Jon Porter describes the people under his care as heroes: They fight daily battles against debilitating backache, arthritis, fibromyalgia, systemic inflammatory conditions and chronic headaches, braving unrelenting pain to care for loved ones and manage their lives. For years, these individuals fought their pain with traditional medical weapons — opioid medications, steroid injections, surgeries — bringing short-term relief and, for some, addiction, depression and anguish. Still, Porter says, they persevere in quests for respite, dignity and joy.
Porter, medical director of the UVM Medical Center Comprehensive Pain Program (CPP), knows that yoga, nutrition, mindfulness, massage and acupuncture can help people manage pain more effectively than traditional approaches. Paying for these therapies is tricky though: For health insurance providers, covering the costs of surgeries, shots and pills comes easier.
To change this paradigm, Porter and a team of UVM researchers gather qualitative data from people participating in 13-weeks of evidence-based integrative therapies paid for Blue Cross and Blue Shield of Vermont (Blue Cross). The program aims to support participants’ self-efficacy and provide tools for coping with pain, while measuring health improvements and impacts on health care spending.
“We want to demonstrate to society the value of this novel approach to pain,” Porter said. “Blue Cross wants to know if it works. They want their subscribers to be healthier and to reduce costs.”
The project models value-based care, a payment system offering financial incentives to medical providers for meeting health outcomes. It’s opposite of fee-for-service, the traditional model that reimburses providers for each procedure. If it works, Blue Cross may cover integrative therapies more broadly, and other payers may follow suit.
Study participants attend group meetings and receive therapies at a clinic in South Burlington. The clinic includes a studio for gentle movement, teaching kitchen for culinary medicine classes and rooms for massage, acupuncture, Reiki, physical therapy and substance abuse counseling.
The program is continuous, with cohorts running consecutively. Participants complete surveys assessing their pain’s intensity and impacts on daily life, fatigue, anxiety, ability to participate in social roles and sleep disturbance. The surveys also gauge self-compassion, confidence and resilience.
Preliminary data show significant changes in key areas: Participants report reduced pain, improved physical function, better sleep and fewer visits to primary care and emergency departments for pain relief.
“The results show a statistically significant improvement in patient outcomes,” said Adam Atherly, director of UVM’s Center for Health Services Research at the Larner College of Medicine. He collaborates with Porter and Janet Kahn, a research assistant professor at Larner and massage therapist at CPP, on the study. Atherly evaluates the survey results and has prepared a manuscript for peer review.
“The research asks, ‘does this program work at UVM Medical Center?’ Early evidence shows that it does. People are getting better,” Atherly said. “Blue Cross has been looking at the claims data, and they see it’s working. As the payer, they are satisfied that it’s a reasonable investment.” The next question is, can it be replicated?”
“We’re helping individuals feel more hopeful and confident in working with their pain. The cost savings will be huge, and cumulative,” said Porter. “If we can help someone in their 30's or 40's find ways to deal with their pain, it will help them for decades.”