Although at present, much of the research into this phenomenon is still bench science, Dr. Szigethy said a growing body of evidence provided in part by advanced neuroimaging techniques indicates that chronic narcotic use changes opioid receptors in some human adults from creating an analgesic effect, to a hyperanalgesic one instead, where the narcotics themselves start to create pain and exacerbate any existing bowel issues.
“In Anne’s case, she was going up and up in her opiates, but her pain was getting worse,” Dr. Szigethy said.
Dr. Szigethy obtained permission from Anne’s insurer, which happened to be UPMC Health Plan, to give her a 5-day inpatient medical hospitalization during which time Anne was weaned from her narcotics. For 6 months prior to her detoxification from the opiates, Anne learned self-hypnosis techniques from Dr. Szigethy and her colleagues, which she used to support her withdrawal from the pain medication. Anne’s self-reported favorite technique was that whenever the pain would start, she would visualize filling a balloon with it, and then letting the balloon drift away until it eventually evaporated into the air.
“I know it sounds corny, but guess what? Last year, Anne had zero hospitalizations,” Dr. Regueiro said.
According to Dr. Szigethy, Anne still has occasional pain, “But she can deal with it.”The exact savings UPMC Health Plan expects to realize by way of reimbursing the IBD center for treatment models created in response to emerging research such as that of Dr. Szigethy is still unknown. But Ms. McAnallen is optimistic the program will meet its broader targets.
“We are at a point where costs are becoming out of control and the consumer can’t afford health care. You have to be in a position where you can rely on your physicians to develop evidence-based pathways for treatment of acute and chronic disease, which Eva and Miguel are doing, and to do be able to do so in a laboratory where you have the premium to support that,” Ms. McAnallen said, adding that had Dr. Regueiro approached an outside payer to help him create the medical home model, she doubted it would have come to fruition.
“Because we’re part of an integrated system, we’re all aligned with the same goals, which include improving the health status of our community and decreasing the cost of care so it’s affordable.”
Analysis of data collected on total cost and quality of care, and patient perception of care, will begin within the next 6 months, said Ms. McAnallen, who did not offer specific margins but noted that if gains are made, UPMC would look at how to apply this integrated approach to treating other chronic diseases such as rheumatoid arthritis and multiple sclerosis.