Affinia Healthcare Pain Management Integration Program

Program Description

Affinia Healthcare instituted an integrated pain management program in 2017 that provides patients who are suffering from chronic pain with optimal treatment towards minimizing their pain and its impact on their mental, social, and physical functioning. Over use of pain medication often results in medical risks, chemical dependency, dangerous sedation and may cause accidental death. This model of care includes a team based approach with visits to the medical provider, pharmacist and behavioral health consultant. Using a multi-modality treatment approach, the primary care provider will assess the patient, provide medical work up, provide diagnosis and prescribe needed medication. The providers will review the state-wide Cyber Access portal for Medicaid and Medicare patients to evaluate patient ER visits, provide medication reconciliation, review medications and provide medication recommendations. The behavioral health consultant will evaluate and conduct a psycho-social assessment, assess risks and patient strengths and provide motivational interviewing that instills behavioral activation. During the course of several group visits, the behavioral health consultant provides motivational interviewing and Cognitive Behavioral Therapy (CBT) and provides educational information to activate behavioral, psychological and social factors that impact pain. Patients are educated on mind-body self care skills, activity pacing, sleep hygiene, mindfulness, and relaxation.

Creativity

This program is innovative in that is integrated across a multi-disciplinary team including: a physician, pharmacist, behavioral health specialist, and chiropractor. The program is integrated with the Medication Assisted Treatment (MAT) program at Affinia Healthcare that works with patients addicted to heroin/opioid substances. Patients are able to receive on-site primary care and behavioral health services at Affinia Healthcare including psychiatry. The pain management program utilizes a bio-psycho-social model and holistic approach that incorporates Mind-Body medicine techniques from certified trainers to build resilience. The program provides peer support groups, teaches self-help tools for patients to learn and use on their own, and offers free yoga classes. The program empowers patients who have more socio-economic challenges than most, including homeless individuals. Most medical providers don’t offer these options, even in private practice and if they do, it is cost and logistically prohibitive for our patients, most who are uninsured.

Leadership

The Missouri Primary Care Association (MPCA ) collaborative on chronic pain gave Affinia Healthcare access to specialists and information on how to create this program. Clinicians were supported by tele-health conferences via a University of Missouri monthly webinar series called ECHO and statewide meetings organized by the MPCA. The administration at Affinia Healthcare implemented this program by supporting chronic pain management through an organization-wide policy supporting multidisciplinary care, a MAT program for those dependent/addicted to opioids, and through the treatment of chronic pain via the team approach. These approaches all enhance the health of our community and decrease the number of opioid prescriptions and ultimately reduce opioid addictions. Other organizations can easily emulate this program with assistance from the MPCA as well as specific information shared by Affinia Healthcare through community partnerships in the St. Louis Integrated Health Network and the St. Louis Regional Health Commission.

Sustainability

Affinia Healthcare has invested clinical and financial support to sustain the pain management program which currently operates at the two largest Affinia health centers. Affinia provided financial assistance for two staff to be certified by the Center for Mind Body Medicine in the practice of Mind Body Medicine Skills. Affinia receives federal funds to help pay some costs of uninsured patients and currently participates in Gateway to Better Health. Gateway provides uninsured patients with incomes at or below the federal poverty with primary medical, dental, and pharmacy care at low co-pays ($3-$5 per visit). Although Gateway does not cover behavioral health care, Affinia has found creative ways to tweak the physician schedule and reimbursement plans so pain management patients can utilize Gateway and increase access to care for patients without increasing co-pays. Affinia has a sliding fee schedule and a strong referral network with other regional health entities including hospitals.

Replicability

Affinia Healthcare is currently a very active member of regional organizations dedicated to improving health care access and racial equity in the St. Louis metropolitan area. These organizations include the Missouri Primary Care Association (MPCA), the St. Louis Regional Health Commission, and the St. Louis Integrated Health Network (IHN). Through this active participation, Affinia Healthcare can share program implementation and results with other health care organizations in the St. Louis area. The MPCA could be especially helpful as they helped provide the information that was the framework for the Affinia Healthcare Integrated Pain Management Program. The MPCA collaborative on chronic pain gave Affinia Healthcare access to specialists and experts. Other organizations can easily emulate this program with assistance from the MPCA as well as specific information shared by Affinia Healthcare through community partnerships through membership in the St. Louis Integrated Health Network and the St. Louis Regional Health Commission.

Results/Outcomes

The Affinia Healthcare Integrated Pain Management Program is a new program that is less than a year old and therefore there are only preliminary results available but these preliminary results are encouraging. Currently there are 53 chronic pain patients who receive opioid prescriptions and who utilize the chronic pain management program to assist with coordination of care and the reduction and weaning off of opioids medications. The goals of the program are to increase functionality, decrease pain, and decrease opioid use or the MED (morphine equivalent dose) of patients suffering from severe pain. The program goal and objective is to move patients away from the controlled substances including opioids. It is also designed to improve patient functioning and general quality of life, not only for the patient but their families, friends and overall community.