The State of Missouri received approval to provide physical function services beginning January 1, 2021, to its “Gateway to Better Health” (Gateway) Pilot Program population from the Centers for Medicare and Medicaid Services (CMS). In addition to current services, the Gateway network of community primary care providers can now offer physical therapy, chiropractic, and occupational therapy to the Gateway population, nearly 20,000 individuals per year in the St. Louis region.

Gateway is sponsored by the Missouri Department of Social Services in partnership with the St. Louis Regional Health Commission (RHC). Under the terms of program, Gateway provides primary, specialty, and urgent care coverage to uninsured adults, ages 19-64, living in poverty in St. Louis City and County, via a network of community providers. With the approval of the physical function benefit, the Commission will continue working with its partners and federal delegates to ensure Gateway members maintain access to quality health care services in the St. Louis region.

Part of the motivation to design this new benefit was to address the regional and national chronic pain crisis. Although sudden acute physical pain can be a life-saving alert, “chronic pain” is maladaptive pain exceeding three months. According to the Centers for Disease Control and Prevention (CDC), approximately one in five U.S. adults suffer from chronic pain, but Gateway patients suffer from chronic pain at a rate greater than twice the national average. Not only is the prevalence of chronic pain high in the Gateway population, but its impact is also significant: approximately two-thirds of Gateway patients who experience chronic pain report that pain affects their ability to seek or maintain employment.

“When we discovered that so many Gateway patients suffer from chronic pain, we understood that significant program changes were needed to address this public health crisis,” said Angela Fleming Brown, CEO of the RHC. “Adding physical function services will help empower patients and providers. Thank you to our Gateway network of community providers for their commitment to addressing chronic pain in our community.”

“The evidence is clear: non-pharmacologic, multidisciplinary treatments can help people living with chronic pain; yet, many providers and patients lack the tools to manage chronic pain effectively,” said Heidi B. Miller, MD, Medical Director for Gateway to Better Health and the project co-lead for RHC’s Chronic Pain Initiative. “Our patients suffering from chronic pain are most likely to optimize function if services such as physical therapy and chiropractic care are available to them.”

“This progressive initiative from the RHC via Gateway will greatly reduce health inequities in our region,” stated Patrick J. Battaglia, DC, DACBR, who serves as the Director of Health Policy and Interdisciplinary Care at Logan University and oversees integration at several community health centers. “Furthermore, the benefit will improve access to safe, effective, evidence-based care for the treatment of chronic pain. Physical function experts, such as chiropractors, occupational, and physical therapists, aim to reduce pain and improve function, helping patients maximize engagement in valued life activities. Besides its regional impact, this program should serve as a model nationally integrating non-pharmacologic therapies for pain management and functional restoration within the primary medical home.”

To accompany the new benefit, the RHC also created a website called BeyondPainSTL.com, which covers a range of topics and strategies to address chronic pain, including promoting mental and emotional health, healthy movement, regular sleep, and a balanced diet. Dr. Miller explains, “Adding a physical function benefit to Gateway is a critical step in addressing chronic pain, but it is only part of the solution. Chronic pain is a complex disease, and we need to empower people to make lifestyle changes and manage the disease holistically. Beyond Pain STL aims to give patients and providers additional resources to treat chronic pain through multidisciplinary strategies.” 

For more information about the St. Louis Regional Health Commission’s Chronic Pain Initiative, please email Amanda Harris at aharris@stlrhc.org.

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