“Often, if we listen in the lines and between the lines, our patients tell us exactly what other factors are involved: why their disease is not getting better, why they are getting headaches, why they have such continued suffering,” Dr. Szigethy said.
Dr. Miguel Rigueiro
“You don’t need to know the basic science to understand the stress these patients feel,” Dr. Regueiro recounted to an audience at a recent Advances in IBD meeting in Orlando, sponsored by the Crohn’s and Colitis Foundation of America.
He shared with his audience the story of 45-year-old Anne, a Crohn’s disease sufferer treated at his center. Anne is not the patient’s real name. Despite her disease being inactive, Anne was hospitalized 23 times, and given 19 CT scans and seven endoscopic procedures in one calendar year alone, qualifying her as one of the center’s top 34 “health care frequent fliers.”
Empowering patients like Anne, whose costly care Dr. Szigethy and Dr. Regueiro recognized was attributable more to her psychosocial rather than medical IBD needs, not only improves their quality of life, it saves the system money.
This is why the same health plan representatives who told Dr. Regueiro they’d like to see cost reductions have partnered with him and Dr. Szigethy to develop a specialty care medical home pilot program that combines specialty, primary, and mental health care in one location. The program officially opened in mid-January of this year.
In the mid-1990s, the UPMC Health Plan was conceived by the medical center as a “strategic move to combine the intellectual capital of the provider system with that of the payer system,” according to Sandy McAnallen, UPMC Health Plan’s senior vice president for clinical affairs and quality performance.
The result, she said in an interview, is greater flexibility when it comes to what care is provided and how it is delivered. “The physicians are setting the evidence-based pathways on the kind of care that patients need to receive, and we have the ability to be very proactive with [how we pay for that] with this kind of relationship.”
Over the course of 2 years, Dr. Regueiro and Ms. McAnallen met several times to parse data on more effective ways to address the fractured way IBD patients, particularly those with undiagnosed psychosocial concerns, were seeking and receiving treatment. The pair also honed in on ways to cut the high cost of surgeries and pharmaceuticals with the overall goal being to create a healthier IBD patient population who perceived their care to be the best possible.