Applying the Stepped Care Model to Chronic Pain Management


Heidi Clune, MD; William Gersch, PharmD; Laurence Hren, MBA

Introduction: Chronic pain management requires a resource-intensive multidisciplinary approach. At Kaiser Permanente Colorado (KPCO), the Integrated Pain Service (IPS) needed to devise a system that increased access to pain specialists to improve patient safety and chronic pain management throughout the Region, using a limited number of fulltime employees.
Methods: KPCO implemented a stepped-care model for chronic pain management to direct members to more intensive resource interventions using a risk stratification model to predict the risk of an opioid-related overdose.
Results: This approach also increased access to pain specialists from about 3500 members at a limited number of clinics to all 15,000 chronic opioid therapy members and to any member with a chronic pain concern at KPCO. In addition to improved access, the implementation of the stepped-care model resulted in 421 chart reviews in a 1-year period, a greater volume than IPS was able to manage previously. The stepped-care model also resulted in a 41% decrease in overall opioid dose, a 33% reduction in concurrent opioid and benzodiazepine prescribing, a 40% improvement in urine drug screen monitoring, and a 16% reduction in the number of high-risk chronic opioid therapy members. There was also a favorable impact on health care utilization with a 25% reduction in per member per month cost, driven mainly by a reduction in ambulatory care appointments, inpatient hospitalizations, and emergency room visits.
Discussion: The implementation of the stepped care model for chronic pain management at KPCO improved access and member safety while decreasing health care utilization and remaining full-time equivalent neutral.

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