The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study

Abstract

Background and objectives Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring. Methods IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups. Results In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (−10%, P=0.012), and numerically fewer surgeries (−25%, P=0.49), hospitalizations (−28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (−25 to −86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24). Conclusion These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.

White Paper AGA: The Impact of Mental and Psychosocial Factors on the Care of Patients With Inflammatory Bowel Disease

“…In Europe, a value-based health care model focused on coordinated care, task differentiation of providers, and continuous home monitoring (using mobile health technologies) showed significantly fewer upper endoscopies, surgeries, hospitalizations, and emergency room visits compared with matched controls. 13,117,118 IBD-related costs were 16% ($771 per patient) less than expected during the 1-year study period. 13 Large health systems also have begun to develop telecommunications and telehealth programs as described in a recent review by Cross and Kane 119 to take care of the "whole patient".…”

Reduced Unplanned Care and Disease Activity and Increased Quality of Life After Patient Enrollment in an Inflammatory Bowel Disease Medical Home

“…The Division of Digestive Disease at UCLA has introduced a comprehensive, integrated, and holistic approach to value-based care in the chronic disease management of Inflammatory Bowel Diseases (IBD), with the development of the “Value- Quotient” (or vQ) for value-based and cost-effective IBD management. 22–25 The Illinois Gastroenterology Group developed Project Sonar, a care management solution for patients with IBD. Project Sonar utilizes nurse care managers and physician medical directors in a team approach to coordinate care for patients with IBD, along with clinical decision support and patient engagement, and has recently partnered with a national payer to create a specialist intensive medical home.…”

Risk Factors and Outcomes of Emergency Room Visits in Intestinal Behçet’s Disease

“…Hoffenberg et al[10] found that one-fifth ER visits for IBD were judged medically unnecessary, and one-half avoidable in a more optimal health care system. van Deen et al [23]. reported that IBD patients treated with the value-based healthcare program, which focuses on highly coordinated care, task differentiation of provider, and continuous home monitoring achieved significantly fewer ER visits…”