New Rheumatoid Arthritis Patient Care Model Leads to Significant Cost Reductions

A new model of rheumatoid arthritis (RA) patient care improves quality while reducing costs, according to research presented at the American College of Rheumatology Annual Meeting held November 14-19, 2014, in Boston.

Researchers from the Geisinger Health System in Central Pennsylvania developed Attribution, Integration, Measurement, Finances and Reporting of Therapies (AIM FARTHER), a value-based, population care model and tested it on 2,378 RA patients cared for by 17 rheumatologists in the central Pennsylvania area. The program launched in August 2012, and at 22 months follow up, improvements were noted by researchers in quality of care and cost areas. About 40 percent of enrolled study patients demonstrated 100 percent of their applicable quality measures at 22 months follow up, compared to only 22 percent achieving this mark at baseline. All quality measures examined demonstrated improvement, except for active RA on DMARD, which started at 92 percent and rose to 93 percent. After saving $720,000 in 2013 from de-escalating the use of costly biologic drugs, the researchers estimate a savings of $1.2 million in 2014.

“We recognized the importance of objectively and routinely measuring disease activity, and using that information to engage our patients and drive a new systematic strategic approach to RA care,” Eric Newman, MD, director of rheumatology for the Geisinger Health System and the program designer, said in a press release. “By using people, process, and information technology in new and novel ways, we hoped to be able to improve the lives of those that we serve — our patients.”

The patient care model of AIM FARTHER includes the following 7 components: registry development; defining roles and attribution; integration of primary and specialty care; a new strategic approach to RA care; RA quality measure bundle development; task management performance reporting; and a new financial incentive model. Specifically, the RA quality measure bundle included 8 prongs: RA on disease modifying antirheumatic drug (DMARD); active RA on DMARD; RA with Clinical Disease Activity Index (CDAI) measurement; RA at low disease activity; tuberculosis testing if on a biologic; influenza vaccination; pneumococcal vaccination; and low density lipoprotein (LDL) level checked.

Using the specialized PACER software system which collects data via a touch screen questionnaire from patients, physicians, nurses, and the electronic health record (EHR), the investigators created a patient level scorecard to measure RA patient gaps. The goal for the investigators was to be able to reliably close these gaps at the clinic visits and between visits. Overall patient care and cost savings were evaluated simultaneously to these scorecards, and performance reports were shared among provider, department, and division level investigators.

“By using industry-vetted problem solving techniques and quality improvement methodology, we were able to design, test and implement a new model of care that has shown improvement in quality and reduction in cost beyond what I had hoped,” Newman concluded. “This approach moved our rheumatology team from engagement to buy-in to ownership. The result is an RA population management program that is sustainable yet evolving, as we challenge ourselves to continuously improve the quality of care for our patients with rheumatic disease.”