The time has come for a smarter spine care solution.

Palladian Health offers a unique, integrated approach to the management of musculoskeletal pain related to the spine. Musculoskeletal care pathways are diverse, outcomes are frequently unsatisfactory and care delivery costs continue to escalate. The Palladian Coordinated Spine Care (CSC) program improves the assessment and management of musculoskeletal pain from spinal disorders, and promotes evidence-based decision making throughout the care cycle.


Palladian CSC incorporates chiropractic and physical therapy management as underpinnings of spine care management, and integrates primary, secondary, and tertiary care to address the complete musculoskeletal care cycle. Palladian CSC is the first back pain solution driven by clinical evidence that integrates patient education, care advocacy, clinical support and surgical prior consultation. The program achieves the highest functional patient outcomes using web-based technologies, and allows for full integration with internal client applications.

Palladian Health developed the CSC program over a two-year period to manage back pain effectively and control expenditures stemming from costly procedures that do not positively contribute to patient outcomes. The Palladian Health Clinical Policy & Advisory Board is comprised of esteemed physicians from across the United States. By vetting thousands of clinical policy statements and criteria, this board has composed the most comprehensive body of evidence-based guidelines for the treatment of spinal conditions. These recommendations, summarized and published in The Spine Journal, form the foundation of the Palladian CSC program, which guides the patient to the proper provider, at the proper point in their treatment cycle, to achieve the highest outcome in the most financially effective manner.

Palladian CSC generates solutions for health plan clients that not only places them at the forefront of musculoskeletal management, but affords them the greatest opportunity for cost savings-without compromising quality of care.

Primary Care

Palladian CSC is centered on education aimed at guidance and evidence based care pathways to recovery. The progression of spine pain is usually self-limiting. Seventy percent of patients with acute, non-specific back pain are substantially improved within six weeks of the onset of their symptoms. Few patients possess significant underlying pathology such as fractures, malignancy, and systemic inflammatory disease; however, Palladian CSC screens for these "red flags".

Despite abundant research, treatment is highly variable. Not unexpectedly, this often results in unnecessary tests and procedures such as MRI, injections and surgery. Palladian CSC removes unnecessary variations from the member's treatment plan and promotes self-management tools to assist the member in his or her course of treatment. These web based tools include:

  • An interactive educational module, helping patients understand what is "normal" spine pain, and educating them regarding the importance of remaining active, and approaches to managing their pain.
  • Instructional videos educating patients on simple home exercises which may assist in speeding recovery.
  • A library of articles addressing frequently asked questions related to back pain management.

Online resources are also available for the providers. Information presented by both the patient and primary care provider is the foundation for web-based clinical support. This information assists the provider in clinical decision making and includes assessment of member outcome forms with mental and physical functional status. Additionally, SOAP note clinical documentation is generated for insertion into the patient record.

Palladian CSC recognizes that there are times when members and providers may benefit from additional assistance in managing back pain. Palladian Health Advocates are available to assist in education and guidance for patients with back pain. This outreach can consist of member education regarding the benign nature of acute spine pain, reassurance of a good prognosis, and development of a plan to achieve small goals inclusive of behavioral modification.

Secondary Care

The Palladian Health Clinical Policy & Advisory Board established evidence-based medical policies which form the basis of Palladian CSC secondary level care. Comprehensive medical policies address aspects of spine care from diagnostic testing and imaging to injections and surgery. The Board is comprised of nationally renowned clinicians, academics, researchers and administrators with a diverse range of professional training in the fields of evidence-based medicine, neurology, orthopedics, pain management, internal medicine, rehabilitation, chiropractic, physical therapy and managed care. Implementation of Palladian CSC policies reduces unnecessary treatment, improves outcomes and ensures that patients are receiving the most appropriate care pathway supported by evidence-based medicine.

Palladian's synthesis of clinical practice guidelines for back pain was peer-reviewed and published by The Spine Journal, the official journal of the North American Spine Society.

Utilization management processes focus on efficiency and quality. Decisions incorporate key clinical indicators provided by the physician as well as patient reported outcomes utilizing validated and standardized outcome questionnaires.

Our URAC accredited and NCQA based Utilization Management program monitors outcomes and ongoing quality improvement activities. Palladian Health's Utilization Management platform is designed on a service oriented architecture that will allow the widest possible variety of implementation options, including:

  • Palladian Health hosted Web portal
  • Palladian Health hosted Web portal branded for your company
  • Integration into your health plan's Web site via iFrames
  • Full Integration into your health plan's Web site through REST/SOAP Web services
  • iPhone/iPad/Android mobile apps via REST/SOAP Web services

Savings Overview

Reuters recently reported that the annual cost of back pain (direct and indirect) in the United States totals $560 billion.

In addition:
  • A Journal of American Medical Association study reported a 15-fold increase in complex spine fusion procedures over the last seven years.
  • A report issued to CMS by The Office of Inspector General (OIG) showed that 34% of all epidural injections administered to the Medicare cohort failed CMS's own clinical recommendations. The OIG also highlighted numerous incidents of billing and documentation irregularities.
  • A recent Wall Street Journal article showed that CMS spent over $2.2 billing on spine fusion surgery - a 400% increase in less than 10 years.

Our research has shown clinical evidence is inconsistent and often conflicting with regard to spine-related procedures and surgical decision making, frequently resulting in poor clinical outcomes and needlessly wasteful expense.


The Palladian Approach to Savings Identification

Palladian's savings methodology stratifies patients and clinical spinal related activity using a combination of diagnosis codes and timing of procedures. We conservatively isolate only the appropriate cases to the application of clinical evidence to alter the care pathway. Once existing patients are properly categorized, we assess the timing and choice of clinical activity, contrasting this against our evidence-based clinical guidelines. These guidelines have been reviewed and approved by our Clinical Policy & Advisory Board, which is composed of national clinical experts in spine and musculoskeletal conditions. Our guidelines allow us, based on evidence, to recommend the most appropriate and effective care pathway for each patient.


The Results

Utilizing our evidence-based clinical guidelines, Palladian can eliminate inappropriate costly procedures and guide patients to the proper provider at the appropriate point in their care cycle to achieve the highest quality outcome. As a result, our clients realize medical savings in excess of 20% of historic spending while reducing the incidence of compounding future trend increases.

savings overview

We would welcome the opportunity to analyze your spending trends and outline specifically how our Coordinated Spine Care program will deliver efficiency and cost savings to you and your members, while improving quality and consistency in the care delivery for spine-related conditions.