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Welcome to the Integrative Pain Care Policy Congress Blog!

Brought together by their collective agreement that comprehensive integrative pain management is the best approach to caring for people with pain, and that none of us can properly advance this kind of care alone, the Integrative Pain Care Policy Congress is made up of leaders from more than 50 organizations (and growing!) representing the full scope of licensed and certified health care providers, public and private payers, policy experts, and pain research and patient advocacy organizations.

Are you or your organization interested in joining the Policy Congress, or would you like to receive email updates when this blog is updated? Contact Amy Goldstein for more information.

 

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Potential Strategies for Achieving Our Shared Goals

Posted By Katie Duensing, Wednesday, February 7, 2018

The inaugural Integrative Pain Care Policy Congress was an invitation-only meeting that brought together approximately 70 leaders from 50+ organizations representing the full scope of licensed and certified health care professionals involved in pain care, along with insurers, regulators, people with pain, researchers, and policy experts (see roster). 

The expertise, effort, and resources required to develop effective plans and interventions that address the public health crises of inadequate pain treatment and opioid-related harms are far beyond the capacities of any one organization (see: Why We Came Together), so it is essential that we find ways to work together to develop areas of consensus and strategies for collaboration.

Focusing on meaningful future action for the Congress by working towards consensus policy and advocacy goals for 2018, Congress participants identified many exciting potential strategies for achieving our shared goals. Workgroups based on some of the many ideas below are currently being developed—more on these to come soon!

If you or your organization has a particular interest in any of the below ideas, or if you have other ideas that should be considered, contact Amy Goldstein.

Communication / Advocacy

  • Agree on consensus definition (Done—see definition)
  • Consistent messaging to policymakers, public, etc. (Example—one-pager re: CARA 2.0 with 38 sign-ons and growing!)
  • Decrease competition and confusion between the messages developed between various pain groups represented at the conference by synchronizing our respective messages.
  • Ensure patients are consistently represented on pain initiatives.
  • Develop core set of Talking Points, Position Statements, and other materials to better define the opioid epidemic and required solutions that involve pain (so that conversation not limited to addiction and to decrease competition and confusion among various groups)
  • Ask for a commitment from each organization that we will use common language (the consensus definition at the very least, common talking points if possible)

Data Collection / Measurement

  • Define metrics
  • Keep and mine data
  • Agreement on collection methods
  • Organize trials (e.g., DoD, CMS, payors)
  • Metrics that talk to plans (what are healthcare leaders responsible for and how can we also meet their needs (e.g., HEDIS, NCQA)
    • Identify minimum package of services that might be included in a comprehensive/integrative package
    • Pilots, demonstrations
    • Pitch to Medicare new quality improvement measures related to pain
    • Collaborate with largest purchasers of healthcare plans
    • Identify high risk/complex/ high cost patient populations and allow for bundled payment options and collect outcomes
  • Cultural shift towards measurement-driven care
  • Data that crosses companies
  • Algorithm for how to choose modalities across pain disciplines/services
  • Clinical financial QOL factors
  • Comparative effectiveness studies
  • Create a spectrum of patient centric pathways to address care
  • Identify specifics around coverage challenges and provider network challenges to better understand current system’s failings

Education / Training

  • Large scale education
  • Comprehensive, integrative pain management
  • Earlier treatment / prevention for pain
  • Approach COE, graduate schools for pain education
  • Target pediatric population
  • Get more people with pain engaged in care
  • Networks and support groups for people with pain

Promoting Quality Pain Care / Outcomes

  • Identify exemplar programs
  • Identify suggested/recommended standards for outcome profiles/measurements adopted
  • Health related quality of life
  • Pilot programs (e.g., CMMI, PCORI, model studies)
    • Scale up successful pilots to address scaling concerns in real-life care
  • Identify existing demonstrations for extending kinds of care (e.g., Project ECHO, telepain, U of WA, Healing Place)
  • Recognition of various specialties as part of the team
  • Look to successful models for ideas (e.g., patient-centered medical home, palliative care, oncology care model, integrated behavioral health, collaborative care, interdisciplinary consultation)
  • Explore outcomes for who and what, considering biomarkers
  • Algorithm for choosing modalities across pain disciplines/services
  • Paying for outcomes
  • Demand VA demonstrations report out
  • Need outcomes to develop better coverage (e.g., PROMIS, PASTOR)
  • Monitor for better quality of life, functionality
  • Identify high risk/complex/ high cost patient populations and allow for bundled payment options and collect outcomes
  • Shift focus to developing and implementing pain treatment guidelines vs. opioid treatment guidelines
  • Consensus outcome measures
  • Seek telehealth modalities (when practical) to extend care to rural/underserved areas
  • Quality and outcomes (start with ADLs, lower pain, improve sleep, ER visits, decrease specialist not intervention)
  • Make it easy for frontline providers to implement (critical)

Information Repository

  • Include peer-reviewed information
  • Identify research gaps

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Involved Stakeholders and Those We Would Like to Engage

Posted By Katie Duensing, Wednesday, February 7, 2018

The inaugural meeting of the Integrative Pain Care Policy Congress began with 70 leaders representing 50+ organizations having dinner with one another as they thoughtfully discussed their respective concerns and shared goals related to advancing individualized care for people with pain.  Attendees represented the full scope of licensed and certified health care professionals involved in pain care, along with insurers, people with pain, researchers, policymakers, and policy experts.

At dinner, each table was carefully designed to bring together diverse stakeholder viewpoints to ensure rich and balanced conversations. At one such table, for example, was a researcher, a person with pain, a policy expert, a nurse, a pharmacist, an integrative health physician, a pediatrician, a payer, and an orofacial pain specialist. 

