Rhode Island integrative pain Medicaid pilot shows significant savings
April 11, 2017
by John Weeks, Publisher/Editor of The Integrator Blog News and ReportsThe results are off the charts, according to Richard Sarnat, MD, the co-founder of Advanced Medicine Integration Group (AMI) as he summarized the outcomes of the distinctive holistic nurse-directed integrative pain pilot project in Rhode Island. Sarnat's firm managed the pilot for two of the state’s managed care plans, Neighborhood Health Plan of Rhode Island (NHPRI) and United HealthCare of New England.AMI, led by Sarnat and his co-founder and board chair James Zechman, recently had their pilot reported in the March 2017 white paper from the Foundation of Chiropractic Progress (F4CP), Chiropractic: A Key to America’s Opioid Exit Strategy. The AMI program and its outcomes were used as example of why U.S. opioid strategy should move toward integrative strategies.The AMI program was initiated through Rhode Island's Communities of Care program. A goal of the initiative was to significantly lower use of emergency room (ER) services, a major driver in pain-related healthcare costs in the outpatient Medicaid population. This population was also associated with high opioid usage.Under the program, high-risk users—defined as those who had four or more ER visits in the prior 12-month period—were eligible to receive acupuncture, chiropractic, and massage services. The two managed care entities noted above developed participation criterion and contracted with AMI for its Integrated Chronic Pain Program (ICPP). In AMI’s model, care coordination is through a holistic nurse care manager who helped triage patients between primary care, behavioral health, and licensed complementary and alternative medicine practitioners. The outcomes were:
- Reduced per member per year (PMPY) total average medical costs by 27 percent
- Decreased the average number of ER visits by 61 percent
- Lowered the number of average total prescriptions by 63 percent
- Reduced the average number of opioid scripts by 86 percent.
- Every $1 spent on CAM services and program fees resulted in $2.41 of medical expense savings.
- Hospital admissions decreased by 60 percent
- Hospital days decreased by 59 percent
- Outpatient procedures decreased by 62 percent
- Pharmaceutical costs decreased by 56 percent