Updated: May 13, 2020
Care for spine and joint related conditions is inflated. A CICN independent analysis in 2018-2019 showed that costs associated with "usual care" (defined as state averages) are 27-34% higher than they should be. For patients, insurance companies, and employers this means that for every $100 spent, $27-34 is wasted.
Many of us quickly point fingers to healthcare systems and providers. However, provider decisions are not responsible for most of the unnecessary spend. The greatest unnecessary expenses are not due to provider decisions, rather they are a consequence of single-disciplinary treatment centers and poorly aligned healthcare groups. Let me walk you through an example.
John Doe is working in the yard one morning. When he lifts a wheel barrow he feels a sudden pain in his back. He calls his primary care provider (PCP) (over 60% of people see a PCP first). The PCP sees him the next day, performs an exam, and gives him a medication(costs $200). Two weeks go by and John continues to have pain. He calls his PCP. His PCP sends a referral to an orthopedic physician (ortho). John gets an appointment with the ortho 4 days later. The ortho performs an exam, orders x-rays, and recommends physical therapy (cost $350 for ortho visit & x-rays). John goes to PT. The PT performs an exam and recommends 12 visits over 4 weeks (cost 1,000). In the third week John is feeling 50% better, but still is not able to fully function. His neighbor recommends a chiropractor. John sees the chiropractor, who performs an exam and recommends 6 visits while undergoing physical therapy (cost $400).
Sure, I'm using an example of somebody being moved through the health system. However, by "usual care" standards this care pathway is not unusual. The average number of independent providers seen for acute low back pain is two. In acute and longer lasting low back pain that progresses to an orthopedic physician, such as what John experienced in this example, the average number of independent providers seen is four.
Here's an important point. As a general rule, when more than one independent provider is involved in a single episode of pain, unnecessary expenses occur. In this example, John had four independent examinations performed that were paid for and took an hour of his time each. He was recommended four different treatment plans. The total duration of the care pathway was 6-7 weeks. John had to drive to 20 different appointments. He likely had 4-5 new diagnoses hit his insurance profile and the total cost was $1,950.
Now let me walk you through a different care pathway, the CICN care pathway...
Following the injury John immediately schedules a virtual consultation with CICN. A CICN provider performs a video visit with John, assessing the onset and pain characteristics, and having John perform some movements to see how the pain reacts (cost $50). The CICN provider makes the determination that John's condition does require in-clinic care, however does not require surgery or injections. John is directed to a multidisciplinary CICN conservative care clinic. These CICN clinics offer physical therapy, chiropractic, massage, acupuncture, and basic medical care.
John gets an appointment that afternoon. At the first appointment, the provider performs a more thorough examination due to the limitations of a virtual examination. John is diagnosed and is shown data on how patients typically respond to treatment at CICN clinics. He learns that for his diagnosis the average visits to resolution under CICN care is 6.7 visits. John and the care team make the goal of resolution within 7 visits. John's care at a CICN clinic will include NSAID medication, physical therapy, chiropractic, massage therapy, and acupuncture. This is his CICN care team, and all types of care are delivered together in each appointment. Treatment is delivered this same day (first visit cost $250).
John is also set up on CICN's patient engagement app that uses a virtual trainer. On days between appointments he goes through the exercises with the virtual trainer. He reports his progress virtually each day, allowing his care team to keep informed. One day he exacerbates the pain by lifting a heavy box. He reports a worsening of pain in the app and a care team member reaches out to him within an hour to ensure there is nothing to be concerned about. John is seen 6 additional visits for a total of 7 visits, right on average (cost $900).
The CICN care pathway lasted 3 weeks. John had 1 examination. John drove to 7 total in-clinic visits and the total cost was $1,150 ($800 savings). John had 2 new diagnoses hit his insurance profile.
Saving Money Through Team-Based Multidisciplinary Care
In the example of John Doe above, it is not provider greed causing unnecessary costs in the "usual care" pathway. Each provider seen in the first example did their job. The unnecessary costs are the result of poor care coordination, poor communication between providers, and healthcare disciplines not being aligned. John needed 4 different types of providers. When they don't work together it is inevitable that visits and costs will increase.
In 2018, CICN performed a pilot program with over 13,000 individual patients experiencing low back pain, neck pain, or sciatica. The pilot program tested the team-based multidisciplinary model (CICN model) against usual care (first care pathway for John). At the time CICN did not have the virtual initial consult. The results of the pilot program showed a total cost of care savings of 21-25% using CICN's care model compared to usual care. That's substantial, but fell a little short of expectations. We found that the shortage was the result of not appropriately steering patients at the beginning. We were inviting all patients to our conservative care clinics for their initial exam. That's when the idea of a virtual first contact was born. CICN implemented the virtual initial consult in April 2020.
As of today, May 1, 2020 CICN is awaiting outcome data from our virtual initial visit program. However, preliminary data is showing additional savings. We are projecting that we will now achieve our goal of 27-34% total cost reduction for spine and joint conditions.
That is how CICN saves people money.