P354 The effect of value based health care delivery for inflammatory bowel diseases on outcomes of patients
Zand A., Aredas E., Duran N., DiNicola C., Lacey P., Arenas A., Hommes D.W.
UCLA Center for Inflammatory Bowel Diseases, Los Angeles, United States
Innovative approaches in the transitioning landscape of healthcare, such as value-based healthcare (VBHC), are widely examined and defined but data on effects of these methods is lacking. VBHC is defined by continuous measurement of health & cost outcomes and precisely timed care coordination and deemed by healthcare pioneers as the way forward to battle the rising costs. The UCLA Center for Inflammatory Bowel Diseases (IBD) started with a VBHC program in 2012. This study aimed to look at readmission rates, flares and hospitalization rates in IBD patients.
The implementation of the VBHC program consisted of designing the program, training of physicians, care coordinators, administrators and patients, and introducing IBD specific technology applications. Data on of IBD patients enrolled at the UCLA Center for Inflammatory Bowel Diseases were collected from the electronic medical health record system (EPIC). IBD patients were selected and identified by using ICD-9 codes that correlate with Crohn's disease or ulcerative colitis. We aimed to directly extract data from the UCLA EMR system, and assess the impact of VBHC delivery on IBD-related emergency department visits, IBD-related admissions (any hospitalization or surgery related to IBD) and IBD flares.
Out of 4053 IBD patients currently treated by the UCLA health system, 829 were enrolled in the VBHC program. Care providers included 2 IBD physicians, 2 IBD nurses and 2 dedicated IBD administrators. The patient facing application was made available on iOS and Android platforms. Educational material for patients consisted of videos and hands-on training in the clinic. Pre-existing IBD care pathways were used to guide disease management. Data on the 829 patients was collected from May 2013 until May 2016. Stunningly, the results show that there was a decrease of 79,4% in IBD related hospitalizations within the study period. Regarding ED visits a reduction of 69,5% was observed and the overall relapse rate decreased by 46,6% during this period.
The implementation of a VBHC program has led to significant reduction in care utilization and associated decrease in medical costs. Shifting away from the fee-for-services model to new value-based approaches can optimally prepare health practices for value-based contracting.