Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1381–1382 | Cite as

Conservative Spine Care Pathway Implementation Is Associated with Reduced Health Care Expenditures in a Controlled, Before-After Observational Study

  • William B. Weeks
  • Jason Pike
  • Jeremy Donath
  • Paul Fiacco
  • Brian D. Justice
Concise Research Reports


In the US, spine pain treatment is expensive and has uncertain outcomes.1 To reduce waste and improve patient outcomes, organizations like the American College of Physicians2 and Choosing Wisely (in concert with Consumer Reports)3 have published conservative spine care treatment recommendations.

As part of an effort to improve the clinical effectiveness and value of spine care, on March 1, 2015, Excellus BlueCross BlueShield (Excellus), headquartered in Rochester, NY, introduced a spine care pathway that incorporated conservative spine care recommendations in 1 primary care practice (with 11 primary care physicians (PCPs)) within an Excellus Accountable Cost and Quality Arrangement (a reimbursement model similar to an Accountable Care Organization) but not in another (with 74 PCPs). We sought to analyze the impact of the pathway’s implementation by comparing expenditures for spine pain care in those practices.


We obtained data on patients who were attributed to...


back pain health care costs practice guidelines value 


Compliance with Ethical Standards

Conflict of Interest

Dr. Pike, Mr. Donath, and Dr. Justice are employees of Excellus BlueCross BlueShield in Rochester, NY. Dr. Fiacco is an employee of Central New York Family Care, Syracuse, NY. Dr. Weeks declares that he has no conflict of interest.


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    Choosing Wisely: Treating lower-back pain. 2018. (, Accessed January 10, 2019).
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    Weeks WB, Goertz CM. Ineffective Policies to Address the Opioid Epidemic. JAMA Psychiatry. 2017;74:974.CrossRefGoogle Scholar
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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • William B. Weeks
    • 1
  • Jason Pike
    • 2
  • Jeremy Donath
    • 2
  • Paul Fiacco
    • 3
  • Brian D. Justice
    • 2
  1. 1.The Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  2. 2.Excellus BlueCross BlueShieldRochesterUSA
  3. 3.Central New York Family CareSyracuseUSA

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