The Digestive Health Physicians Association (DHPA) is a national trade association of independent gastroenterology (GI) physician practices with the aim of promoting and preserving accessible, high quality and cost-efficient care in the independent GI medical practice setting. DHPA focuses on collecting, benchmarking and analyzing data relevant to independent GI medical practices. The association capitalizes on its member practices' data resources to augment DHPA's public policy, education and advocacy efforts to serve independent practices and their patients. Members strive to improve patient care and outcomes by supporting policies that promote accessible, high quality and cost-efficient medicine in independent practice settings.
In the first of a series from the Digestive Health Physicians Association, Dr Lawrence R. Kosinski writes about Project Sonar, an innovative proposed Advanced APM that has cleared the first regulatory step. Project Sonar has saved thousands in hospitalization costs in pilot studies.
Lawrence R. Kosinski, MD, MBA, AGAF, FACG
As the drama unfolded this summer during Congress’ failed attempts to repeal and replace the Affordable Care Act, our healthcare system continued its inevitable move away from fee-for-service toward value-based care. One immediate step HHS Secretary Tom Price, MD, can take to increase access to affordable, high-quality healthcare and reduce Medicare spending is to approve Project Sonar, a new payment model that would improve treatment for patients with inflammatory bowel disease—a move that could also significantly affect the way we treat other chronic diseases and conditions
Inflammatory bowel disease (IBD) afflicts more than 1.5 million Americans, having a significant impact on a person’s quality of life due to ongoing symptoms, social stigma, and restrictions in career choices. The disease’s unpredictable nature creates a burden on our nation’s economy, with more than $1.26 billion in direct and indirect costs annually.1
In May, the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which advises CMS on the development and implementation of new healthcare delivery models, recommended that Secretary Price approve the Project Sonar Advanced Alternative Payment Model (APM) for limited scale testing.2 Advanced APMs require physicians to take on risk and provide compensation based on quality of care. They are 1 of 2 payment programs—the other being the Merit-Based Incentive Payment System (MIPS)—included in the Medicare Access and CHIP Reauthorization Act (MACRA) enacted in 2015. PTAC has currently deliberated on only 3 of the 25 proposals submitted for Advanced APMs, and Project Sonar was the first of 2 recommended to the secretary for limited scale testing.
The Project Sonar APM is an “intensive medical home model” that targets patients with IBD and is designed to reduce costs and improve care for patients by getting them directly engage in their care. It utilizes SonarMD, a web-based platform that evolved from a partnership between Blue Cross Blue Shield of Illinois (BCBSIL) and the Illinois Gastroenterology Group (IGG). In a review of 2 years of claims data on roughly 21,000 patients, IGG noticed that the high rate of hospitalizations was largely driven by patients who didn't recognize their conditions were worsening and didn't follow up with their doctors.3
In an initial pilot study of 50 patients with Crohn's disease, costs savings were seen among patients who responded frequently to monthly surveys with a subset of questions derived from the Crohn's Disease Activity Index.3 Responses to the questions are coded into a symptom or “Sonar Score.” A nurse care manager calls the patient if a score is poor, and enters information about the patient's status into health records—bringing a physician into the conversation when necessary.
Under the study, hospitalizations dropped from 17% to 5%. Patients who responded to inquiries at least 50% of the time generated an average annual savings of $6000 per person for BCBSIL, in a disease with an average annual cost of $24,000 per patient.3 Additionally, the program fosters a true partnership clinicians and patients—with patient engagement more than tripling over a 20-month study period.3
Once approved by Secretary Price, the Project Sonar payment method will be refined in cooperation with the Center for Medicare & Medicaid Innovation (CMMI) and deployed to the 600 physicians who are currently using the SonarMD platform in 20 independent GI practices nationwide.
The Project Sonar APM will enable caregivers to provide better medical management, reducing emergency department visits and inpatient admissions because physicians can better identify and assess high-risk patients before complications arise. Project Sonar is currently exploring a program with primary care physicians to target type 2 diabetes patients, with a focus on monitoring high glycate hemoglobin levels.
The platform changes how physicians approach patients with chronic disease. While most physicians deal with a single patient at a time, Project Sonar encourages them to look at an entire population of patients with a specific disease to understand how their decisions impact the ultimate outcome.
These types of changes to the healthcare system have major implications for delivery, and the Project Sonar APM presents new opportunities for specialists to participate in Advanced APMs without requiring them to do so through a hospital system. Project Sonar has also been approved as a MIPS Improvement Activity, enabling physicians to receive higher Medicare payments based on performance.
The Project Sonar APM will be of tremendous value by affording specialists an opportunity to navigate MACRA more efficiently, while helping to improve health care quality on a population level. It will also provide cost savings to the Medicare system, preserve patient choice and improve patients’ lives.
About the Author
Lawrence R. Kosinski, MD MBA, AGAF, FACG, is a managing partner at the Illinois Gastroenterology Group (IGG). He is also president and CEO of SonarMD, LLC. Dr. Kosinski also recently completed a three-year position on the governing board of the American Gastroenterological Association (AGA) and served as one of its Clinical Private Practice Councilors. He also chaired the AGA’s Crohn’s Disease and Ulcerative Care Pathway taskforces.
1. Crohns and Colitis Foundation website. Fact sheet about IBD. http://www.crohnscolitisfoundation.org/news/for-the-media/media-kit/fact-sheet-about-ibd.html. Accessed August 4, 2017.
2. Physician-Focused Payment Model Technical Advisory Committee. Report to the Secretary of Health and Human Services. Comments and Recommendation on Project Sonar. https://aspe.hhs.gov/system/files/pdf/255906/SonarReportSecretary.pdf. Published May 31, 2017. Accessed August 4, 2017.
3. Illinois Gastroenterology Group. PROJECT SONAR (PS) Advanced Alternative Payment Model. https://aspe.hhs.gov/system/files/pdf/253406/ProjectSonarSonarMD.pdf. Published December 16, 2016. Accessed August 4, 2017.