August 20, 2019

How Benefits Professionals Are Measuring and Addressing Low Back Pain

Artemis Health’s analytical team keeps a close eye on hot topics for our clients. Opioid abuse, diabetes case management, wellness program ROI, risk scores—you name it, we’ve looked into it. Clients care about these issues and more not just because they affect the rising cost of coverage, but also because they affect an employee’s quality of life.

A recent journal article in the National Institutes of Health identified low back pain as the leading cause of disability in U.S. adults, and a common reason for missing work.

“An estimated 149 million days of work per year are lost due to LBP (low back pain). The condition is also costly with total costs estimated to be between 100–200 billion dollars annually, two-thirds of which are due to decreased wages and productivity.”

It’s a difficult condition to treat, and patients often see multiple doctors, physical therapists, chiropractors, and surgeons before they find relief. And that’s only if they do. Low back pain can be a chronic condition that patients deal with for years, and it can also lead to disability claims.

One of our clients wanted to look at the impact low back pain was having on their population, and they wanted to see how members with this condition compared to those without. We used the Cohorts app in the Artemis Platform to conduct this analysis.

First step: we built a “cohort” (a group of members) that we flagged as those who had low back pain related claims. We found a cohort of 1,456 members with this condition based on Rx and med claims. We also found out what this meant for the employer’s claims spending:

Artemis Platform screenshot.

We found that those with low back pain account for 21% of total plan costs in the analysis period (1 year in this case).

Next, we compared those in our low back pain cohort against patients who were outside of the cohort (i.e., those who did not have any claims for low back pain in the analysis period). We found that our LBP cohort were costing more than double than other members!

Platform screenshot.

We also wanted to see if the current opioid crisis in the U.S. was affecting these members. Opioids are commonly prescribed for low back pain relief, though their effectiveness is in doubt for many medical professionals. Indeed, a recent study published in the journal JAMA Internal Medicine suggests that patients cannot tell the difference between the pain relief offered by opioids vs. a placebo.

“Of the 20 [clinical] trials, 17 compared [the pain relief from] opioids with a placebo, and three compared opioids with each other.”

Of our LBP cohort, we found 417 had been prescribed opioids. That’s nearly 30%.

Platform screenshot.

The Artemis Platform makes it easy to drill down to the individual claim level to see which drugs are being prescribed. You can see in this graph that 360 of our cohort of 417 are taking either Oxycodone-Acetaminophen or Hydrocodone-Acetaminophen.

Platform screenshot.

Finally, we looked across a few different benefits feeds to get a better sense for how these members stack up against the wider employee population. While their Rx costs and risk scores were not higher than other members, we did find one metric where the LBP members were significantly higher than the norm—absence days.

Platform screenshot.

Employers who find these insights in their data have a number of avenues to take action. For low back pain, here are a few they might consider:

  • Adjusting their formulary to require doctor pre-authorization on opioid refills after a certain treatment period
  • Adding physical therapy services at their on-site clinics
  • Communicating with members at risk for opioids abuse through the carrier to offer substance abuse benefits or EAP benefits
  • Encouraging participation in wellness programs or exercise challenges

For our clients, it’s not enough to simply find this information in their benefits data—they want to take action to help their members get the most from their benefit programs. That’s the power of the Artemis solution.

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