The real-world pain evidence your medical policy team has been asking for.
Coverage decisions for interventional pain procedures are made with RCT data that doesn't reflect your member population, and claims data with no functional outcome attached. Celéri Health gives payers structured, longitudinal, PRO-linked real-world evidence from the point of care — so coverage policy, prior authorization criteria, and value-based contracts can be built on what actually happens to patients.
Built for Medical Directors, HEOR teams, Network Management, and Value-Based Care leaders at commercial insurers, Medicare Advantage plans, and regional health plans who need real-world functional outcomes to inform coverage policy, prior authorization criteria, and provider contracting in interventional pain and neuromodulation.
Claims data tells you what was done. It doesn't tell you if it worked.
Payers managing interventional pain spend have procedure codes, diagnosis codes, and downstream utilization — but no structured outcome attached to any of it. Did the SCS implant reduce pain and restore function? Did the patient reduce opioid use? Did the RF ablation hold at 12 months? Claims can't answer these questions. The PainRWD™ Science Cloud is a de-identified longitudinal dataset in interventional pain that links procedures to validated patient-reported functional outcomes at 3, 6, and 12 months — collected prospectively at the point of care.
Evidence that closes the gap between what was billed and what was gained.
Celéri Health's data and research infrastructure addresses the specific evidence gaps that drive inconsistent coverage policy, imprecise prior authorization, and misaligned provider incentives in interventional pain.
Coverage Determination Evidence
When your medical policy team reviews coverage for SCS, RF ablation, peripheral nerve stimulation, or emerging neuromodulation therapies, Celéri Health provides longitudinal, PRO-linked outcomes from real-world practice populations. Not trial patients. Not claims proxies. Functional outcomes from the procedures your members are receiving.
PA Criteria Development and Refinement
Which patient characteristics are associated with durable outcomes after SCS? Structured data linking baseline diagnoses, severity scores, and prior treatment history to 12-month functional outcomes can inform PA criteria that approve the right patients faster — without adding administrative burden.
Opioid Utilization Context
Opioid-related PROs — PHQ-9, Opioid Risk Tool, pain severity trajectories — are captured alongside procedure outcomes. For payers managing procedure spend alongside opioid formulary decisions, this is the linkage claims alone cannot provide: what happens to opioid use after a neuromodulation implant.
Provider Performance and Outcomes-Based Contracting
As payers move toward value-based arrangements with pain practices, outcomes measurement becomes the foundation of the contract. Celéri Health's point-of-care infrastructure can serve as the measurement layer — giving payer and practice a shared, validated, longitudinal view of patient outcomes.
Total Cost of Care Modeling
Functional improvement linked to downstream utilization context — including ZIP-level SDOH enrichment through Celéri Health's Socially Determined partnership — supports total cost of care analyses beyond episode-level procedure costs.
Commissioned Research and Custom Analyses
Commission targeted analyses from the PainRWD™ Science Cloud — specific procedure cohorts, geographic subgroups, diagnosis-matched populations, or outcome trajectories for a defined therapy. Delivered as a structured data package or a published analysis through the Celéri Research Group.
PainRWD™ Science Cloud
Celéri Health's de-identified longitudinal patient dataset — built from structured PRO and procedure data collected prospectively at the point of care across the Celéri Pain Research Network.
It is not a claims database. It is not survey-based. It is not assembled from EHR notes through NLP. It is structured, validated, patient-reported functional outcomes data linked to specific procedures — collected at clinical milestones before and after treatment, by the treating physician's own practice.
For payers, that distinction matters. This is the evidence your medical directors and HEOR teams have been asking device sponsors to produce for years — governed independently by Celéri Health, across therapies and sponsors, not assembled in support of any single coverage request.
The evidence gaps Celéri Health closes — by role.
Different teams within a payer organization have different evidence needs. Celéri Health's data and research capabilities address each of them.
Coverage policy grounded in real-world functional outcomes.
Medical policy reviews for interventional procedures rely on literature that is often years old, trial-based, and poorly representative of your member population. Celéri Health provides current, real-world PRO data — by procedure type, diagnosis, and patient profile — that medical directors can use to set and defend coverage criteria.
- Coverage determination evidence — procedure-level outcome data
- Comparative effectiveness across therapy types
- Patient subgroup analysis by diagnosis and baseline severity
- Independently governed data across therapies and sponsors
Total cost of care modeling with functional outcomes attached.
HEOR teams need more than claims to model the full value of an interventional procedure. Structured PRO data linked to SDOH context and downstream utilization proxies gives health economists the functional outcome layer that turns a cost analysis into a value analysis.
- Functional outcome trajectories at 3, 6, and 12 months
- SDOH enrichment for equity and social risk modeling
- Opioid utilization context alongside procedure outcomes
- Custom cohort analysis through the Celéri Research Group
PA criteria that approve the right patients — not just the right codes.
Prior authorization for SCS and other high-cost procedures is a high-stakes decision made with thin evidence. Data on which patient characteristics are associated with durable outcomes gives utilization management the real-world signal to calibrate PA criteria more precisely than guidelines alone allow.
