May 24, 2018
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GI leader to expand specialty medical home care model

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Michael Regueiro

In his new role as Cleveland Clinic’s chairman of gastroenterology and hepatology, Miguel Regueiro, MD, plans to expand on the inflammatory bowel disease specialty medical home concept that he and colleagues successfully piloted at University of Pittsburgh Medical Center.

The “specialty medical home” is an alternative health care model designed to improve care and reduce the costs of managing chronic illnesses via a patient-centered multidisciplinary team. The UPMC IBD Medical Home, which Regueiro helped launch in 2015, was formed as part of an integrated payer-provider network, and has successfully improved care quality and patient satisfaction, and reduced emergency department visits, hospitalizations and costs.

“The IBD medical home represents an alternative model of care for patients with Crohn’s disease and ulcerative colitis who receive most of their health care by a gastroenterologist,” Regueiro told Healio Gastroenterology and Liver Disease.

The lack of continuity of care for patients with chronic illnesses was the essential problem that prompted the development of the specialty medical home model. By leveraging a payer-provider partnership, a multidisciplinary team of specialists, nurses, dieticians, social workers and psychiatrists can provide “one-stop shopping” for patients rather than traditionally segmented care, according to Regueiro. Remote monitoring and telemedicine can even be used for follow-ups between visits.

“The idea is to provide comprehensive care in an efficient manner, with minimal disruption to a patient’s life and personal schedule,” he said in a press release.

The UPMC IBD Medical Home’s first year was notably successful, and just recently, Regueiro and colleagues published initial outcomes data in Clinical Gastroenterology and Hepatology.

“The study showed that our IBD Medical Home team was able to improve the quality of life and disease activity while decreasing unplanned care, ie, emergency room visits and hospitalizations,” he told Healio Gastroenterology and Liver Disease.

His team retrospectively analyzed data on the 322 patients who enrolled between June 2015 through July 2016 and were followed up for at least 1 year (58% female; mean age, 34.6 years; 62% with Crohn’s disease; 32% with prior IBD surgery). Compared to the year before enrollment, patient emergency department visits dropped by 47.3% (P < .0001), and hospitalizations dropped by 35.9% (P = .008). In the year after enrollment, median Harvey-Bradshaw Index scores dropped significantly from 4 to 3.5 (P = .002), and median ulcerative colitis activity index scores dropped from 4 to 3 (P = .0003). Median short IBD questionnaire scores measuring quality of life also increased from 50 to 51.8 (P < .0001).

Expanding the concept

Based on this initial success, Regueiro recently became Chair of the Gastroenterology and Hepatology Department at Cleveland Clinic and plans to expand on the specialty medical home concept in Ohio. Regueiro plans to continue developing programs that deliver multidisciplinary, holistic care for patients with chronic diseases using a population-health approach, starting with IBD, and then expanding to liver, obesity, metabolic and functional bowel diseases.

He also plans to expand clinical research that will complement the specialty medical home model, namely health care economics, population health and epidemiology studies.

“As our healthcare delivery evolves new models of care that are reliant on integration of providers, payers, industry, innovative technology and patients, we will have an opportunity to write a new ‘healthcare playbook,’” he said in the press release. “To do this, understanding the economic impact of these models, and how regional and national patient populations are cared for, are at the core of next-generation medicine.”

Regueiro is optimistic about the potential of the specialty medical home model for improving the value of health care.

“I believe specialty population health is within our grasp and will rely on placing the patient at the center of the ‘healthcare’ universe, implementation of a team-based approach, and integration of care with the primary care and family practice providers,” he said in the release. “I look forward to expanding this model across GI and liver diseases and working with the new Population Health department at the Cleveland Clinic to implement population-based specialty care. Rather than working with a single payer, we will engage multiple payers to realize these novel specialty care models.” – by Adam Leitenberger

Reference:

Regueiro M, et al. Clin Gastroenterol Hepatol. 2018;doi:10.1016/j.cgh.2018.04.007.

Disclosures: Regueiro reports consulting and serving on advisory boards for AbbVie, Janssen, Takeda, Pfizer, Celgene and UCB.