Joyce* is a 55-year-old woman with a history of neck pain. Lately, the pain has progressed to her lower back and upper arms, affecting her daily activities even with over-the-counter medications.
Joyce consulted her doctor about her worsening pain, which did not include any indicators of a severe condition needing urgent intervention (known as “red flag symptoms”). The doctor ordered an MRI of her spine with and without contrast—the treatment plan did not include conservative approaches, such as physical therapy.
Joyce's back pain
Joyce began physical therapy as part of her conservative care plan. After two weeks, the MSK corePath team checked in with Joyce to assess her progress.
Conservative care with ongoing engagement
Anticipating member and provider needs
The MSK corePath team explained to Joyce the benefits of conservative care before pursuing imaging or surgery. They helped her understand additional evidence-based treatment options including physical therapy, chiropractic care, massage therapy and acupuncture that could effectively address her pain.
Exceptional member outreach and education
Evidence-based guidelines call for the exploration of conservative care approaches before advanced imaging (like MRI) or invasive treatment. As a next step, EviCore by Evernorth MSK corePath team reached out to Joyce directly to discuss more appropriate next steps for her condition.
Our MSK corePath program educates members about their treatment options and associated costs, empowering them to make informed health care decisions. Our team provided Joyce with personalized guidance and educational materials to help manage her neck and back pain. Armed with this information, Joyce felt confident choosing physical therapy as her first step.
During the two-week check-in, the MSK corePath team member listened to Joyce’s positive physical therapy experience, answered follow-up questions and made sure she had all the information she needed to continue the plan. At 30 days, Joyce received another follow-up call from the same team member to reassess her pain levels and the effectiveness of her physical therapy.
The EviCore by Evernoth MSK corePath program combines evidence-based clinical review with personalized member education and ongoing support. This approach empowers members to make informed decisions about their care, leading to improved outcomes and more efficient use of health care resources.
With a 66% voluntary participation rate, MSK corePath shows that members are willing to engage when approached proactively. By connecting directly with members like Joyce, the program helps them avoid unnecessary, costly and invasive procedures while achieving effective pain relief and improved quality of life.
FOLLOW-UP CALL
MSK corePath
Clinical review
We ensure procedures are in accordance with the most up-to-date literature and national guidelines to promote the most clinically appropriate and cost-effective care for each patient.
A peer-to-peer discussion enables a patient’s physician to discuss a complex case with an EviCore medical director with experience in the same specialty. During a P2P, the doctors discuss how the clinical guidelines apply in these particular circumstances.
Peer-to-Peer (P2P) Discussion
*Not patient’s real name. Images are for illustration purposes only.
IS THIS THE RIGHT COURSE?
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MSK@evicore.com.
Meet Joyce
After completing physical therapy, Joyce reported feeling much better with significantly less pain.
MAKING THE RIGHT CALL
Through our MSK corePath program, Joyce saved time and avoided discomfort, as well as potentially unnecessary interventional procedures. In contrast, an MRI-first approach might have resulted in similar outcomes but at a higher cost and with a delay in achieving the positive results from physical therapy, or might have resulted in progression to invasive procedures that were unlikely to improve her pain symptoms.
Through physical therapy, she gained new strategies and tools beyond over-the-counter medications to reduce her pain long-term.
Joyce remained consistent with her treatment plan and regained the ability to perform daily activities and enjoy life.
A peer-to-peer discussion enables a patient’s physician to discuss a complex case with an EviCore medical director with experience in the same specialty. During a P2P, the doctors discuss how the clinical guidelines apply in these particular circumstances.
Peer-to-Peer (P2P) Discussion
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