An ounce of prevention could heal a pound of pain


Ever hear a message so many times that it just goes in one ear and out the other? That's how I feel insurers sometimes respond to hearing that prevention and wellness are keys to improving our healthcare system.

Well, I'm hoping that some cold, hard facts can incite insurers into action: Chronic pain affects 116 million Americans--that's more people than affected by heart disease, cancer, and diabetes combined--and costs the United States $635 billion each year. That's what the Institute of Medicine (IOM) found in its report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research.  

If that's not jarring enough, here are some more staggering facts: The United States spends $2 trillion on healthcare, but only 4 cents of every dollar goes to prevention and public health, despite being among the best tools to reduce spending. For every $1 invested in prevention, we save $6 in projected healthcare costs, says Sen. Tom Harkin (D-Iowa), who participated in the Department of Health and Human Services' (HHS) announcement of its guidelines to incorporating prevention throughout the healthcare industry.

Putting two and two together, we as a nation are suffering in tremendous pain while spending exorbitant amounts of healthcare dollars, but we fail to use preventive services to ease that pain and decrease our spending.

Both the IOM and HHS recommended specific steps insurers can take to help improve this potentially dire situation. First and foremost, insurers (and providers and the community at large, for that matter) must recognize chronic pain as a serious disease. The IOM urged health plans to incentivize primary-care providers to deliver coordinated, evidence-based, interdisciplinary pain assessment and care through adequate reimbursements that cover the physician's time and effort for coordinating pain care outside of the face-to-face patient visit.

Meanwhile, HHS pushed for insurers to use payment and reimbursement mechanisms to encourage physicians to provide preventive services. It says that reimbursement mechanisms focused on proven interventions and measurable treatment outcomes can increase patients' use of preventive services.

HHS added that payers can establish patient and clinical reminder systems for preventive services, coordinate preventive care among diverse care providers, adopt medical home or team-based care models, and use alternative communication methods and tools like smartphone apps to support more traditional written and oral communication.

I know that many payers are already taking great steps to decrease chronic pain and improve preventive health. But it seems that more must be done. "There is a crisis in the impact of and response to pain in America," the IOM wrote. "It is our hope that this report will help stimulate a concerted response to this crisis." I wholeheartedly agree. - Dina

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