Quality of Care Improved by New Model for Treating Rheumatoid Arthritis Patients

A new model of rheumatoid arthritis patient care that is designed to improve quality while reducing costs has been developed by rheumatologists at Geisinger Health System in Central Pennsylvania. Their findings were presented this week at the American College of Rheumatology Annual Meeting in Boston. Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

AIM FARTHER is a new value-based, population-care model. AIM FARTHER was designed and tested on 2,378 RA patients cared for by 17 rheumatologists in the Geisinger Health System in Central Pennsylvania. The model''s name stands for Attribution, Integration, Measurement, Finances and Reporting of Therapies. The rheumatologists launched the program in August 2012 using a new strategic approach to care delivery. Significant improvement in quality of care and cost were noted at 22 months of follow up. Cost savings tallied from de-escalating use of costly biologic drugs came to $720,000 for 2013. The study''s authors projected a savings estimate of $1.2 million for 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 rheumatoid arthritis care," said Eric Newman, MD, director of rheumatology for the Geisinger Health System and the program designer. "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 AIM FARTHER care model includes seven 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 and performance reporting; and a new financial incentive model.
The RA quality measure bundle included eight measures: RA on disease-modifying anti-rheumatic 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 a specialized software system (PACERâ„¢) that collects information from patients (via a touchscreen questionnaire), physicians, nurses and the electronic health record, Geisinger Health System rheumatologists created a patient level scorecard to measure RA patient care gaps, enabling these care gaps to be reliably closed at the clinic visit and between visits. The individual patient scorecard results were then rolled up into performance reports at the provider, department and division level and shared transparently with each other to improve overall patient care and cost savings.

The study''s authors reported that 40 percent of the 2,378 RA patients tracked had achieved 100 percent of their applicable quality measures at 22 months, compared to only 22 percent achieving this mark at the beginning of the study. They noted significant improvement in all the quality measures tracked except active RA on DMARD, which started at 92 percent and rose to 93.

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"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," said Dr. Newman. "The success is not due to any one individual, but rather rests on the following strengths: meaningful involvement of all members of the rheumatology team, holding ourselves accountable, dedicating the time needed to perform the work, and creating an internal forum to discuss quality improvement on a regular basis. 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."

This work was internally funded by the Geisinger Health System.

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The American College of Rheumatology is an international professional medical society that represents more than 9,500 rheumatologists and rheumatology health professionals around the world. Its mission is to Advance Rheumatology! The ACR/ARHP Annual Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.acrannualmeeting.org/ or join the conversation on Twitter by using the official #ACR14 hashtag.

Paper Number: 1830

A Novel Population Care Model in Rheumatoid Arthritis - Significant Improvement in Quality and Reduction in Cost of Care

Eric D. Newman1, William T. Ayoub2, David M. Pugliese3, Chelsea Cedeno1, Jason Brown1, Thomas M. Harrington1, Thomas P. Olenginski1, Androniki Bili1, Alfred E. Denio1, Lisa L. Schroeder1, Dennis Torretti1, Tarun Sharma1, Lyudmila Kirillova1, Susan Mathew1, Jonida Cote1, Brian Oppermann2, Cynthia Sullivan2, Shantanu Bishwal4, Brian DelVecchio3 and Howard Aylward2, 1Geisinger Health System, Danville, PA, 2Geisinger Health System, State College, PA, 3Geisinger Health System, Wilkes-Barre, PA, 4Geisinger Health System, Wilkes Barre, PA

Background/Purpose: Rheumatoid arthritis (RA) is a common chronic disease with significant morbidity, mortality, and cost. To optimize care for RA patients, we developed a novel value-based population care model - AIM FARTHER (Attribution, Integration, Measurement, Finances, And Reporting of THERapies). AIM FARTHER was designed to improve quality and reduce cost of RA care.

Methods: The AIM FARTHER model was designed and implemented for all RA patients cared for by the 17 rheumatologists within our health system (n=~2,300 patients). Components included 1) registry development; 2) defining roles and attribution; 3) integration of primary and specialty care; 4) strategic approach to RA care; 5) RA quality measure bundle development; 6) task management and performance reporting; and 7) a new financial/incentive model. The RA quality bundle included 8 measures - RA on DMARD (Disease Modifying Anti-Rheumatic Drug), Active RA on DMARD, RA with CDAI (Clinical Disease Activity Index), RA at low disease activity, TB testing if on biologic, Influenza vaccination, Pneumococcal vaccination, and LDL (low density lipoprotein) checked. These measures were collected electronically, providing the analytics for a patient scorecard (Figure 1). The scorecard was used to close care gaps, rolled up into provider and department performance reports, and shared transparently. Analysis of AIM FARTHER included quality (individual measures and "all or none" bundle score) and cost (biologic de-escalation savings).

Results: AIM FARTHER was implemented August 2012 (2,150 RA patients) with 22 month follow-up (2,378 RA patients). Significant improvement was noted in all quality measures except active RA on DMARD (92% to 93%)(Figure 2). Final values were RA on DMARD 90%, RA with CDAI 84%, RA at low disease activity 53%, TB testing on biologic 93%, Influenza vaccine 75%, Pneumococcal vaccine 72%, and LDL checked 95%. The all or none bundle improved from 22% to 40% (40% of the 2,378 RA patients had achieved 100% of their applicable quality measures). Cost savings from biologic de-escalation were $720,000 for 2013 with projected savings estimate of $1.2 million for 2014.

Conclusion: AIM FARTHER is a novel care model employing provider engagement, process redesign, measurement, and information technology to provide optimal care for patients with RA. AIM FARTHER showed significant improvement in quality measures and reduction in cost of care for a population of over 2,300 RA patients. Additionally, it supports the pivotal role that rheumatology can play in the systematic care of patients with RA.

Disclosures:
E. D. Newman, None
W. T. Ayoub, None
D. M. Pugliese, None
C. Cedeno, None
J. Brown, None
T. M. Harrington, None
T. P. Olenginski, None
A. Bili, None
A. E. Denio, None
L. L. Schroeder, None
D. Torretti, None
T. Sharma, None
L. Kirillova, None
S. Mathew, None
J. Cote, None



Source-Newswise