Practice management: The road aheadConstructing an Inflammatory Bowel Disease Patient–Centered Medical Home
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Constructing an Inflammatory Bowel Disease Medical Home: Where to Begin?
In conjunction with the UPMC HP, we designed and established an IBD patient-centered SMH, designated in July 2015 as UPMC Total Care–Inflammatory Bowel Disease.11 The development of the medical home was facilitated by our unique integrated delivery and finance system. The UPMC HP provided important utilization data on their IBD population, which allowed for focused enrollment of the highest-utilizer patients. In addition, the UPMC HP funded positions that we hired directly as employees of our
Key Components of the Inflammatory Bowel Disease Medical Home
Based on our experience, we believe the following are key components of a successful IBD SMH: (1) team-based care with physician extenders, nurse coordinators, schedulers, social workers, and dietitians as essential members of the IBD SMH; (2) effective care coordination to reduce barriers to comprehensive biopsychosocial care; (3) tracking of process and outcome metrics of interest; (4) appropriate use of technology to enhance clinical care; and (5) care access (eg, open-access appointments),
New Payment Models for Specialty Medical Homes
The SMH transitions away from relative value unit–based reimbursement and toward a value-based paradigm. In the SMH, the gastroenterologist serves as the principal medical provider for the IBD patient. Both providers and payers will be able to refer patients to the SMH. Data on quality metrics will be tracked and physician extenders and nurse coordinators will help ensure that goals are met. Quality improvement, preventive medicine, telemedicine, and point-of-contact mental health care will
Conclusions
With increasing costs of health care, the transition to value-based care is occurring. In new models of care, specialty providers partner with payers in a patient-centered system to provide principal care for patients with chronic diseases, including IBD, in an effort to reduce costs and provide efficient, high-quality care. These models will require close collaborations with payers, a sufficiently large patient population, a physician champion, and a multidisciplinary staff targeting various
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Conflicts of interest These authors disclose the following: Miguel Regueiro serves as a consultant and on advisory boards for Abbvie, Janssen, UCB, Takeda, Miraca, Pfizer, Celgene, and Amgen, and he receives research support from Abbvie, Janssen, and Takeda; Benjamin Click serves as a consultant for Janssen; and Eva Szigethy serves as a consultant for Abbvie and Merck. The remaining authors disclose no conflicts.