1. Presentation of AMI’s Integrated Chronic Pain Program (ICPP) to CTC-RI’s Clinical Strategy and Cost Committee
Richard Sarnat, M.D. – President
Linda Eldridge, MBA – Vice President Client Services
November 18, 2016

2. IMDIS® IMDIS® - Reliable standardized actionable data.
Integrated Medical Data Information System
IMDIS® - Reliable standardized actionable data.
Two Unique Platforms
Integrated Chronic Pain
Physical Medicine – Chiropractic/PT/OT Management
HIPAA Compliant
Nearly 2,000,000 patient records

3. “Not seeing the Forest through the Trees” Scientific Reductionism
C.J. recently enrolled with AMI.
Currently enrolled in a disease management program for asthma.
Her pain and fatigue levels were “seven” while depression was a “six.”
When asked, she reported she was being treated by her physicians for fibromyalgia, back and neck pain and headaches and migraines.
18 month timeframe identified 230 claims  
The highest number of paid claims by diagnosis was for abdominal pain, with an additional 7 professional claims for sprains and strains. The health plan had overlooked the patients low unit-cost professional claims related to pain and had focused only on the higher unit-cost institutional claims related to ER utilization and asthma.

4. The Chronic Pain Patient – the antithesis of the single variable.
15 – 20 pharmaceuticals, including opiates.
5+ co-morbidities
High % of substance abuse
High % of behavioral health issues
High % of psycho-social barriers

5. Requested data fields to produce usable information and results
AMI Does All the Work
Requested data fields to produce usable information and results
Claims
Claim/Bill Type
Claim number
Patient ID
Begin date
End date
Provider ID*
Diagnosis codes
Paid amounts
Claim Status*Lines
Claim line
End Date
Procedure code
Procedure modifiers*
Revenue Codes*
Claim Line Status* RX
Patient ID
Provider
Date of service
NDC
Quantity
Paid Amounts
Claim Status*
Lookup tables
One table for each of the elements flagged above with “*”
Lookup value
Description of value

6. Your Paid Claims Data In
AMI Proprietary Algorithms
Information Out

7. Opportunity Analysis 56,984 members
11,395 non-cancer and non-pediatric individuals
Four chronic pain conditions: Chronic Fatigue, Neck and Back Pain, Osteo-related Pain and Headache.
Member Gender
1 - Fatigue, Aches
2 - Back, Neck
3 - Osteoarthritis
4 - Headaches
5 - None
Grand Total
Female Total
1796
4556
638
1526
27059
35575
Male Total
537
1713
298
331
18530
21409
2333
6269
936
1857
45589
56984

8. Average (PMPM) cost for Non-Chronic Pain patients of $160
Average (PMPM) cost for Non-Chronic Pain patients of $ versus the average PMPM costs for chronic pain patients by severity.
No Chronic Pain/ Chronic Pain Category
# Patients
% of Total Chronic Pain
Average PMPM by Severity
Ratio of Chronic Pain $ to Non-Chronic Pain $
No Chronic Pain
45,589 
N/A 
$160.68
N/A
Mild Chronic Pain
7,955
69.80%
$420.10
2.6:1
Moderate Chronic Pain
3,070
26.90%
$705.43
4.4:1
Severe Chronic Pain
370
3.20%
$1,489.67
9.3:1

9. Where the Money Goes
Colors match to draw eyes
69.8 link to 54%

10. AMI Process Workflow Data Mine Severity Rate Organize Communication
Distribute Marketing Material
Enrollment Calls
Answer Questions
Eligibility
Demographics
Psycho-social History
Barriers to Care
Medical History
Baseline Metrics
Acceptance Level of CAM
Goals
CAM Modality/ Frequency
CAM Provider
Community Resources
Assess BH Needs
Forward Care Plan
Educational Materials
Initial CAM Encounter
Provider Encounter Form
Nurse Review/Encounter
Nurse Follow Up/Patient
Health Plan Coordination
Adjust Care Plan
6 Month Reassessment
Clinical Reassessment
Cost Reassessment
Satisfaction Survey
Pat ID: 1. Data Mine
Severity Rate
Organize Communication
Engagement Process:
Distribute Marketing Materials
Enrollment Calls
Answer Questions
Patient Evaluation
Eligibility
Demographics
Physco-Social History
Barriers to Care
Medical History
Baseline Metrics
Acceptance Level of CAM
Care Planning
Goals
CAM Modality/Frequency
CAM Provider
Community Resources
Assess BH Needs
Forward Care Plan
Care Management
Educational Materials
2. Initial CAM encounter
3. Provider Encounter Form
4. Nurse Review/Encounter
5. Nurse Follow Up/Patient
6. Health plan coordination
7. Adjust Care plan
8. 6 Months Reassessment
Outcomes Measurement
Clinical Reassessment
Cost Reassessment
Satisfaction Survey

11. Baseline Metrics CLINICAL SF-12 mental SF-12 physical
CAGE – substance abuse
PHQ9 – depression/BH issues

12. Baseline Metrics COST PMPM – granular utilization Pharmaceuticals
Emergency Room
Inpatient Care

13. ¹ER Reduction – Reduction in number of ER visits ²Rx/Opioid Reduction –Reduction in number of prescriptions PMPM

14. AMI’S Integrative Chronic Pain Program
Significant improvement of quality of life
Measurable and meaningful cost savings
QUESTIONS?