Overcoming Barriers to the Implementation of Integrated Musculoskeletal Pain Management Programs: A Multi-Stakeholder Qualitative Study

Journal Article

Overcoming Barriers to the Implementation of Integrated Musculoskeletal Pain Management Programs: A Multi-Stakeholder Qualitative Study

Published date

May 5, 2023

Highlights

  • Integrated pain management (IPM) programs are highly variable in funding, structure, services offered, and populations served.
  • IPM programs have innovative ways to overcome payment, care coordination and regulatory hurdles.
  • Lessons learned from existing programs can inform efforts to expand implementation of IPM.
  • Program success is dependent on imparting meaningful benefits to a broad range of stakeholders.
  • Payers and health systems need “proof of concept” examples that support IPM return on investment.

 

Abstract

Integrated pain management (IPM) programs can help to reduce the substantial population health burden of musculoskeletal pain, but are poorly implemented. Lessons learned from existing programs can inform efforts to expand IPM implementation. This qualitative study describes how health care systems, payers, providers, health policy researchers, and other stakeholders are overcoming barriers to developing and sustaining IPM programs in real-world settings. Primary data were collected February 2020 through September 2021 from a multi-sector expert panel of 25 stakeholders, 53 expert interviews representing 30 distinct IPM programs across the United States, and 4 original case studies of exemplar IPM programs. We use a consensual team-based approach to systematically analyze qualitative findings. We identified 4 major themes around challenges and potential solutions for implementing IPM programs: navigating coverage, payment, and reimbursement; enacting organizational change; making a business case to stakeholders; and overcoming regulatory hurdles. Strategies to address payment challenges included use of group visits, linked visits between billable and nonbillable providers, and development of value-based payment models. Organizational change strategies included engagement of clinical and administrative champions and co-location of services. Business case strategies involved demonstrating the ability to initially break even and potential to reduce downstream costs, while improving nonfinancial outcomes like patient satisfaction and provider burnout. Regulatory hurdles were overcome with innovative credentialing methods by leveraging available waivers and managed care contracting to expand access to IPM services. Lessons from existing programs provide direction on to grow and support such IPM delivery models across a variety of settings.

 

Perspective

Integrated pain management (IPM) programs face numerous implementation challenges related to payment, organizational change, care coordination, and regulatory requirements. Drawing on real-world experiences of existing programs and from diverse IPM stakeholders, we outline actionable strategies that health care systems, providers, and payers can use to expand implementation of these programs.

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Duke-Margolis Affiliated Authors

Trevor Lentz

Trevor Lentz, PhD

Assistant Professor in Orthopaedic Surgery
Margolis Core Faculty

Jonathan Gonzalez-Smith

Jonathan Gonzalez-Smith, MPAff

Assistant Research Director

Katie Huber

Katie Huber, MPH

Policy Research Associate

Christine Goertz

Christine Goertz, DC, PhD

Professor of Orthopaedic Surgery
Margolis Core Faculty

William K. Bleser - Margolis headhot

William K. Bleser, PhD, MSPH

Research Director, Health Care Transformation for Social Needs and Health Equity
Senior Team Member
Anti-Racism and Equity Committee Member

Robert Saunders

Robert Saunders, PhD

Senior Research Director, Health Care Transformation
Adjunct Associate Professor
Executive Team Member
Margolis Core Faculty