Patient-centered IBD home reduces expenditures, improves QOL
LAS VEGAS — The institution of a patient-centered medical home for patients with inflammatory bowel disease resulted in less visits to the ED, less hospitalizations and overall improved quality of life in the first year, according to a presenter at ACG 2016.
“Enrollment of IBD patients in a patient-centered medical home in which there’s a payer-provider model is feasible. There’s a significant improvement in quality of life that we saw in the first year and saw by a short period of three visit,” Miguel D. Regueiro, MD, professor of medicine at the University of Pittsburgh Medical Center, said during his presentation. “There’s a significant decrease in unplanned care in terms of ER and hospitalization.”
This patient-centered medical home (PCMH) included patients aged 16 to 50 years with confirmed ulcerative colitis and Crohn’s disease who held insurance through UPMC (n = 308). The primary reason for physician visits in the past year had to be for the patients’ IBD, Regueiro said.
“Our UPMC IBD Total Care … includes open access, pathways, remote monitoring, telemedicine and a multidisciplinary approach. Our medical home relies on the gastroenterologist as providing principle care to the whole person and is in collaboration with our insurance company,” he said.
The health plan funded some of the positions in the PCMH, such as the nurse practitioner, social worker, dietitian and part of the psychiatrist, a cost Regueiro estimated at $500,000. These positions and more contribute to the process, he explained.
“We have schedulers with a high touch interaction … who ask what the patient wants to get out of the visit. Prior to the visit, we meet as a team and quickly huddle to plan the care of that patient and how we are going to integrate the visit,” Regueiro said. “We have weekly meetings in which we talk about our patients where we alter the plan based on the patient and their needs.”
In the year prior to PCMH enrollment, this cohort had 322 ED visits, with 41.7% of patients having at least one visit. The group also had 160 hospitalizations with 30.6% admitted for care.
“This was a high utilizer group by definition,” Regueiro said.
After 1 year in the PCMH, there was a 51.9% decrease in ED visits for the total cohort (155 visits since enrollment). In patients with at least 6 months of follow-up, there was a 41% decrease in ED visits (197 in year prior vs. 116 since enrollment; P = .001).
Hospitalizations for the total cohort decreased by 53.1% (160 vs. 75) and in those followed for at least 6 months, the decrease was 44% (100 vs. 56; P < .005).
“If at the end of 1 year, we lost money or broke even, I probably wouldn’t be standing here presenting this quite honestly. However, when you look at the reduction in ER and hospitalizations and you realize that each ER visit can be between $50,000 and $150,000 depending what goes into that visit and each hospitalization can be between $50,000 … up to $2 million for some of our patients, those numbers start to add up,” Regueiro said. “That’s where the return on investment will be.”
Regueiro said he hopes to present final numbers at Digestive Disease Week 2017.
Additionally, Regueiro showed that QOL improved by 9.1 points (31.2 vs. 40.3; P < .001) by the end of the year. He explained that the short IBD questionnaire is filled out in person at each visit (98.85% of visits).
“Do we have a lot to learn? Yes. There’s a lot we’re still working out,” he said. “Hopefully we will see in the future real change.”– by Katrina Altersitz
Regueiro MD, et al. Abstract #69. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 17-19, 2016; Las Vegas, NV.
Disclosures: The researchers report no relevant financial disclosures.