1. Navy Comprehensive Pain Management Program (NCPMP):
Implementing the SCM Across Navy Medicine
Mr. Joseph A. Phillips, BUMED M33, NCPMP Program Manager
28 September 2018

2. Disclosures Mr. Joseph Phillips has no interest to disclose.
AMSUS and ACE/PESG staff have no interest to disclose.
This continuing education activity is managed and accredited by Affinity CE/Professional Education Services Group (ACE/PESG) in cooperation with AMSUS. ACE/PESG, AMSUS, planning committee members and all accrediting organizations do not support or endorse any product or service mentioned in this activity.

3. Disclaimer
The views expressed in this article reflect the results of research conducted by the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government

4. Copyright Statement
I am a federal employee of the United States government. This work was prepared as part of my official duties. Title 17 U.S.C. 105 provides that
`copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C. 101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person's official
duties.

5. Learning Objectives
At the conclusion of this activity, the participant will be able to:
Understand Navy’s Stepped Care Model (SCM) implementation approach and progress
Understand how Navy has integrated the SCM into the Primary Care setting
Understand current NCPMP efforts to provide support and additional clinical resources to the deckplate to successfully implement the SCM

6. NCPMP Vision and Mission
The Navy Comprehensive Pain Management Program (NCPMP) supports the Readiness mission by ensuring active duty Sailors, Marines, and their families are receiving the appropriate level of care with alternatives provided to pharmacologic treatment to ensure deployability and improved quality of life.
Vision
Restoration of function through coordinated, patient-centered pain management.
Mission
Enable the Navy Medicine Enterprise to provide consistent, comprehensive, and high-quality pain management to those entrusted to our care.

7. Policy Directives and the NCPMP
NCPMP priorities and initiatives stem from the 2010 NDAA and subsequent ASD(HA) Memo which established the Navy Comprehensive Pain Management Program (NCPMP).
Policy and Directives NCPMP Strategic Priorities
2010 National Defense Authorization Act (NDAA) Requirements
Consistent standard of care for pain management
Consistent pain assessment
Access to pain care
Research related to acute and chronic pain
Achieve optimal allocation and utilization of Pain Management program personnel and resources 1
Increase communication and coordination across the continuum of care to foster a collaborative culture of pain management 2
2011 ASD(HA) Memo Policy on Comprehensive Pain Management Directions
Common tool for pain assessment
Use of CPGs
Training and education of providers in pain management
Beneficiary access to comprehensive, multidisciplinary pain care
Patient education in Medical Home and other clinics where pain patients are treated
Expand pain management education and training for providers, patients, and their families 3
Improve the consistency and quality of pain management care through standardized policies and procedures 4

8. Stepped Care Model (SCM): At a Glance
Guiding Themes
Pain exists on a spectrum and the care for it must also exist on a spectrum in order to deliver the right level of care to manage a patient’s need without using unnecessary resources
Clinical resources must exist in the primary care setting to aid PCMs in the management of patients whose pain advances in complexity though falls short of needing to be managed by pain specialists
A robust pain clinic must exist with a robust diversity of modalities to offer comprehensive, multimodal, and interdisciplinary care as needed by the most complex patients

9. NCPMP Focus Areas to Support SCM Implementation
Creating & Sharing Policy
Clinical Guidance
Opioid Safety
Develop and disseminate policy to enable clinical assets to operate consistently across the enterprise and coordinate effectively to deliver the appropriate level of care to patients.
Engaging & Communicating
Mitigate the risks of opioid therapy for pain management through monitoring and active management of patients employing this modality in their treatment plans.
Long-Term Opioid Therapy Safety (LOTS) Compliance Monitoring
Stepped Care Model Implementation Guide
Opioid Safety Guidance
Tracking Progress
Clinical Capabilities
Performance Management
Ensure that patients with pain challenges have access to the appropriate multidisciplinary set of modalities to manage their pain at different levels of pain complexity and severity.
Track and understand the target population’s utilization of the Navy Medicine system, the utility of pain-focused assets, and the program’s progress against strategic goals.
Professional Services
Providing the Right People
Program Performance and Assessment
Complementary and Integrative Medicine Availability
Stepped Care Model Adoption
Continuing Education
Change Management
Enhancing Patient Safety
Equip patients as well as clinicians at all levels of care with the knowledge and training necessary for them to be comfortable and confident in the management of complex pain conditions.
Build key stakeholder engagement and foster a collaborative culture around pain management between clinicians, SMEs, the NCPMP, and Tri- service efforts to enable continuous process improvement.
Equipping Our People for Success
Clinician Education
NCPMP supports the Readiness mission by ensuring Sailors, Marines, and their families are receiving the appropriate level of care with alternatives provided to pharmacologic treatment to ensure deployability and improved quality of life.
Deckplate Engagement
Patient Education
Tri-Service Alignment

