4196 Putting Spine Care in the Right Hands
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Dynamic Chiropractic – March 1, 2019, Vol. 37, Issue 03

Putting Spine Care in the Right Hands

By Editorial Staff

With the guideline clarity we have, the current state of affairs when it comes to spine care is unacceptable. "No more research, no more data; just make this happen." That's the call to action urged by David Elton, DC, senior VP of clinical programs at OptumHealth, in a powerful presentation at the National Academies of Sciences, Engineering and Medicine in Washington, D.C.

Dr. Elton presented during a recent two-day workshop at the NASEM titled: "The Role of Nonpharmacological Approaches to Pain Management," outlining the tremendous efficacy and cost savings associated with chiropractic and other forms of conservative care for spinal episodes; and the two-year plan to impact the 125 million consumers – in the majority of U.S. hospitals, Fortune 100 employers, health plans, and life sciences organizations in all 50 states and the District of Columbia – OptumHealth serves.

Here are some of the key points from Dr. Elton's presentation, which took place during session III of the workshop – "Policies to Promote Evidence-Based Nonpharmacological Approaches."

spine care - Copyright – Stock Photo / Register Mark Clearly the Best Choice ... But Not Used Enough

  • "The pathway that's most aligned with all prevailing guidelines [is] when patients start with chiro / PT / acupuncture. ... You receive the services you should, you avoid the services you shouldn't, imaging is aligned, total episode cost is lowest."
  • Average per-episode costs for care that begins with a DC / PT / acupuncturist is only $619, compared with $728 for primary care and $1,728 for specialist care. If you make the initial investment in chiropractic / PT / acupuncture, significant total-episode savings occur.
  • However, first contact with a DC / PT / acupuncturist only occurs in 30 percent of cases, compared to 70 percent for primary (30 percent) or specialist (40 percent) care.

Road to Change: Optum's Plan

Optum's two-year goal is to take front-door access to conservative care from 30 percent to 50-plus percent and timely referrals from self-selected medical providers from 2 percent to 10-plus percent. According to Dr. Elton, "[T]he actuaries have done the work, it's presented at the actuarial conference, the net of the increased conservative care will take out about 230 million in annual medical expenditures and reduce opiate prescribing for back pain by 25-26 percent." Here's how Optum plans to achieve its goal:

  • Increase referrals to conservative care by waiving out-of-pocket costs (co-pays or deductibles) for consumers who access conservative care options for back pain. (These changes are included in Optum's 2019-20 benefit plans, according to Dr. Elton.)
  • Broad-based public-service communication efforts to help employers and patients become better consumers of care for spine-related episodes.
  • Provide tools and resources to help patients understand their options / preferences, match up with the appropriate conservative care provider and easily schedule an appointment.
  • Connect the dots from primary care to conservative care offices so medical physicians can streamline patient referrals to conservative care providers.

Editor's Note: Dr. Elton's presentation is available on the NASEM website. To learn more about OptumHealth, visit www.optum.com. DC's publisher, Donald Petersen Jr., discusses more aspects of Optum's action plan and how they impact the chiropractic profession in this month's Report of Findings.

Dynamic Chiropractic editorial staff members research, investigate and write articles for the publication on an ongoing basis. To contact the Editorial Department or submit an article of your own for consideration, email .

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