VT Pilots to Manage Chronic Pain

Vermont Governor Phil Scott http://governor.vermont.gov is confronting the opioid epidemic in his state. In his testimony before Congress, the Governor outlined Vermont’s focus on Prevention, Recovery, Treatment, and Enforcement.

The “Vermont All-Payer Accountable Care Organization Model Agreement” provides flexibility for the state to include Medicare in potential solutions to this crises and in return, expects that the state will reduce drug overdose deaths.

To move forward, the state convened a working group of payers and clinical leaders to help design pilot prototypes seeking more integrated and comprehensive approaches to the management of pain.

The Department of Vermont Health Access http://ovha.vermont.gov issued a Request for Proposal (RFP) on August 27, 2018, seeking proposals to pilot test alternative approaches to use to manage chronic pain.

The pilots will test new services that will provide coordinated specialists, Complementary and Alternative treatment Modalities (CAM), and provide ongoing enhanced primary care for Medicaid Members. Many of these members are experiencing complex pain conditions for three months or longer duration.

The idea outlined in the RFP is based on the hypothesis that non-pharmacological and non-surgical treatments for chronic pain can serve as the foundation for effective treatment.  However, while the evidence is growing that mental health, physical conditioning, and CAMs are central to restoring functioning for patients with complex pain conditions, the practice of these disciplines may not always entail rigorous standards of care and consistency that health plans require.

The pilots will help identify the services and arrangements to:

  • Produce the greatest impact on member outcomes by decreasing the impact of pain on psychological and physical function, and increase self-efficacy
  • Produce pilots that will be feasibly replicable and scalable for statewide implementation
  • Impact on reducing the total cost of care to help assure funding sustainability over a long period

 

Pending the results of the pilot tests, the state may seek policy and appropriation authority to use approaches that will prove most effective to state-wide implementation. Proposals for the pilot programs will be restricted to currently enrolled Vermont Medicaid providers.

It was also found that providers face significant challenges and barriers to offer patients appropriate and successful care for chronic pain conditions. The care management and panel management services required to organize care across disciplines are not adequately reimbursed. The time need for transdisciplinary teams to meet, formulate treatment plans, and monitor progress is also not sufficiently supported within payment systems.

Go to http://blueprintforhealth.vermont.gov/news/rfp-chronic-pain-pilots for more information. The RFP response id due September 28, 2018.

 

 

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