Implementation with a subset of ACO primary care providers led to a 28% reduction in spine episode costs with 1 year versus control (same ACO) which saw an 8% increase, a 36% difference
12% decrease in commerical PMPM spine costs within 1 year... not against the trend
15% lower PMPM spine costs inpathway trained PCMH providers compared to comparable PCMH without training
Pathway trained DCs and PTs had 41% lower episode costs than untrained DCs and PTs plan-wide, and demonstrated statistically significant shift toward biopsychosocial approach to spine
HOSPITAL W/VALUE BASED CARE
Reduce admissions for non-surgical back pain (DRG552) from 130/yr to 36/yr
95% "excellent" rating by patients
Reduced repeat visit to E.R. for back pain from 26% to 6%
STRATEGIC CLAIMS REVIEW
Post payment audit with provider counseling 3:1 ROI
Post payment audit plus educational program >10:1 ROI