

 

February 2022

Low Back Pain Implementation Collaborative (Low Back PIC) Launches!

Working to improve the delivery of evidence-based care for low back pain by all stakeholder groups, the second phase of the Washington Health Alliance’s Driving Value Project, the Low Back Pain Implementation Collaborative (Collaborative), met as an all-stakeholder group for the first time on February 3rd. Committed to this project are 29 participants, with the majority from purchaser organizations, but also including commercial insurance plans, large provider groups, and several other important organizations, such as the Bree Collaborative, the Washington State Department of Labor and Industries, and the American Physical Therapy Association.

Alliance Executive Director Nancy Giunto said, “We are so appreciative of our partners on this project. It’s an exciting opportunity for us to not only make a significant difference to thousands of people across Washington state but potentially serve as a model for the nation and help millions.” As part of the Collaborative, there will be individual stakeholder meetings to address the unique issues facing health plans, providers, and purchasers. Priorities include:

  • benefit design changes to best support employee and members returning to function with optimal health outcomes for purchasers;
  • changes to contracts with provider groups to support the use of evidence-based care and patient awareness for plans; and
  • identifying evidence-based practices and supporting changes to workflows that support delivery of high-value care for providers.

During the kickoff meeting, the Alliance heard from:

  • Andrew Friedman, MD, Section Head of Physician Medicine & Rehabilitation, Virginia Mason Medical Center; Chief of Physiatry, Virginia Mason Franciscan Health; Clinical Assistant Professor, Department of Rehabilitation, University of Washington; and Chair, Industrial Insurance Medical Advisory Committee, Department of Labor.
  • Joshua Liao, MD, MSc, FACP, Associate Professor Medicine; Associate Chair for Health Systems, Department of Medicine; Adjunct Associate Professor, Health Systems and Population Health.
  • Mark Fendrick, MD, Director, Center for Value-Based Insurance Design; Professor, Internal Medicine, School of Medicine and Professor, Health Management and Policy, School of Public Health, University of Michigan, is also a project advisor.

If you are interested in making a difference in the quality of health care relating to low back pain across Washington state, contact Alliance Director of Purchaser Strategies Denise Giambalvo.

This project is supported by Arnold Ventures’ Provider Payment Incentives portfolio.

 

October 2021

Join the Alliance’s Low Back Pain Implementation Collaborative (Low Back PIC)

The Washington Health Alliance is continuing its groundbreaking work to translate its data into actionable health care improvements and invites you to join the effort!

As you may recall, the Driving Value Project, made possible by initial support from Arnold Ventures, leveraged select measures from the Alliance’s reporting on high-value care in the Community Checkup and low-value care in First, Do No Harm to work with purchaser members to improve the value of care received by their 550,000 plan participants. You can download the whitepaper here.

Now, with additional support from Arnold Ventures’ Provider Payment Incentives portfolio, the Alliance is taking those lessons learned and expanding the work to include purchasers, plans, providers, and other health care stakeholders. Over the next year, we will work together to make measurable improvements by implementing patient and provider focused strategies that are underpinned by clinical evidence and aligned incentives.

If you are interested in participating or have questions about the Low Back PIC, please contact Medical Director, Performance Measurement and Practice Transformation Sharon Eloranta.

 

June 2021

Driving Improvement Together

The Washington Health Alliance (Alliance) recently completed a purchaser-led project with the central aim of using data and collaboration to fuel collective action. In its white paper, Aligning to Drive Value: Using Data, Relying on Evidence, and Building on Trust, the Alliance shares the learnings gained through its work with eight self-funded purchaser members, which includes private and public employers, union trusts, and a multi-employer plan. Together, they provide health benefits to approximately 550,000 individuals or about 7% of Washington state’s population.

Each purchaser received customized reports that identified high- and low-value improvement opportunities. These reports included 48 measures of low-value care using the Milliman MedInsight Health Waste Calculator™ that serves as the basis of the First, Do No Harm reports published by the Alliance and 24 measures of high-value care from the Community Checkup, a comprehensive report on health care quality that has been published by the Alliance since 2008.

Alliance purchasers selected improving the value of care for low back pain as a shared priority for action. Informed by collaborative discussions with provider and health plan leaders, purchasers developed patient and provider-focused strategies to improve the care of low back pain consistent with the strong evidence-base for non-opioid, non-invasive services.

To download your copy, click here. To read the blog post click here.

The Driving Value Project was supported by Arnold Ventures, a philanthropy dedicated to investing in evidence-based solutions that maximize opportunity and minimize injustice.

 

June 2021

Alliance Moves Forward on Driving Value Together Project

Alliance Director of Performance Improvement and Innovation Karen Johnson shared our progress on the Driving Value Project with the Smarter Health Care Coalition (Coalition), committed to working together to improving health care in a variety of ways with a strong focus on policy. The Driving Value Project supported by Arnold Ventures, is working with eight self-funded members of the Alliance to identify and reduce low-value care and increase high-value care.

The Coalition’s goal is to integrate benefit design innovations and patient engagement to achieve smarter health care that improves the patient experience. In particular, the Coalition is focused on better aligning health insurance coverage, quality, and value-based payment goals. Created in 2016, building on the work of Dr. A Mark Fendrick, Director of the University of Michigan Center for Value-Based Insurance Design, and Harvard Medical School Professor Michael Chernew, the Coalition represents a broad-based and diverse group of health care innovators, including consumer groups, employers, patient advocacy organizations, health plans, and life science companies.

The Coalition recently issued a letter asking US Department of Health and Human Services Secretary Xavier Becerra to:

  • eliminate Medicare payment for services rated “D” by the U.S. Preventive Services Task Force;
  • allow Medicare Advantage organizations to reduce payments or increase cost-sharing for “D” rated, harmful preventive services; and
  • enable the Center for Medicaid and Medicare Innovation to build a new, multi-state demonstration project to reduce low-value care in commercial, Medicare, and Medicaid populations.

View the presentation here.

 

January 2020

The Alliance leveraged the First, Do No Harm report series on low-value care, as well as the ongoing work we do to report on high-value care in the Community Checkup, to create the Driving Value initiative, made possible with $350,000 in support from Arnold Ventures.

This support enables us to work with a group of self-insured purchaser members of the Alliance, representing more than 550,000 members across the state, to improve the value of care received by their plan participants. The Driving Value project provides purchaser members the opportunity to benefit individually within their own organizations, as well as to have a collective impact by working collaboratively with each other as well as with providers and health plan leaders across the state to propel action. The participants are currently in the process of exploring how they can collectively improve the value of care for those suffering with low back pain by increasing reliance on evidence-based, non-opioid, and nonsurgical treatments.

We are “the tip of the spear” in this kind of purchaser-led multi-stakeholder collaboration, according to our external advisor to the project, Dr. A. Mark Fendrick, who leads the Center for Value-Based Insurance Design at the University of Michigan. This effort is already attracting national attention with this innovative approach. Stay tuned for updates on our progress and learnings from this endeavor.