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 22 February 2018

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News

Development of a new IBD patient–centered medical home

A study in August's issue of the Clinical Gastroenterology & Hepatology constructs an inflammatory bowel disease patient–centered medical home.

News image

Inflammatory bowel diseases (IBDs) including Crohn’s disease and ulcerative colitis are life-long chronic diseases with high morbidity.

Recent studies have shown increasing global IBD incidence and prevalence rates.

Furthermore, there has been remarkable progress in the understanding of disease pathophysiology, leading to new medical therapies and surgical approaches for the management of IBD.

These trends have resulted in a marked increase in the cost of IBD care, with current estimates ranging from $14 to $31 billion in both direct and indirect costs in the United States.

Dr Miguel Regueiro and colleagues from Pennsylvania, USA develop a new model for  IBD patient-centered homes.

IBD patients have unique behavioral, preventive, and therapeutic care requirements.

Because of the complexity of care, the team observed a large degree of segmentation and fragmentation of IBD management across health care systems and among multiple providers.

Primary care providers play a central coordinating role in these new models
Clinical Gastroenterology & Hepatology

This siloed approach often falls short of seamless, efficient, high-quality, patient-centered care.

To address the increasing costs and fragmentation of chronic disease management, population-based health care has emerged as a new concept with an emphasis on reward for value, not volume.

The team noted that 2 such examples of population-based health care include accountable care organizations, and patient-centered medical homes.

This concept relies on the development of new payment models and shifts the risk to the providers.

Primary care providers play a central coordinating role in these new models.

However, the team observed that the role of specialists is less well defined, with limited sharing of risk for the care and costs of populations.

The researchers found that bundled payments have been implemented to reduce costs of episodes, but no good evidence exists on how specialists can take risks for the populations they serve.

The IBD specialty medical home (SMH) implemented at the University of Pittsburgh Medical Center (UPMC) is an example of a new model of care.

The team reports that the IBD SMH is constructed to align incentives and provide up-front resources to manage a population of patients with IBD optimally—including treatment of their inflammatory disease, co-existing pain, and psychological issues, among others.

In the case of the IBD SMH, the research team reports that the gastroenterologist is the principal provider for a cohort of IBD patients.

The gastroenterologist is responsible for the coordination and management of health care of this population and places the IBD patient at the center of the medical universe.

Dr Regueiro's team concludes, "In this article, we draw from our rich partnership between the UPMC Health Plan, and Health System to describe the construction and deployment of the IBD SMH."

"Although this model is new and we still are learning, we already have seen an improvement in the overall quality of life, decreased utilization, and reduction in total cost of care for this IBD SMH population."

Clin Gastroenterol Hepatol 2017: 15(8): 1148–1153.e4
28 July 2017

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