Disbelief filled my mind as I passed by my co-worker’s office door. My friend had complained about neck and back pain for as long as I had known him. He had decided to get something done about it not long after we completed a business review of an innovative spine surgery called SonoSpine®.
The review had revealed the amazing story of SonoSpine’s founder and ultrasonic technology, but I had never imagined the surgery would be this effective. Here was a co-worker of mine whose quality of life and productivity had suffered greatly for the last few years and now, just days after getting the SonoSpine procedure, he was ear-to-ear smiles. He was working joyfully for the first time in a long time!
He even told me how the tractor on his hobby farm was “calling his name.” “Wow,” I said. “I am so happy for you and what a difference SonoSpine has made in your quality of life!”
After making my way down the hall to my office, I sat in my chair and began to think.
SonoSpine’s team of people and medical innovation had greatly improved this man’s life. More than that, our team had received the added benefit of his quick return to work, plus added productivity now that he is pain-free. SonoSpine is such a good thing, and good deserves attention.
Insurance was a key issue, though. The technology SonoSpine uses is FDA-approved, but the procedure does not have a Medicare procedure code allowing for broad insurance coverage at this time. My friend was able to afford an out-of-network service that he believed would provide him with superior care. But this lack of insurance coverage seemed to be an injustice. Our whole office should have been able to take advantage of this care option.
Fortunately, not long after I witnessed this mini-miracle, an opportunity presented itself for me to contribute as the Chief Development Officer to the “good work” they were doing at SonoSpine. A sense of service to something greater overwhelmed me, and I said yes, but on one condition — that we find a way to help more people. Dr. Dilan Ellegala, SonoSpine’s founder and chief surgeon, smiled and said, “SonoSpine’s fusion avoidance spine surgery as the standard of care is our goal, so welcome to the team!”
As we considered the best ways to reach new patients, we saw that self-insured employers have an optimal insurance-coverage path for their employees who are suffering from chronic back and neck conditions.
Some 90 million workers and dependents were covered by their employers’ self-funded insurance plans in 2011, according to the Self-Insurance Institute of America (SIIA). More than half of employers in industries — such as transportation, manufacturing, finance, retail, healthcare and wholesale — self-insure, SIIA said.
While commercial insurance will surely one day cover SonoSpine procedures, self-insured employers already have advantages, as they can determine what procedures their insurance will cover. This means self-insured employers can simply include SonoSpine as a covered procedure for their employees.
Our medical outcomes and the bundled benefits approach show a clear win-win-win for providers, patients and employers:
Employers/payors have significant cost savings, realized first from the lower initial cost of the SonoSpine procedure compared with traditional surgical spinal fusion, and secondly from savings derived from a patient’s speedy return to work and community after a SonoSpine procedure.
Patients benefit from a higher level of care (and far fewer complications) and ultimately have excellent quality of life due to the fusion-avoidance focus of the SonoSpine.
We here at SonoSpine believe we are so fortunate to assist with patients’ pain alleviation. Surgery is NOT the goal, but if it is clearly the best option, we should do it in as minimally disruptive a method as possible.
Our desire to push ourselves further in patient care creates a ripple effect in their communities and organizations: Patients’ ability to enjoy their days pain-free is so impactful to others around them. For us, that never gets old.
We are asking others to join us in the effort to expand the coverage for SonoSpine’s procedure.
We see clearly that this technology, which evolved out of DARPA-funded programs, would greatly benefit veterans and U.S. service members with TRICARE, Tri-West and Healthnet benefits.
Please contact us as we would love to band together with others who are blazing healthcare paths — such as the Center for Medicare and Medicaid Innovation and the VA Center for Innovation in the Department of Veterans Affairs — and supporting the country’s ability to utilize better outcomes and cost-saving procedures such as SonoSpine.
Ultimately, America is what you make it! The 18 percent of the nation’s GDP that is represented by healthcare expenses can be something that unites us in heart. We can tackle this if only we are willing to take the risk to stop for a moment and help where possible.
• Seth Wade is the Chief Development Officer for SonoSpine and a proud U.S. Army veteran. Contact Seth at firstname.lastname@example.org.