Chapter 3 Case Study
Evidence-Based Medicine and Accountable Care Organization Performance:
Lower Back Pain
Sally Campion, the manager of Vincent Valley Health’s (VVH) accountable care organization (ACO), has just completed a cost analysis of its members with lower back pain. Based on comparative data, she felt her ACO’s costs were too high—especially for surgical services. However, this analysis project was one of her first that directly confronted practice variation. She was aware that many physicians on her medical staff had different clinical judgements about the most appropriate treatments for back pain. As a result, she formed a team to do deeper analysis of her data and to examine all treatment options before she would begin a project to deliver the most cost-effective, high-quality care.
Her team consisted of Dr. Ira Moscone, chief medical officer; Dr. Robert Munsey, chief of family medicine; Phyllis Colson, nursing director for surgery; and Sameer Inanpudi, director of business intelligence.
Issues she felt needed research included the following:
- What are well-accepted guidelines for treating lower back pain from nationally respected sources such as the Cochrane Institute, or peer-reviewed articles in Pub Med?
- What alternatives are available for pain management outside of medications (e.g., alternative and functional medicine)?
- Could “shared decision making” play a role in any new therapeutic approaches?
- Would a value purchasing system be helpful to maintain or increase VVH revenue?
- What would you recommend as an evidence-based approach to improving lower back-pain care at VVH?