P487 The effect of a coordinated care programme for inflammatory bowel diseases on health care utilisation
W. K. van Deen*1, M. Skup2, A. Centeno1, N. Duran1, P. Lacey1, D. Jatulis3, E. Esrailian1, M. G. van Oijen4, D.W. Hommes1
1UCLA Centre for Inflammatory Bowel Diseases, Division of Digestive Diseases, University of California, Los Angeles, California, United States, 2AbbVie, US Immunology, North Chicago, Illinois, United States, 3Anthem Blue Cross, California, Woodland Hills, California, United States, 4Academic Medical Centre, Amsterdam, Department of Medical Oncology, Amsterdam, Netherlands
To bend the cost curve, value-based health care (VBHC) is thought to be the way forward. Central in this concept are a coordinated care infrastructure and the measurements of outcomes and costs. Despite that many institutions have implemented key components of VBHC, the evidence-base is still limited. We aimed to evaluate the performance of a VBHC programme specifically for inflammatory bowel diseases (IBD) management, in the first year after implementation. Key components of the programme were care coordination, task differentiation, and remote patient monitoring.
Administrative data from Anthem California were used to identify IBD patients treated by participating IBD centre providers using the coordinated care protocol. A control population of IBD patients treated by other academic providers in California was identified, as well. IBD Centre patients were matched 1:3 with controls based on comorbidities, IBD subtype, age, and relapse rate in the index year (2012). IBD-specific outcomes in 2013 were compared between groups, including medication use, office visits, IBD-specific tests, ED visits, and hospitalisations.
In total, 98 IBD centre patients were matched to 293 control patients. We observed 52% less corticosteroid use (p = 0.027) and 77% less long-term corticosteroid use (p = 0.13) in IBD centre patients, 6% more biologics use (p = 0.77), and 22% more immunomodulator use. IBD-specific office visits increased with 20% (p = 0.009), whereas overall office visits decreased with 12% (p = 0.54). No difference in colonoscopy rates was observed (0.3% difference, p = 0.86), whereas EGD use decreased by 72% (p = 0.062). More biomarker testing was performed (increase of 36%, 6%, and 7% in CRP, ESR, and calprotectin testing, respectively), whilst less imaging studies were performed (26%, 28%, and 50% decrease in the number of CT, MR, and US, respectively). Hospitalisations decreased by 43% (p = 0.96), ED visits by 66% (p = 0.36), and 40% less surgeries were performed (p = 0.38).
The first-year results of an IBD=specific VBHC programme show significantly less steroid use and more IBD-specific office visits compared with matched IBD patients treated by other academic gastroenterologists. Overall, beneficial trends towards less imaging studies, more biomarker testing, and less ED visits and hospitalisations were observed. More long-term larger sample data are warranted to assess the long-term effect of VBHC in IBD.