IBD may require more intense care approach due to higher cost volatility
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In value-based care programs, inflammatory bowel diseases like Crohn’s disease and ulcerative colitis may require more intense management compared with other chronic gastrointestinal conditions due to much higher cost volatility, according to data from DDW.
“Patients with Crohn’s and UC tend to normalize their conditions, which means they often can’t tell when their symptoms are worsening,” Lawrence Kosinski, MD, founder and chief medical officer of SonarMD, and the lead author of the study, said in a press release from SonarMD. “That can lead to complications and hospitalizations – and highly variable per capita costs.”
Kosinski and colleagues postulated chronic gastrointestinal diseases may be profiled using measurement of volatility based on cost. Investigators collected data from 40,523 members of the Health Care Service Corporation, such as professional, facility and pharmacy claims for calendar year 2017, to calculate an index and beta rating for GERD, peptic ulcer disease (PUD), gastritis, Celiac disease, pancreatitis, irritable bowel syndrome, Crohn’s disease, UC, colon polyps and diverticulitis.
For each condition, researchers calculated the total disease specific cost. They also calculated a GI Disease Index with the total disease specific cost for each GI condition, which was then separated into deciles. The cost/decile was assessed for each condition and compared with the GI index.
Compared with the GI index, results showed strongly positive beta scores in CD and UC but not in the other GI conditions.
“Like stocks in the stock market, diseases can be profiled by their volatility. Some diseases have high variability (high beta), whereas others have low variability (low beta),” Kosinski told Healio Gastroenterology and Liver Disease. “Variability drives cost for these diseases. The higher the variability (beta rating) the higher the overall cost/patient.”
Kosinski and colleagues noted in the poster, low beta conditions had more predicable costs and outcomes may be better suited for bundled payments and episodes of care because their cost volatility is low. However, to improve care and lower costs, high beta conditions need value-based programs with a focus on care coordination, patient engagement and disease management.
“Payers and gastroenterologists need to work together to engage patients with high beta conditions, track symptoms, catch deterioration early, and intervene before it becomes a bigger problem,” he said. “That way, patients stay healthier and out of the hospital, resulting in lower costs.” – by Monica Jaramillo
Reference: Kosinski L, et al. Abstract 485. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
Disclosure: Kosinski reports he is an owner, board member and option holder of SonarMD. Please see the study abstract for all other authors’ relevant financial disclosures.
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