A call to action: Expand coverage for adults with chronic pain

This week the FDA is considering expanding booster shot coverage to all adults, and a leading patient advocate says, “it’s about time”.

Patients on the substance abuse side of healthcare historically need be checked for cancer, be vaccinated against tetanus, meningitis and polio, and be checked for certain behavioral or psychiatric conditions and current medications, to get access to health care. Now, it’s time to cover all adult requirements.

In a 2015 survey, the Patient-Focused Medical Home (PBMH) of 600 adult patients found that many adults over the age of 40 were eligible for medication therapy, but not for medical equipment or basic follow-up care like visits to the emergency room and outpatient diagnosis and treatment of disease, and insufficient follow-up care is a major reason why many patients don’t realize they are sick. Inadequate follow-up and healthcare access for the 70 percent of Americans currently eligible for opioid medication treatments for non-cancer pain, according to a study published in the Journal of Psychiatric Nursing, can cause the side effects of opioid use without effective, or even alternative, pain management therapies.

As CDC Director Dr. Robert Redfield recommends: “Before we start attacking an infection, we first have to investigate how we got it. Once we understand the cause, we can design a treatment plan, one that involves prevention, education, and monitoring. With chronic pain, we also have to understand the root cause to improve our treatment.”

In the United States, approximately 50 million people, one-third of the adult population, suffer from chronic pain. Addressing the needs of that growing population requires effective, accountable, and accessible health care. The Patient-Focused Medical Home (PBMH) is one approach that offers affordable healthcare solutions to empower patients with health information, link them to appropriate services, and facilitate the safe and proper use of the services provided. It includes the concept of conducting routine and thorough diagnoses and diagnosis screenings to ensure adequate and appropriate care is provided; conducting screening and outreach, such as counseling, in order to connect patients with appropriate therapies; ensuring that patients are safe while they are in the care of medical professionals; and implementing financial incentives to encourage incentives for appropriate healthcare resources utilization and patient satisfaction.

“Most people think that when it comes to chronic pain, insurance coverage ends at age 65, but you don’t,” says Janet Ruiz, MD, MSPH, President and CEO of CHAD USA, a national patient advocacy organization. “CHAD will continue to do all we can to protect the 18 million Americans over the age of 40 without current chronic pain management support and coverage for supplemental medications to increase their chances of receiving the treatment and preventive care that will allow them to lead healthier, more productive lives.”

As the CDC reports, chronic pain often interferes with sleep, cause physical and psychological pain, and can result in accidents and other health issues. Given the increasing prevalence of chronic pain among the U.S. population, the financial burden of chronically ill pain patients weighing on our healthcare system is clear. That’s why expansion of Medicaid eligibility, expanded PBMH coverage, and enhanced national guidelines to ensure all adults are eligible for needed PBMH care is a critical step forward.

Jeff Klapper is Chief Medical Officer and Vice President for Outcomes Research and Improvement at the Robert Wood Johnson Foundation. Jeff serves on the board of advisors of CHAD USA, and supports the research mission and policy initiatives of CHAD USA in Washington, D.C.

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