A report from the University of Michigan (U of M) found that patients on opioid treatments are not receiving adequate care due to significant administrative and litigatory barriers to primary care clinicians and specialty pain clinics. In response to these findings, researchers gathered a multidisciplinary expert panel to discuss ways to address these barriers.
The panel generated 11 recommendations under three overarching themes. They include improved care models to better support patients, enhanced provider education and training, and implementation of practices to reduce racial bias and inequities.
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The report found 40% of primary care clinicians were unwilling to accept new patients, but 51% of specialty pain clinics required referrals from primary care physicians. The 11 recommendations from the panel are potential strategies to increase access to care for those on opioid treatments.
The panel of 24 experts met twice between September 2020 and January 2021 and provided multiple rounds of feedback between official meetings. Panelists included policymakers, providers, insurers, patient advocates, and researchers. The full list can be seen here.
The group gave overall ratings to their 11 recommendations based on three characteristics: feasibility, impact, and importance. Below is a table outlining their recommendations, their rankings, and averages of their ranks for the three characteristics.
The first recommendation to establish reimbursement models for chronic pain attempts to solve the issue of physician incentive. According to the panel discussion, visits for chronic pain are complex and require more time from the physician.
In Michigan’s current model, health care professionals on pain-related care teams do not receive reimbursement specifically for their services, which disincentivizes physicians from taking on time-sensitive patients. The panel said a value-based model could incentivize physicians to take on more opioid patients while improving quality of care. However, some panelists cast doubt on insurers’ willingness to move to a value-based model. The panel said:
“Similarly, some panelists thought insurers might be reluctant to increase reimbursement due to the cost or would want robust evidence of cost-effectiveness. Interestingly, panelists with insurance expertise were more confident than other panelists that insurers would, in fact, be willing to shift their existing reimbursement structures to drive provider behavior.”
The highest priority recommendation in the provider education theme — the third overall recommendation — seeks to train new members, like social workers, to help address biopsychosocial concerns and attempts to provide more multimodal treatment among patients taking opioids.
These additional staff would provide support for opioid therapy and behavioral health interventions to address the full person and their individual needs. However, panelists were concerned about hiring staff to fill these roles, which could make implementation of these programs difficult. Existing reimbursement models do not typically cover such assistance, and the model would need to change so these workers can be reimbursed for their time.
The highest ranked recommendation related to addressing racial bias and inequities — the seventh overall recommendation — would require mandatory data reporting. It aims to find more data on how pain management and prescriptions differ across different races and ethnicities. The panel said:
“Systematic protocols, such as screening and management checklists, may reduce individual provider biases in pain treatment and variation across providers. Mandatory reporting of treatment data may increase data transparency with respect to racial outcomes and demonstrate potential areas for improvement.”
The panel hopes these recommendations can be useful to policymakers, stakeholders, and legislators as they work to improve access to care.