10. Navy’s SCM Implementation: Progress to Date
Over the past year, the NCPMP has made great strides towards Stepped Care Model Implementation through the achievement of key milestones, such as roll-out of the Cadre of Speakers training and education initiative, and formalization of the BUMED LOTS INST.
Pain Champion identification tasker released, to include expansion of Primary Care Pain Champions across all 27 MTFs
BUMED LOTS
Instruction formally signed and approved
MTF LOTS Committees established under MEC and all 27 Chairs identified
Pain Champions identified at the 7 target NCPMP MTFs
SEP 2017
NOV 2017
JAN 2018
MAR 2018
MAY 2018
JUL 2018
SEP 2018
Initiation of NCPMP’s training and education initiative: Cadre of Speakers
Identification of Speakers, development of curriculum, and logistics planning with MTF Pain Champions
Cadre of Speakers Roll- out executed across all 7 NCPMP target sites
Throughout the course of the year, the NCPMP continued to support the funding and hiring of clinical resources (aka NCPMP Professional Services) across the MTFs.

11. Increasing Primary, Secondary, and Tertiary Support
Professional Services Resource Hires: Current Status **July 2018
NH CAMP PENDLETON
NMC CAMP LEJEUNE
NH JACKSONVILLE NH PENSACOLA
NH BREMERTON NMC SAN DIEGO
NMC PORTSMOUTH 3 4 8 4 4 4 4 7 9 11 8 11 11
Level
Resource Type
Medical Home Port/Medical Neighborhood (Primary/ Secondary)
Care Coordinator
Licensed Pharmacist
Specialty Pain Clinic (Tertiary)
Medical Assistant
Physical Therapist
Psychiatrist
Acupuncturist
Health Psychologist
LPN
Pain Management MD
RN Case Manager RN
Physician Assistant
This table provides a summary of the different resource types currently provided and funded by the NCPMP to the MTFs. This illustrates how the NCPMP tries to create a multidisciplinary team to ensure appropriate management of care and escalation/de-escalation of patients as needed.

12. Augmenting CIM Modalities
Complementary and Integrative Medicine modalities are being developed, championed, and scaled by the NCPMP’s CIM Working Group to increase patient access to additional modalities for pain care.
Revised Clinical Practice Instruction
The CIM group was formed in 2015 with the goal of revising the BUMED Instruction governing the clinical practice of acupuncture (BUMEDINST ).
Revisions contained within the new draft include the re-designation of Licensed Acupuncturists as privileged providers and a reduction of emphasis on specific clinical indicators for acupuncture.
Acupuncture Training Initiatives To increase acupuncture capacity among AD providers, the CIM group is working to develop a recurring contractor-led Medical Acupuncture Certificate training course. The CIM group also promotes an online auricular acupuncture training developed by a Navy Nurse Practitioner.
Tracking Acupuncture Capacity
As acupuncture has become a increasingly accepted as an important treatment modality in the management of chronic pain, the CIM group has sought to begin tracking which providers are credentialed in some form of acupuncture across the NAVMED Commands.
Mind Body Medicine
The CIM group has recently sought to broaden its activities beyond acupuncture and into other CIM modalities. The CIM group promotes a Mind Body Medicine Program which emphasizes self-care techniques for improving Operational Stress Control and resiliency, and leverages modalities including meditation and yoga.
The CIM group promotes a comprehensive approach to pain management through increased patient access to CIM modalities

13. NMC Portsmouth: Primary Care Pain Model Pilot
NMC Portsmouth (NMCP) is conducting a pilot of their “Primary Care Pain Model” to enhance pain management capabilities at the Primary Care level as well as the Tertiary level to make the NCPMP Stepped Care Model come to fruition. Within this model, NMCP is also looking to do a Opioid Renewal Program to ensure every LOTS patient in the Boone Triad has the necessary screenings, UDS, OCAs, to meet LOTS requirements.
Patients seen at Boone Triad (Chesapeake, Boone and Northwest) will be evaluated by a multidisciplinary team (e.g. IBHC, Physical Therapist, Primary Care, Clinical Pharmacist, PM&R/PM, Nurse Coordinator) and offered alternative therapies in order to manage chronic pain without the use of long-term opioid therapy by September 2018.
Project Goal
To increase provider awareness of pain management services through a collaborative team approach that will: Increase patient access to pain management services (increase access to care and therapies), improve patient satisfaction, improve patient health outcomes and patient safety (decrease long-term opioid therapy use and known side effect to include dependence and death), improve provider satisfaction with support.
Expected Benefit
Resources Provided by NCPMP
1 Acupuncturist (or training for a Family Physician to do this)
1 Addiction Specialist
2 LPNs
1 Medical Assistant
1 Physical Therapist

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CE/CME Credit
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