New RA Care Model Reduces Costs and Improves Quality

Boston—Rheumatoid arthritis (RA) is largely associated with significant morbidity, mortality, and overall costs. This chronic condition affects an estimated 1.3 million Americans, and the disease typically affects women twice as often as men.

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In a study highlighted at the ACR/ARHP meeting, rheumatologists at Geisinger Health System, located in Pennsylvania, sought to optimize care for RA patients by developing a novel value-based population care model: AIM FARTHER [Attribution, Integration, Measurement, Finances, And Reporting of Therapies], which was designed to improve patient quality of care and reduce the costs of RA treatment.

The novel model was implemented for 2378 RA patients cared for by 17 rheumatologists in the Geisinger Healthcare System. The program was launched in August 2012, concluding with a 22-month follow-up in May 2014.

Components of the model design included registry development, defining roles and attribution, integration of primary and specialty care, strategic approach to RA care, RA quality measure bundle development, task management and performance reporting, and a new financial/incentive model.

The RA quality bundle included 8 measures:

(1) RA on disease-modifying antirheumatic drug (DMARD)
(2) Active RA on DMARD
(3) RA with clinical disease activity index (CDAI)
(4) RA at low disease activity
(5) Tuberculosis (TB) testing if on biologic
(6) Influenza vaccination
(7) Pneumococcal vaccination
(8) Low-density lipoprotein (LDL) cholesterol check

These 8 measures were collected electronically for patients included in the study, providing a patient scorecard, which was then used to close care gaps.

“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 [RA] care,” said the study’s program designer, Eric Newman, MD, director of rheumatology, Geisinger Health System, in a press release.

At 22-months follow-up, significant improvements in quality of care and cost reduction were noted. Cost savings from de-escalating use of costly biologic therapies totaled $720,000 for 2013, and the study’s authors estimated that a savings of $1.2 million could be seen in 2014.

In addition, 40% of the RA patients tracked had achieved 100% of their applicable quality measures at 22-months follow-up compared with 22% of patients achieving these measures at baseline.

In terms of improvement in quality measures established, all but active RA on DMARD showed significant improvement. For active RA on DMARD the difference from baseline to follow-up rose from 92% to just 93%, respectively. For RA on DMARD, improvement measures rose from 88% at baseline to 90%. For RA with CDAI, improvement measures rose from 52% to 84%. For RA at low disease activity, improvement measures rose from 35% to 53%. For TB testing on biologic agents, improvement measures rose from 83% to 93%. For influenza vaccine, improvement measures rose from 59% to 75%. For pneumococcal vaccine, improvement measures rose from 59% to 72%. And, for LDL cholesterol check, improvement measures rose from 93% to 95%.

The study was funded internally by the Geisinger Health System.—Kerri Fitzgerald