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

van Deen, Welmoed K.; Spiro, Arlen; Burak Ozbay, A.; Skup, Martha; Centeno, Adriana; Duran, Natalie E.; Lacey, Precious N.; Jatulis, Darius; Esrailian, Eric; van Oijen, Martijn G.H.; Hommes, Daniel W.

European Journal of Gastroenterology & Hepatology: March 2017 - Volume 29 - Issue 3 - p 331–337
doi: 10.1097/MEG.0000000000000782
Original Articles: Infl ammatory Bowel Diseases

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.

aCenter for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles

bGehr Family Center for Implementation Science, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine

cLeonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles

dAnthem Blue Cross, Woodland Hills, California

eAbbVie, North Chicago, Illinois, USA

fDepartment of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Correspondence to Daniel W. Hommes, MD, PhD, Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California at Los Angeles, 10945 Le Conte Ave #2338, Los Angeles, CA 90095, USA Tel: +1 310 206 5403; fax: +1 310 206 9906; e-mail: dhommes@mednet.ucla.edu

Received July 23, 2016

Accepted September 28, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.