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Digestive Disease Week

Measuring, Improving, and Reimbursing for Quality in IBD Management

Christina Mattina
At a session during Digestive Disease Week 2017, held in Chicago from May 6-9, speakers discussed the ongoing efforts to define, measure, and improve the quality of care for patients with inflammatory bowel disease (IBD).
The next speaker, Lawrence Kosinski, MD, MBA, managing partner of the Illinois Gastroenterology Group, presented his work on Project Sonar as an example of how to succeed in a physician-focused payment model. The project’s name comes from the analogy that patients with Crohn’s disease are like submarines, “running silent and deep” and only surfacing when they’re in trouble. Instead, this model aims to engage patients and intervene before they develop serious problems. It does so by “pinging” patients monthly and asking them to complete an online questionnaire that produces a “sonar score” indicating their Crohn’s disease activity level.
Kosinski’s data demonstrated that as patients’ sonar scores declined, so did the cost of care; in fact, the insurer that funded Project Sonar saw a 650% return on its $840 per member annual investment in the program. Inpatient costs for the study population have been cut in half, and the total cost of care decreased by 9.8%. Patient satisfaction also increased, as hospitalizations dropped and their quality of life improved. These successes helped Project Sonar gain a positive recommendation from HHS’ Physician-Focused Payment Model Technical Advisory Committee.
When asked about the take-aways from the Project Sonar experience, Kosinski said the key was patient engagement, which providers “will have to focus much more on if we want to succeed.” He also stressed the importance of a long-term vision that focuses on improving infrastructure and population health. “We shouldn’t focus on our own revenue streams when trying to build value,” he said.
Finally, presenter Corey Siegel, MD, MS, director of the IBD Center at the Dartmouth-Hitchcock Medical Center, spoke about quality collaboratives in IBD care, specifically the IBD Qorus initiative launched by the Crohn’s and Colitis Foundation of America. The program has been implemented in 30 states, and all of the participating sites collaborate to share which ideas have been successful in improving clinical outcomes and lowering costs.
In this system, the care team feeds clinical data and the patient feeds patient-reported outcome data onto a shared data platform used during visits. This “coproduction” platform has “transformed patient visits,” as it incorporates patient concerns, clinical measurements, symptom trackers, and treatment history onto an easy-to-use dashboard that allows clinicians to spend more time talking about what’s important to the patient.
It also facilitates population management efforts, as it lets practices sort patients by salient characteristics and create interventions for specific high-risk patient groups. According to Siegel, this “incredibly powerful tool” not only lets clinicians manage their own patient populations, but also helps each practice learn from and guide one another, as they “push each other towards success.”
The presentation was evidently persuasive, as an audience member asked Siegel how his own practice could join the IBD Qorus initiative. 

Corrected May 11 to clarify AGA position on bundled payment models.

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