Exemplary Integrated Pain Management Programs: University of Vermont Medical Center Comprehensive Pain Program

Background
The University of Vermont Medical Center Comprehensive Pain Program (CPP) was established in 2017 to improve treatment options for patients struggling with opioid use for musculoskeletal pain conditions. CPP developed “Partners Aligned in Transformative Healing” (PATH), a customized intensive 13-week outpatient program that includes an array of integrative therapies to optimize patients’ function and maximize their well-being. Through a partnership with BlueCross BlueShield Vermont (BCBSVT), the PATH program is supported by bundled payments that allow BCBSVT members to access a variety of CPP services for a fixed price.

Care Delivery Approach
CPP created the PATH program to equip patients with tools to improve pain self-management, offering services traditionally inaccessible through commercial or public Fee-For-Services (FFS) insurance models. The integrated care team includes physicians, psychiatrists, psychologically informed physical therapists, occupational therapists, clinical dieticians, chef educators, movement specialists, acupuncturists, Reiki practitioners and massage therapists.

Results to Date

• Quantitative assessment of patient-reported data shows statistically significant improvements in patient satisfaction, well-being, chronic pain acceptance, ability to recover from stress, self-compassion, physical function, and depression following the program.
• Analysis of medical and pharmacy claims from the twelve months prior to and following participation in the PATH program has shown reductions in health care costs and utilization.
• Reduced Emergency Department (ED) visits (all-cause and pain-related) for patients in six cohorts that participated in the PATH program for at least one month. 

Challenges with Implementation
CPP encountered a variety of challenges establishing and implementing the PATH program. Major challenges included educating referring clinicians about the program, getting patients to commit to completing a group oriented intensive program, administrative difficulties setting up the coding and back-office support for the bundle, technological infrastructure to streamline data collection and sharing, cultural challenges integrating practitioners that offer integrative services into the health system, and regulatory limitations on provider scope of practice. CPP is also looking to expand eligibility for the PATH program but has had difficulty getting the program covered by additional payers due to a range of issues, including behavioral health carveout models that limit coverage for integrated services.

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