Taking Aim at Multiple Sclerosis

The exact cause of multiple sclerosis (MS) is unknown.¹ With MS, the immune system attacks the protective sheath that covers nerve fibers and causes communication problems between the brain and the rest of the body. The signs and symptoms of MS vary widely between patients depending on the severity and location of the nerve fiber damage. According to a 2020 study, the estimated number of people with MS in the US is nearly 1 million.²

People with MS often have comorbidities; they’re more likely to have depression, anxiety, cerebro- and cardiovascular diseases, and certain autoimmune disorders.³ Comorbidities can worsen the severity of a person’s MS and can cause an increase in hospital admissions and readmissions. The estimated lifetime cost of MS is more than $4.8 million per patient, ranking it second in direct all-cause medical costs for chronic conditions. Despite having more than 22 approved treatments for MS, called disease-modifying treatments (DMT), the average cost is over $90 000 per year.⁴

This burden is felt through the entirety of the health care continuum, and the payer is no exception—MS costs our health system over $63.3 billion in direct medical costs.⁵ While payers understand MS, its varying degrees, and the potential comorbidities, there is only one diagnostic code for MS, making it challenging to navigate patient care.

Part of the payer’s role in MS care management is working with providers to ensure that resources are used optimally, reducing the economic burden for all parties.

This collaboration can be made possible through the quadruple aim, a framework designed to improve the health care system by supporting collaboration.⁶ Payers can utilize it to lower costs by addressing unmet needs in the MS space. As the name suggests, the quadruple aim is composed of four branches:

• Improving the patient experience
• Improving the provider experience
• Improving health outcomes
• Reducing payer cost

We recognize that what lies ahead of the payer as they grapple with neurodegenerative diseases is no small task. It will take years of collaboration to achieve anything close to value-based care. We believe that a forward step in this process, in terms of MS care and management, is in creating and implementing a comprehensive, longitudinal health solution with each branch in mind. We think this approach can help ensure better care in the following ways:

• Allow MS patients to be more in control of their care.
• Enable providers to better understand each patient’s needs and select appropriate treatment.
• Reveal real-world insights about patient populations so they can be comprehensively diagnosed, monitored, and treated.
• Reduce hospitalization and disease-related costs.

Patients are engaging with their health at a higher level than ever before, expecting personalized care and shared decision-making with their doctors that take their entire lives into account. This level of involvement allows patients to feel more in control of their care journeys and management. Unfortunately, this level of engagement has not yet been seen in the MS community. This is partly due to a lack of enough MS clinics and specialists to care for patients, low appointment availability, and long waitlists to see providers. To combat these barriers, digital solutions can offer patients flexibility with more holistic and honest communication with their doctors, which in turn allows for more accurate patient tracking, more frequent analysis and decisions on treatment paths, and increased adherence to therapy—all of which ultimately improve the patient experience while relieving cost for patients and payers.⁷

When it comes to care decisions, physicians have the most direct influence. When providers are given the necessary tools to address each patient and their specific needs, they are able to make better and more informed decisions with their patients, allowing them to optimize care paths and achieve better outcomes. For those treating MS specifically, one of the greatest unmet needs is a lack of objective measurement tools. This prevents doctors and nurses from being able to measure and track the magnitude of the disease over time, or gain additional knowledge and insights on how MS impacts the patient’s overall health.

In addition to the many other benefits of telemedicine and remote monitoring, by using measurement tools such as the MS Precision Care Solution⁸ neurologists can proactively manage care, moving from providing more reactive treatment recommendations to making data-backed decisions for each patient.⁹

Discussing health outcomes is a complex topic with many factors, including understanding the needs of the patient population and developing tools, methods, and treatments that will benefit them. In the MS community, there are a few areas of need: technological advancements, gaps in access, and health equity. While there have been incredible breakthroughs on the therapy side of MS, there has been a lack of technological developments. We’ve seen the wonders technological advances have had in other fields—such as oncology—and should look to them for reference as we start to work on and improve digital solutions for neurodegenerative diseases. In MS, these types of tools help streamline treatment and lower costs, meeting multiple stakeholders’ needs.

Digital solutions address an essential need for those who live in underserved communities,¹⁰ closing the gaps in access that once stood in their way (more and more experts are calling this a fifth aim). This type of solution is designed with the entire patient population in mind, meaning it is working toward im­proving health equity. For instance, African Americans tend to have more aggressive MS, yet they are less likely to be diag­nosed and receive effective therapies.¹¹ Digital solutions start to bridge this gap, offering increased access regardless of race, location, gender, and economic status.

There are many facets to what moves the needle on payer cost, but two important ones are optimizing DMTs and reducing avoidable health care utilization. Optimizing DMTs reduces costs to the payer, as patients are more likely to avoid unnec­essary treatments. In 2021, many DMTs exceeded prices of $90 000 per year⁴—and we know prices are not decreasing¹²— creating a financial burden on the payer. This cost increase can be mitigated by using a digital solution that incorporates bio­logical information and patient tracking, which will optimize DMTs by allowing providers to determine the most effective treatments and prevent gaps that could potentially worsen a patient’s outcome.

Additionally, solutions that utilize biomarker tests bring more confidence to providers when recommending treat-ments,¹³ including generic therapies—which are 80%-85% less than brand-name medicine when correctly recommended¹⁴— hitting the wish list of most payers. When a health plan part­ners with a diagnostic company and the creators of a generic therapy, its overall costs can also be lowered by reducing the number of ER visits, preventing relapses and readmissions, and increasing patient adherence to therapies. This approach is pos­sible through a data-fed digital solution’s capability to measure, analyze, and track test results and self-reporting of individual patients and clinic populations, knowing what works best for them without paying the price of trial and error.

Taken together, applying the quadruple aim to neurodegen­erative diseases like MS is no small task. But by using innovative tools and solutions to accurately measure and, therefore, better manage patient care, we can start to make a dent. The beauty of the quadruple aim framework is that one branch does not need to be sacrificed in order for the others to flourish—it works in harmony to improve health care as a whole. Within this frame­work, a digital solution designed for disease management can significantly impact our health care system. We believe that, with adoption and application, these solutions will change the field as we know it.