Pro's and Con's of accepting Medicaid...

Business as usual just isn't going to pencil out in caring for this cohort. If you take the 45y/o -54y/o
CNP cohort - probably the highest risk of bad outcome - an OR CCO is given about $7-8K/yr to manage
all of their care. Even before being diagnosed with CNP the cost of managing the patients described below
was $20K. It's hard not to predict that specialty care and pharmacy costs are going to be a big target.

Pain Pract. 2015 Oct 7. doi: 10.1111/papr.12357. [Epub ahead of print]
Cost Burden of Chronic Pain Patients in a Large Integrated Delivery System in the United States.
Park PW1, Dryer RD2, Hegeman-Dingle R1, Mardekian J1, Zlateva G1, Wolff GG3, Lamerato LE3.
Author information

Abstract
OBJECTIVES:
To estimate all-cause healthcare resource utilization and costs among chronic pain patients within an integrated healthcare delivery system in the United States.

METHODS:
Electronic medical records and health claims data from the Henry Ford Health System were used to determine healthcare resource utilization and costs for patients with 24 chronic pain conditions. Patients were identified by ≥ 2 ICD-9-CM codes ≥ 30 days apart from January to December, 2010; the first ICD-9 code was the index event. Continuous coverage for 12 months pre- and postindex was required. All-cause direct medical costs were determined from billing data.

RESULTS:
A total of 12,165 patients were identified for the analysis. After pharmacy, the most used resource was outpatient visits, with a mean of 18.8 (SD 13.2) visits per patient for the postindex period; specialty visits accounted for 59.0% of outpatient visits. Imaging was utilized with a mean of 5.2 (SD 5.5) discrete tests per patient, and opioids were the most commonly prescribed medication (38.7%). Annual direct total costs for all conditions were $386 million ($31,692 per patient; a 40% increase from the pre-index). Pharmacy costs comprised 14.3% of total costs, and outpatient visits were the primary cost driver.

CONCLUSIONS:
Chronic pain conditions impose a substantial burden on the healthcare system, with musculoskeletal conditions associated with the highest overall costs. Costs appeared to be primarily related to use of outpatient services. This type of research supports integrated delivery systems as a source for assessing opportunities to improve patient outcomes and lower the costs for chronic pain patients.

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Pro's and Con's of accepting Medicaid...

Pro's and Con's of accepting Medicaid...

I pretty much agree with Duct, and I think his heart is in the right
place. But, IMO Medicaid dollars would be better spent by bolstering
behavioral health boots on the ground rather than referrals to a
traditional IPM pain management clinic. This cohort of patients
won't benefit from injections or opioids.

Having seen lots, and lots of Medicaid patients these past
two years has lead me to believe that the attached graph is right.
But with the caveat that, within the CNP medicaid population,
the social and environmental factors and individual behaviors
contributions are much, much larger than depicted, while health
literacy is much lower than in commercial and Medicare insurance.

I think the ACA - I'm in a rural blue state - has created a 'new' cohort of
'patients' heretofore unstudied in the US because they were never
before insured. Treating the social/environmental + individual behaviors
in a traditional medical model is too costly and doesn't address the root cause
of the distress. The big insurer in OR found this out the hard way and
has had to scale back operations due to losses sustained due to an
underestimation of the cost of caring for these newly insured as well as
the Feds risk corridor recalculations.

If you really want to treat this cohort it can't be through the traditional
PA for narcs > IPM doc for injections model. That model makes money
for the IPM doc but it's costly and not beneficial to these patients. The
CCO's know this and the hospital systems are becoming aware. In my
area a hospital system shut this model down, closed the pain clinic, because
the primary care docs and hospital admin realized that pills and shots
wasn't working, the patients never got better and stayed on opioids. Now
the same hospital system is trying to come up with something that
will work, and find someone willing to staff it.

This is pain management as a money saver, not money maker. That's
an entirely different culture than what IPM fellowships inculcate.

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Pro's and Con's of accepting Medicaid...