Dr. Mino is a fellowship-trained spine surgeon and a member of the North American Spine Society and American Academy of Orthopaedic Surgeons. He practiced spien care and surgery for 17 years.
Q: What was the impetus for developing this spine care program?
Dr. David Mino: The state of Wyoming, which is a Cigna client, has one of the highest rates of spine and back pain problems nationally. This was confirmed by Cigna data as well as a third party. The state of Wyoming expressed interest in developing a program for improving spine health and care. Some of the procedure costs were on the high end as well.
Q: How was the program developed?
DM: We wanted to figure out how to give the people of Wyoming the best care possible for back pain while also lowering the cost of care. Initially we met with our clients for the state of Wyoming and then sat down locally with the leadership at the medical center in Casper to discuss the program. We worked for a while putting together our thoughts, looking at the literature and studying the needs of our customers in the area. We acquired evidence based guidelines.
It was a very collaborative approach to providing the early access for appropriate care within one business day. This includes physician evaluations, physical therapy, education and self management for patients with individual back pain. Another key component of the program was minimizing work time loss.
Q: Who manages the program and directs patients when they enter?
DM: There is a clinic we've set up specifically in Casper that is managed by a physiatrist who is the gatekeeper. He promoted education of the program within the community. We also work with primary care physicians, rehabilitation staff and others in the local community to disseminate the program. We want to work with primary care physicians and help them provide the typical care to their patients.
Q: What unique aspects of the program have made it successful?
DM: This program only began this past year and so far we are hearing good feedback. It's a very customer-centric program which focuses on patient satisfaction. That has been a key metric of the program, along with developing an interdisciplinary approach to care. We are able to feed data back into the program as well.
One of the key areas we are looking at is early identification of individuals experiencing back pain and experiencing psychological or social issues that might be contributing to the back pain. This program includes the support of local psychologists in Casper and Cigna also brings services to the table, like pain management and conditioning support programs. There is an emphasis to really enhance care decision making for our customers. In coordination of those services through the gate keeper physiatrist we are able to provide effective management and direction for our customers.
Those who have gone through the program show very high satisfaction and at the end they have not returned for further care; they continue managing on their own. Thus far we have been primarily seeing individuals with acute back pain and typically they are seen by the physical therapist for three or four visits and the physiatrist for one or two.
Q: How does the program cut costs while maintaining quality of care?
DM: The focus of the program is to provide the right care at the right place at the right time with the right provider. The program is based on following evidence-based guidelines. Early physical therapy intervention provides education and management techniques while avoiding unnecessary costs including emergency room visits and advanced imaging, when those may not be able to accurately manage the condition.
We are trying to avoid over dependency on the healthcare system for back pain, which would include multiple medications and non-evidence based interventions. It's really about having the customer seen in the right place at the right time.
Q: Where do you see the program headed in the future?
DM: The early success of the program is really creating interest with other Cigna clients and employers to develop a similar program for their employees. There is also interest from other provider groups that really see the benefit and value of a coordinated and collaborative spine program for their patients and our customers.
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Lowering Spine Care Costs in Wyoming: Q&A With Cigna's Dr. David Mino FeaturedWritten by Laura Dyrda | Thursday, 24 January 2013 14:25
Cigna HealthCare has partnered with Wyoming Neuroscience and Spine and Elkhorn Rehabilitation Hospital in Casper, Wyo., to create a program that increases quality and lowers cost for patients in the area: Pathway to Improved Health for Back Pain. The State of Wyoming is among the highest spenders when it comes to spine and back pain, and related claims which nearly doubled from 2007 to 2009. Here, David E. Mino, MD, MBA, Cigna HealthCare National Medical Director, Orthopedic Surgery and spinal disorders, discusses the program and where it's headed in the future.
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