Low Back Pain Pilot Frequently Asked Questions
1. What is the Low Back Pain pilot?
The pilot program helps members weigh various low back pain treatment options. The
pilot uses a combination of personalized telephonic, print and web-based educational
communications and resources. This program also focuses on shared decision-support
between members and their provider.
2. What are the pilot goals?
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Teach members about potential low back pain treatments and options
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Improve communication and collaboration between the member and their
provider
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Reduce the number of potentially unnecessary surgeries by helping members
evaluate the risks and benefits of non-surgical options
Decrease the use of invasive or aggressive surgical options by helping members
evaluate less complex or invasive alternatives
Improve procedure outcomes by educating members about possible complications
and infections and what to expect after surgery
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3. What accounts are being targeted for the pilot?
Anthem Blue Cross Fully Insured, Non-Refunding Large Group and Key Accounts that
have the MyHealth Advantage program will be participating in the Low Back Pain Pilot.
4. How does the program work?
Members are identified through analysis of their medical (including radiology exams)
and pharmacy claims. Once identified, members will receive a personalized
communication called a MyHealth Note which describes treatment options, tools and
resources that can help inform them about the risks and benefits of various low back pain
treatments. Resources can include a mix of:

Telephonic nurse coaches and other health professionals including exercise
physiologists, dietitians, & pharmacists

A low back pain care guide with content and tools to help a member
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prepare for office visits and manage their low back pain
Targeted Emmi® programs which are engaging web-based video programs that
can help explain complicated medical information
Web resources on anthem.com/ca - including a symptom checker,
exercises, diagnostic aids and more
5. What are the program benefits?
Members, providers and employers all benefit from the program.
Members will benefit from a better understanding of the benefits and risks of low back
pain treatment options. By participating in this pilot, members will gain a greater
understanding of their treatment options and also get the support and answers that they
need in order to make informed health care decisions with their provider.
Providers will benefit from a more informed patient who is educated about medical
procedures and is more prepared to make treatment decisions when they come to their
appointment.
Employers benefit from improved employee health and productivity which may result in
lowering employer costs attributed to low back pain.
6. Will providers know which of their patients are participating in the pilot?
Yes, providers that have patients in the pilot will receive a letter in mid-June describing
the program and listing their patients that are participating.
7. When does the pilot begin and end?
Members will be contacted by mail about the program in late April. They may receive an
additional communication if we see that they have not completed their Emmi® program
online.
8. Can a member opt-out of the pilot?
Participation in the program is completely voluntary and is designed to assist the member
in making informed decisions regarding their health. Members can opt out if they
choose, but they may receive one additional communication.
9. How will pilot success be measured?
Claims will be analyzed for approximately 24 months after the first member
communication. Success will be measured based on the following areas: cost of care
(overall and LBP-specific), impact on member satisfaction and ability to self-manage
care, and time to surgery.
10. Do members need access to a computer/Internet?
Some low back pain resources are web-based; therefore it is recommended that members
have access to a computer and the internet.
11. How frequent are the MyHealth Note communications?
Pilot participants may receive two mail based communications. In addition, if the
member is enrolled in the ConditionCare program for Low Back Pain, they may be
contacted by a nurse coach to discuss their condition on an ongoing basis.
12. How much does the program cost?
The program and all program resources are available to identified members at no
additional cost.
13. Who is Emmi®? Emmi® Solutions is a third-party vendor which helps to improve
doctor patient communication through Emmi® programs, engaging web-based programs
that help patients make sense of complicated medical information, empowering them to
take more active roles in their care.