In an effort to ensure our Policy Congress advocates for the best possible policies related to integrative pain care, Congress attendees took time at dinner to discuss what other stakeholders should and/or must be included in the collective conversation as the Congress moves forward. In addition to those who were already at the table (see roster), attendees suggested a number of stakeholders that should be engaged.

Feedback could be grouped in the following ways:

  • Areas of interest (e.g., dental, health care educators, sleep, nutrition, food health, homeopathic medicine, yoga)
  • Payors (e.g, workman’s compensation, state Medicaid directors, CEO private insurance)
  • Government—Federal (e.g., NIH, HRSA, FDA, CMMI, White House Opioid Commission, SAMSHA, NIDA, Congresspeople)
  • Government—State (e.g., NAAG, NGA, state health departments, state insurance commissioners, legislators)
  • Patient advocacy (e.g., professional athletes, voting block, AARP, consumer organizations)
  • Provider organizations (e.g, family physicians, naturopathic physicians, public health association, herbalist guild, college of nutrition, addiction, pediatrics)
  • Pain team representatives (e.g., chaplain, first responders, orthopedic surgeons, oral surgeons, surgeons, gynecologist, rheumatologists, mentors, coaches, behavorial health, family practice, AARP dental educators)
  • National associations (e.g., AHIP, AHA, ASTHO, NQF, NRHA, state EMS officials)
  • Provider education (e.g., ACGME)
  • Purchasers of health care (e.g., large employer coalitions, purchaser coalition, public and private sector, employee assistance)
  • Quality healthcare measurements (e.g., NCQA, HEDIS)

Who are we missing? If you know of other organizations/agencies/institutions that should be involved in developing and implementing policies related to comprehensive integrative pain management, please send your thoughts to Amy Goldstein.

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Coming to Consensus: Defining Comprehensive Integrative Pain Management

Posted By Katie Duensing, Wednesday, February 7, 2018

What is comprehensive integrative pain management?

For years, there has been a growing consensus by a wide variety of stakeholder groups that optimal pain care is patient-centered and brings together all evidence-informed therapeutic approaches to reduce pain and achieve optimal health and healing, the health care team working in a coordinated, team-based approach on behalf of the patient. However, until the inaugural Integrative Pain Care Policy Congress, there was never a definition that varied stakeholders agreed upon to that explain precisely what this care is and what it should be called.

To best empower our collective to advocate for policies that will help all of those people whom Policy Congress attendees represent, we first needed to define what, exactly, we were advocating for by addressing the lack of a consensus definition for optimal pain management: achieving a definition was the first priority for the inaugural meeting.

Using information gleaned from pre-Congress surveys, followed up by in-person discussions and many revisions, approximately 70 leaders from 50+ participating organizations agreed on a consensus definition for “comprehensive integrative pain management”. 

Comprehensive integrative pain management includes biomedical, psychosocial, complementary health, and spiritual care. It is person-centered and focuses on maximizing function and wellness.  Care plans are developed through a shared decision-making model that reflects the available evidence regarding optimal clinical practice and the person’s goals and values.

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The Integrative Pain Care Policy Congress: Why We Came Together

Posted By Katie Duensing, Wednesday, February 7, 2018

Held in San Diego, California, from October 21-22, 2017, the inaugural Integrative Pain Care Policy Congress was an invitation-only meeting that brought together approximately 70 leaders from 50+ organizations representing the full scope of licensed and certified health care professionals involved in pain care, along with insurers, regulators, people with pain, researchers, and policy experts (see roster). 

Our nation is facing two inter-related public health crises—chronic pain and prescription opioid misuse. To address these intertwined health crises, there is an ever-growing number of guidelines and policies intended to reduce opioid use at both the state and federal levels. While well-intentioned, these policies are impacting the health care that is available to those in need of acute and chronic pain management. Yet, often missing from the conversation surrounding the development of these policies is any talk of how to improve patient access to effective and affordable non-opioid treatments for pain, whether pharmacological or non-pharmacological.

The expertise, effort, and resources required to develop effective plans and interventions that address the public health crises of inadequate pain treatment and opioid-related harms are far beyond the capacities of any one organization, so it is essential that we find ways to work together to develop areas of consensus and strategies for collaboration. Facilitated by Academy of Integrative Pain Management and State Pain Policy Advocacy Network, in partnership with Alliance for Balanced Pain Management, Integrative Health Policy Consortium, and PAINS, the inaugural Integrative Pain Care Policy Congress provided us with the opportunity to do just that by:

  • Gathering, for the first time, leaders and experts representing the full scope of licensed and certified health care professionals involved in pain care, along with insurers, regulators, people with pain, researchers, and policy experts who believe that integrative pain care is essential.  We aimed to highlight current successes and barriers and to discuss opportunities to jointly promote optimal models to provide this kind of care.
  • Achieving consensus on the definition of comprehensive integrative pain management. This was accomplished relatively quickly in person due to focused pre-Congress survey work.
  • Considering stakeholders who should and/or must be included in the collective conversation as the Congress moves forward (in addition to those already participating).
  • Connecting the dots related to past and current efforts to find quality evidence supporting reimbursement for comprehensive integrative pain management.  To discuss the current state of coverage and constraints for payment, along with the most current data available on the effectiveness of these therapies for pain, the Congress facilitated conversations between CMS and private payers; clinical, policy, research leaders; health care providers; and patients.  
  • Focusing on meaningful future action for the Congress by working towards consensus policy and advocacy goals for 2018.  Congress participants identified many exciting Potential Strategies for Achieving Our Shared Goals, and a number of project-specific workgroups are currently being established.

To help kick off the inaugural in-person meeting and help each attendee understand the perspectives of the other attendees, we produced a short video.  This piece included statements shared in advance by attendees and intended to answer the question: What brings us together?

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