The Innovation Equation for Pain

There are two options when faced with a choice – maintain the status quo or do something different. Choosing the status quo means no change by continuing to do what was done previously with likely the same outcome (and if those results aren’t beneficial, Einstein was right). Choosing to do something different opens up the possibility of making the wrong choice, which can be so scary that some never make the logical leap. The synergy between desiring a different outcome and choosing to change creates the opportunity for innovation, which can be both exhilarating (by driving different outcomes in a unique way) and confusing (which innovation / innovator is the right one for this circumstance). 

As an example, consider the wake-up call about the over-prescribing of opioids and other painkillers. Workers’ compensation PBM drug trend reports confirm that opioid prescribing reached its peak in 2014 with utilization declining by double-digits each year since then. In contrast, the use of NSAIDs, gabapentinoids (off-label) and compounds / topicals increased dramatically. So did non-pharma options like TENS units, spinal cord stimulators and virtual reality therapy plus modalities such as physical therapy, acupuncture and psychotherapy and paradigm shifts like claims advocacy and biopsychosocial treatment models. A new batch of inventions (or derivations) popped up in the marketplace, each promising to reduce or remove the need for prescription painkillers. The number of vendors likewise blossomed, each making their claims at conferences, in magazines and on sales calls. 

All of those options made the choices by a claims adjuster more difficult for what should be made available to injured workers to improve health and financial outcomes. How can non-medical people responsible for overseeing medical decisions best decide what’s in and what’s out? 

Here’s the answer. Partner with vendors that have mastered the Innovation Equation, and offer a product or service that answers “yes” to the following variables:

• Is it Safe? The benefits outweigh the risks so there is little possibility for harm to the patient.
• Does it Work? There is objective and subjective proof that it works as advertised with a demonstrated Return on Investment.
• Is it Easy to Use? There is no / low learning curve for the patient to start using it and the buyer to pay for it.
• Is it a Good Experience? The interaction between the vendor and the patient, physician and buyer is positive.

The Institute for Healthcare Improvement calls it the “Triple Aim” of healthcare: Improving patient experience (care), improving the health of populations overall (health) and reducing the per capita costs of healthcare (cost).

Future articles will dive into the details of each of those variables, but here are some thoughts on how to “solve for” the Innovation Equation:

Step One: Ask for the evidence that validates the efficacy. This evidence can come via two methods – anecdotal and/or clinical studies. Anecdotes are powerful because they typically are in the form of personal stories that elicit emotion but focus only on successes (so they might not tell the whole story). Clinical studies are meant to assess effectiveness with as little bias as possible but are impersonal. While enough similar anecdotes can create “real world data” (something the FDA is increasingly supportive of), the highest standard are clinical studies published by a variety of sources that confirm the findings or foundational science. In other words, dig deeper than the salesperson’s claims. 

Step Two: Using the levels of evidence in Step One, a claims adjuster (or their clinical peers) can narrow the list of viable products. It’s important then to identify specific circumstances where each solution should be tried. Spoiler alert … 100 percent is the wrong answer … but a pilot might be. Everyone involved – including the vendor – should recognize that each situation is different (pre-surgical, post-surgical rehab, unresolved chronic pain, etc.) and each individual is different (physical and psychosocial comorbidities, body chemistry, resilience level, etc.) Define how to identify the candidates most likely to succeed. Document a clear and concise process for consistent use by all stakeholders, including the information needed to drive an approval or denial. Identify clear methods for measuring success before the very first use. If it is a competitive situation where multiple vendors are vying to provide similar services, ensure the measurement process and data are identical for each participant. Then launch with all stakeholders clear on the goals and timeline, learn from experience and adjust as necessary.

Step Three: Provide adequate time to determine if the modality can live up to the promised positive outcomes. Finding the “goldilocks” timeframe – not too short and not too long – comes from an investment in preparation, ongoing communication among stakeholders and the ability to adjust as results are reported. Sometimes defeat can be snatched out of the jaws of victory with a premature analysis timeframe or by waiting too long to apply to a broader audience. 

Just as every human being is unique, so are the circumstances around their work comp claim. There is not a single pain management tool that works for everyone, and the more that fact is acknowledged the higher the likelihood of making a positive difference. Medical treatment can be instinctual but the selection from among various options should be methodical and based on evidence. Incorporating the three steps above will help the selection process be more precise and productive and reduce the cloud of uncertainty for a claims team.

Authors:

Gerry Stanley, M.D. is the Senior Vice President and Chief Medical Officer for Harvard MedTech with a passion for healthcare transformation. Dr. Stanley has a deep expertise in population health management, self-insured health plan management, medical consumerism and direct to employer network enablement. As a third-generation family physician he has grown up in the evolution of health care delivery systems and is an active proponent of utilizing data and analytics to educate clinicians about the power of managing patient populations one clinical interaction at a time. He describes the opportunity to find a solution for the growing opioid epidemic and create a resource for clinicians to treat this condition as “a once in a lifetime opportunity to solve a societal need." 

Mark Pew is an award-winning international speaker, blogger, author and jurisdictional advisor. He has focused on the intersection of chronic pain and appropriate treatment since 2003. He is the driving force and co-founder of The Transitions and launched The RxProfessor consulting practice in August 2021. He has been a member of the Advisory Board for Harvard MedTech since October 2019.

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