How will pain care be influenced by the anticipated reforms in the U.S. healthcare system? Current models of healthcare delivery offer both obstacles and opportunities for achieving quality and effectiveness in pain-related care, according to Daniel Carr, MD, Tufts University in his keynote address at the American Pain Society Annual Scientific Meeting.
"Recent triumphs in biomedical science have extended lifespan, but the futility and unsustainable cost of treating advanced disease have brought health care back full circle to its ancient roots with interventions intended primarily to reduce symptoms," said Carr. "Today we are in the midst of a disjointed and politically volatile reshaping of the American healthcare system, and chronic pain is by far one of the most prevalent and costly conditions that has to be addressed."
Carr explained that the preferred approaches to pain care delivery are evidence-guided, sensitive to individual variability, and are focused on quality and achieving favorable outcomes. In the future, Carr believes, healthcare professionals committed to pain management will find that it's advantageous to be aligned with the priorities of accountable care organizations (ACO), such as avoiding hospitalizations and other measures of quality and cost-effectiveness. An ACO is a group of health care providers that agrees to link reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.
The ACO model rewards prevention, early detection and inter-professional, team-based management in low-cost settings such as primary care practices. "Although this model is perceived as threatening, it is the very same public health approach that leaders in the pain community have long advocated," said Carr. "When working properly, ACOs untether fees from services, encourage time to be allocated for complex patients, and support use of less invasive and behavioral therapies.
In June 2011, The Institute of Medicine submitted to Congress its long-awaited report Relieving Pain in America: A Blueprint for Transforming Prevention, Treatment, and Research, which made recommendations for improvements in pain care, education and informing policy makers and public and private funders of health care that pain is a major national public health problem that must be addressed with aggressive action. The broad task for the IOM Pain Committee was to study the current state of pain research, patient care and education and explore new approaches to help advance the field. It is the first comprehensive, high-level government look at pain as a prominent public health problem in the United States.
"The key contribution of the IOM report is its endorsement of a broad public health approach to pain care. Pain is being recognized as a public health concern because it is very costly and impacts a large population, so our health care system needs to promote multi-faceted, community-based care for pain rather than relying on a limited number of pain specialists," Carr said. He explained that the public health approach involves defining a health problem, identifying its risk factors, adopting community-based intervention models to improve health outcomes in the target population, and monitoring effectiveness.
"The upbeat news for the pain care community is that the intent of the Affordable Care Act is to focus on population-based health management, which for pain care means addressing the complex, multifaceted components of chronic pain. This public health approach strongly favors community-based, multidisciplinary pain care that not only seeks to deliver pain relief but also avoid hospitalizations and improve overall functioning and quality of life," Carr said.
"I am optimistic about the future of pain management in an ACO model that eliminates unnecessary cost and seeks to improve populations-based outcomes. Its advantages for pain care make this an exciting time for adaptive, collaborative professionals seeking to treat pain within a patients-centered, public health approach," Carr concluded.
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