- Responder profile analysis — who benefits most, and from which therapy
- Baseline severity and prior treatment history linked to outcomes
- Identify appropriate vs. inappropriate implant patterns
- Reduce administrative friction for high-probability responders
Outcomes-based provider contracts built on shared, validated data.
Outcomes-based arrangements with pain practices require measurement infrastructure both parties trust. Celéri Health's point-of-care PRO infrastructure — already deployed at interventional pain practices — can serve as the neutral, validated measurement layer for value-based contracts.
- Practice-level outcomes — procedure-specific and longitudinal
- Shared measurement infrastructure for VBC contract design
- Provider performance benchmarking across the network
- Identify high-performing practices for preferred network designation
How payers engage with Celéri Health's data.
Each engagement is scoped to the specific evidence need. Most organizations find that multiple use cases apply once the data is in hand.
| Payer Function | Evidence Need | Celéri Health Asset | Delivery Format |
|---|---|---|---|
| Medical Policy | Real-world outcomes evidence for SCS or neuromodulation coverage review | PainRWD™ Science CloudLicensed Dataset | Structured data package or commissioned analysis report |
| Medical Policy | Comparative effectiveness across competing therapy types | PainRWD™ Science CloudCustom Analysis | Research report with biostatistical support |
| Prior Authorization | Identify patient-profile predictors of durable SCS outcomes | PainRWD™ Science CloudResponder Analysis | Analytic report; PA criteria recommendations optional |
| HEOR | Total cost of care modeling with functional outcomes attached | PainRWD™ + SDOH EnrichmentHEOR | Custom model; publishable analysis available |
| Pharmacy · UM | Opioid utilization patterns before and after neuromodulation | PainRWD™ Science CloudDrug Utilization | Cohort analysis — diagnosis- and procedure-matched |
| Network · VBC | Outcomes measurement layer for value-based pain practice contracts | PainIntel™ DeploymentMeasurement Layer | Point-of-care PRO infrastructure; practice-level reporting |
| Network · VBC | Provider performance benchmarking across interventional pain practices | PainRWD™ Science CloudNetwork Analysis | Practice-level outcomes benchmarking report |
Independent evidence infrastructure. Not a device company.
Payers routinely receive outcomes data from device manufacturers in support of coverage requests — generated under the manufacturer's protocol, analyzed by the manufacturer's team, and delivered with a commercial objective in mind. Celéri Health has no therapy to sell and no reimbursement outcome to influence. The PainRWD™ Science Cloud is governed by an independent evidence infrastructure company, collected across therapies and sponsors, and stewarded for the integrity of the data. That independence is what makes it useful to payers.
What payer teams ask us most.
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Manufacturer-sponsored registry data is generated under a protocol designed by the manufacturer, analyzed by teams with a commercial interest in the outcome, and delivered in support of a specific coverage request. PainRWD™ is governed by Celéri Health — an independent evidence infrastructure company with no therapy to sell. The data is collected prospectively from real-world clinical practice across multiple procedure types, therapy categories, and sponsors, and stewarded independently. That independence is what makes it a credible reference for medical policy purposes.
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Yes. All data in the PainRWD™ Science Cloud is de-identified per HIPAA Safe Harbor. Celéri Health handles PHI stripping, normalization, and Safe Harbor de-identification as the data steward. Practices contribute data under Celéri Health's data-use framework; patients are never in a direct data relationship with payers or any downstream data user. Individual-level matching for specific analyses may require IRB coordination or updated consent.
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Yes. Payers can commission targeted analyses — specific procedure cohorts (SCS for persistent spinal pain syndrome vs. CRPS, for example), geographic subgroups, diagnosis-matched populations, or outcome trajectories for a defined therapy. Custom analyses are delivered through the Celéri Research Group with biostatistical support from Hart Clinical Consultants. Contact us to scope a request.
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Yes. ZIP-level social determinant of health data is available through Celéri Health's partnership with Socially Determined — no patient data transfer is required for ZIP-level enrichment. Individual-level SDOH matching requires IRB coordination or updated consent. For health equity analysis, total cost of care modeling, or social risk stratification, the SDOH enrichment layer is available as part of a custom data engagement.
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Yes, and this is an area Celéri Health is actively developing. PainIntel™ — the point-of-care outcomes platform — is already deployed at interventional pain practices, collecting longitudinal PRO data at every clinical milestone. For payers designing outcomes-based arrangements, PainIntel™ can serve as the neutral measurement infrastructure that both payer and practice trust. Contact us to discuss how a pilot could be structured.
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The PainRWD™ Science Cloud covers a broad range of interventional pain and neuromodulation procedures — spinal cord stimulation across waveforms, RF ablation, peripheral nerve stimulation, intrathecal drug delivery, vertebroplasty and kyphoplasty, epidural steroid injections, and adjacent procedures. Biologics and regenerative medicine are also represented. Coverage continues to expand as the network grows. Contact us for current procedure-level coverage relevant to your review.
Tell us what coverage question you're trying to answer.
Whether your medical policy team is reviewing SCS coverage criteria, your HEOR team needs a total cost of care analysis, or your network team is exploring outcomes-based contracting — Celéri Health can scope the right data engagement.
