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Finding a more holistic approach to spine health

In the late 1970s, when many physicians still had a rigid view of what influences illness, Brian Justice was eager to pursue a career that championed the connection between body and mind.

“So I made the then-radical move of going to chiro school instead of med school. Little did I know at the same time that Rochester was evolving as the incubator for biopsychosocial medicine, which is really what I was kind of looking for back then,” said Justice, medical director at Excellus BlueCross BlueShield and medical director of Pathway Development and Spine Care at Lifetime Health Medical Group.

Diagnosing, treating and preventing mechanical disorders of the musculoskeletal system have kept Justice plugged into his profession for more than 30 years. The Hilton native has been part of a private practice, worked for an employer-based occupational medicine program and served as a staff clinician in a hospital-based complementary medicine department.

After years of treating patients in a range of settings, Justice began noticing striking variations in how physicians, physical therapists, pain specialists, surgeons—and even his fellow chiropractors—approached spine health. He became convinced that a spine-care delivery model, or pathway, could fast-track patients to the right providers, ease communication among medical professionals and help control costs.

Justice and a team of colleagues initially tested the concept of a care pathway at a Massachusetts hospital that was taking a more holistic view of spine health.

“That ended up being fortuitous because Massachusetts is ahead of the curve from where health care is going,” Justice said. “So it ended up being a wonderful place to model this care.”

Findings published after the rollout in Massachusetts generated national buzz and led to piloting the pathway at Lifetime Health Medical Group in Rochester, which was “a great learning laboratory,” he said.

Through its affiliation with Excellus BlueCross BlueShield, the pathway recently trained 200 primary care physicians on the “first touch”—the initial contact with a health care professional that often shapes the trajectory and extent of spine care. Some 200 physical therapists and chiropractors also have benefited from the pathway’s in-depth trainings.

Patient feedback on the care pathway has been overwhelmingly positive.

“There’s a lot of needless human suffering in spine, meaning that (the health care industry has) kind of medicalized spine pain a bit,” said Justice, a medical director at Excellus. “We’ve made it a disease in search of a cure, when it’s really an aspect of life that needs to be managed and controlled.”

The pathway also is bringing about “some decreases in health care costs,” Justice said. “There’s been a lot of needless imaging on spine pain. It’s really an interesting and somewhat confusing concept that if you order an MRI or an X-ray too early, you can complicate the spine pain.” Misinterpreting normal aging variants during an acute episode of pain, for instance, sometimes opens the door to the wrong treatment.

“So we’re trying to improve levels of communication between providers and between providers and patients,” he said.

Myths about spine pain abound, Justice added. Some patients, for instance, believe that inactivity will help them get back to normal.

“Motion is probably one of the key driving factors of healing,” he said. “A lot of things that generate pain in your spine (are) cartilage-based, and cartilage needs motion to heal, and so even light activity or short bursts of activity—even when you’re in fairly acute pain—is actually going to be helpful,” both mentally and physically.

Justice’s knack for being “somewhat of a shameless optimist” will likely help the spine-care pathway flourish here and elsewhere, said John Ventura, consultant and partner member at Rochester-based Spine Care Partners LLC, in which Justice has an ownership stake.

“And what may be a more practical way to express that is that when people say, ‘Why?’, Brian always says, ‘Well, why not?’”

Sheila Livadas is a Rochester-area freelance writer.

3/20/15 (c) 2015 RBJ Health Care Achievement Awards. Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.

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