As musculoskeletal health drifts closer to value-based care, a question that must be asked is "How do we reduce average visits to resolution without compromising outcomes?". Colorado Integrated Care Network (CICN) is on the forefront of the movement of musculoskeletal healthcare to value-based. CICN announced readiness to move fully to value-based reimbursement for musculoskeletal care in April of 2017 following nearly 3 years of study, pilot programs, and analysis.
A principle component to reducing average visits to resolution for musculoskeletal conditions is multidisciplinary or multimodal care. CICN metrics show that clinics that deliver collaborative care pathways that include chiropractic, physical therapy, soft tissue therapy, and acupuncture achieve better outcomes than single disciplinary clinics. CICN refers to these clinics as multidisciplinary when this care is delivered by multiple providers licensed in the fields above. CICN refers to these clinics as multimodal when a single provider is licensed to deliver all of the types of care listed above.
Early CICN outcome metric analysis pointed CICN leaders to the effect of multidisciplinary or multimodal care pathways on average visits to resolution. This led to a pilot program in which CICN recruited clinics able to deliver multidisciplinary and/or multimodal care pathways. The results were eye opening. The number of visits to achieve resolution of a complaint (resolution of equal or greater value than single disciplinary clinics) were significantly reduced. For most musculoskeletal diagnoses average visits were reduced by nearly 50%. The smallest impact was a 30% reduction in number of visits to resolution. This led to the creation of CICN's Centers of Excellence Spine Program (CESP). Results of the initial pilot program are shown in the graph below.