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Back care program helps to keep pain under control
94% of enrollees are 'very satisfied'
After being enrolled in MVP Health Care's back care program for a year, the percentage of participants reporting that their back pain did not interfere with their work increased from 10.9% to 22.9%.
The percentage of program participants who reported their back pain as "none," "very mild," or "mild" increased from 28.2% on enrollment to 44.3% a year later. Nearly 94% of members enrolled reported being "very satisfied" with the program one year later.
MVP Health Care's Back Care program takes a multi-tiered approach to helping members learn to manage their pain. The program includes educational materials, health coaching by registered nurses with education on back pain management techniques, and support for health care professionals who treat patients with back pain.
The Schenectady, NY, health plan established its back care program in 2002 in response to the increase of unproven, high-cost treatments for low back pain among members.
"Our utilization management review showed that members were getting procedures that were not effective, such as epidurals or laminectomies. We felt that the best way to help our members deal with their low back pain was to promote a conservative approach," says Jana Altieri, RN, MS, quality improvement program manager.
The health plan modeled the low back pain program after its asthma, diabetes, and heart disease programs, Altieri says.
Members who have been diagnosed with low back pain and have had at least two claims at least 10 weeks apart are eligible for the program. They are identified through claims data, referrals by physicians and MVP staff members, and self referrals.
The health plan mails information about the back care program to all members identified with low back pain and asked them to return a health risk assessment that measures functional health and well-being.
The survey, an adaptation of the SF-36 Health Survey, asks members to rate their health on an analogue scale in categories that include physical functioning, physical limitations, bodily pain, and general health. It includes questions about the severity of back pain; how it affects physical activity, emotional well-being, energy, and fatigue levels; and how members perceive their health.
Members are stratified into risk levels based on the health risk assessment and other factors. The outreach portion of the program focuses on people who are high risk and report a high level of pain, Altieri says.
Members identified as being high risk receive a call from the health plan's outreach staff, describing the program. Those members who are at high risk are assigned to a registered nurse, trained as a health coach for back pain. The nurses go over members' medical history with them and identify any psycho-social issues. They work with the members to set goals and come up with the steps they should take to reach those goals.
"People have chronic pain because of so many different situations. It may be wear and tear over a long period of time or an injury. There's no one solution to alleviate the pain so the nurses examine all the possibilities," she says.
The nurses assess members' needs, such as losing weight, stretching, or modifying work environments, and help them identify goals and come up with strategies to meet the goals.
"One-on-one support is an important part of the program. The nurses work with the members to set individual and realistic goals," Altieri says.
The health coaches encourage members to take "baby steps" in setting their goals, rather than setting themselves up for failure, Altieri says.
"They help them overcome barriers to achieving their goal, work on problem-solving skills, and help them learn to self-manage their condition," she says.
For instance, a member's goal may be to be able to pick up her grandchild.
"The nurse works with the member on losing weight, exercising, stress reduction — whatever is needed to help her reduce the pain and improve her functionality so she can do that in the end," Altieri says.
The nurses ask the members about which remedies they have tried including physical therapy, 'chiropractic care', home exercise on a daily basis, and using proper lifting techniques, heat, ice, and other modalities.
"We encourage members to try all of that first and if it doesn't work and they're still in pain and functionally impaired, maybe an epidural is the next step," she says.
The nurses call the members at regular intervals for up to a year, based on their needs. Most of the members are in the program for four or five months.
"The frequency depends on the individual. In the beginning, the nurse may call a member weekly, then monthly, and then just occasionally," she says.
Members are asked to repeat the health risk assessment upon discharge from the program, six months later, and one year later.
The health plan sends members a biannual newsletter with information on effective care for back pain. Members receive a back care workbook with information on strategies to alleviate back pain.
The health plan sends information to primary care physicians about members who are eligible for the high-risk portion of the program but did not agree to participate so the physicians can encourage them to enroll.
Once a year, MVP sends physicians who treat a high volume of MVP members a CD that includes clinical practice guidelines for treating back pain and other information.