Medical home models could cut health care utilization, costs for IBD
CLEVELAND — Rheumatologists should consider the medical home model of health care for patients with inflammatory bowel disease who experience high medical costs and utilization rates, and whose care comes primarily from a specialist, according to Miguel Regueiro, MD, chairman of the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic.
“I would submit that, for rheumatology, this probably would even apply even more than in gastroenterology — inflammatory bowel disease, in essence, is an immune-mediated disease that all of you take care of in terms of rheumatologic disorders,” Regueiro told attendees at the Biologic Therapies Summit VIII. “I think we are moving from the traditional IBD centers of excellence and evolving more into these specialty medical homes.”
“And, really, when I say ‘IBD,’ you can put in your rheumatic disease of choice here, because they apply here, too,” he added.
At its heart, the medical home model focuses on the interactions between biological and environmental factors, and establishes a health plan dedicated to addressing the unmet needs of patients with chronic diseases that lead to excess utilization, Regueiro said. It is team-based, coordinated and patient-centered, with a team that can, for IBD, include a primary care physician, a gastroenterologist, nurses and a nurse practitioner, a dietitian, a social worker, IBD surgeons and a psychiatrist or psychologist. These teams can start small and expand as demands dictate.
The model also makes use of schedulers, patient questionnaires, after-visit follow-up calls, meetings among various members of the care team and video telemedicine. In addition, it features a collaboration with health plans and insurance companies and systems “for the long haul,” he added.
“You have to look at the psychosocial care, examining the whole patient with a multidisciplinary team,” Regueiro said. “Interestingly, in my experience, the payers have begun supporting positions, such as social workers. If you show the payers that you are going to reduce their ER visits and hospitalizations — and those are millions of dollars, to be quite honest — they are going to realize that hiring a social worker costs much, much less.”
According to Regueiro, the medical home model can improve health and the individual experience of care for patients, as well as reduce per capita costs. He added that he and his colleagues witnessed this effect firsthand at the University of Pittsburgh Medical Center, where they had established an IBD specialty medical home. In a study published in 2017 in Clinical Gastroenterology and Hepatology, the medical home model succeeded in improving disease activity in ulcerative colitis and Crohn’s disease, as well as reducing unplanned care, including emergency room visits and hospitalizations, he said.
However, for all of this to work, it requires a team that “buys in” and believes that this is a new model of care that works, Regueiro added.
“I will tell you, 90% of gastroenterologists in this country will not do this model,” Regueiro said. “They are not trained in it, they want to be very specific in terms of the disease and they like to do procedures. I am not saying this critically, but this is essentially what the specialty model has become. However, we are starting to see physician buy-in with champions of this model. Medical schools are starting to teach these models, where it may be called the ‘team-based approach.’ The collaboration may not be just with the hospital anymore, but directly with the payers and insurance companies.” – by Jason Laday
Regueiro, M. What are the lessons of building a medical home for IBD for the rheumatologist. Presented at: Biologic Therapies Summit VIII; May 16-17, 2019; Cleveland, Ohio.
Disclosure: Regueiro reports consulting fees from AbbVie, Janssen, Pfizer, Seres Health and Takeda.