This article is more than 5 years old. Information may no longer be current.
Multidisciplinary care clinics pave the way for future IBD care
Click Here to Manage Email Alerts
ORLANDO, Fla. — Integrating various disciplines into the care of the patient with inflammatory bowel disease improves patient satisfaction, decreases health care costs and will be the way of the future for patient care, according to experts at Advances in IBD 2017.
“This a complex illness that affects people at various stages of life makes it a ripe environment to consider multidisciplinary care,” Gil Y. Melmed, MD, MS, FACG, from Cedars Sinai, said during his presentation. “It’s not what we do, it’s really the structure in which we work. It takes a very different approach.”
Miguel D. Regueiro, MD, agreed, supporting this approach with evidence from the University of Pittsburgh Medical Center’s patient-centered medical home.
“In essence, this is taking the patient and put them at the center of the universe in which their nurse practitioners, surgeons, a multidisciplinary team surround them,” Regueiro said.
Logistical concerns
Melmed said they recently implemented a multidisciplinary clinic “to provide care across the continuum.”
Their new model integrates IBD care with pregnancy care, psychosocial care, group visits, telemedicine, nutrition and surgery. Traditionally, he said, a gastroenterologist refers a patient to another specialist when care intersects and that provider discusses the issues and suggests varying methods of handling the new hurdle. Many physicians say the referring provider can call at any time to communicate the care plan, but that often does not occur.
“When we are not there with the patient and other provider, there’s certainly room for that communication to break down,” he said. “Wouldn’t it be great if we could bring everybody together with the patient in the room, all giving the same or complementary messages?”
Melmed explained this was the basis for their multidisciplinary clinic, but the varying needs of the providers, patients and payers are “not simple or straightforward.”
From assistants to nurses to schedulers to just room assignments, everything must be considered. And “you need buy-in ... from the very top,” he said.
Regueiro and his team involved peer specialists and patient advocates when designing their program. They “are part of this and helped design this from a patient standpoint,” he said.
Financial considerations
Physicians hoping to develop a multidisciplinary system in their own practices should consider developing a business plan, Melmed added, to understand the financial impact on an institution, program and practice.
“Financial impact may also come in the form of it’s good for business,” he said. “It could be a marketing opportunity.”
Melmed said juggling the various specialties and physicians is not easy, but it can be done, and considering the non-reimbursed services like nutrition and psychosocial care add another layer to financial considerations.
For a social worker and psychiatrist, for example, he said, “We had to fundraise. We had to raise money for the ... salary. This is something we found that grateful patients are willing to support because this is a program that tends to speak to many people with IBD.”
At UPMC, Regueiro and his colleagues partnered with their in-house health plan, and while an in-house program is not required, he said partnership with a payer is essential.
“The insurance companies are now looking at population-based health and working with multidisciplinary groups and not only improving outcomes but decreasing costs,” Regueiro said. In the years since the patient-centered medical home became reality, Regueiro showed that not only has quality of life improved, but health care utilization and costs have decreased.
“If a health care plan or insurance company is going to be involved in this, they are going to want to see decreased costs. Decreased costs can come in different ways, but [we saw] unplanned care decreasing in emergency room visits and hospitalization,” he said.
In the end, Regueiro said while physicians may not be trained in a culture of collaboration, the new age of health care will require methods like this.
“If we don’t figure out some of these chronic care models that we as specialists take hold of, we will be told how to do it,” he said.
Outcomes improvement
The other essential part of a multidisciplinary visit is to understand what the patient’s goals are for his or her care, Regueiro said.
“We should ask our patients what are the top three things that are bothering them. ... What are the top three things that they want to get out of their visit?” he said. “If we don’t ask our patients what they really want, we will never know what drives their interest in the visit.”
After knowing the patient’s goals and starting that conversation, Regueiro suggested following up via phone or telemedicine. It maintains the connection with the patient yet increases the convenience for both the team and the patient.
“This is actually very effective because the patients hate coming to see us in the city. They’d rather stay at their home,” he said. “Leveraging technology ... and whole life care is going to be critical for these populations.”
Melmed equated it to a one-stop shop.
“Putting it all together, a one-stop shopping approach is complex to organize but it is feasible,” Melmed said. “It can improve adherence, compliance and specialist referrals. Patients can get consistent messages and patient convenience is significant, which can boost patient satisfaction. However, these programs are difficult and complex and there’s a lot of financial considerations that need to go into understanding the financial impact of developing and creating such a program.” – by Katrina Altersitz
Reference: Melmed GY, Regueiro MD. Clinical Session IA. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.
Disclosures: Melmed reports acting as an advisor/consultant for AbbVie, Celgene, Janssen, Medtronic, Pfizer, Samsung Bioepis, Takeda and UCB. Regueiro reports acting as an advisor/consultant for AbbVie, Amgen, janssen, Pfizer, Takeda and UCB.
Editor's note: This item has been updated to reflect the correct affiliation for Melmed.