Illinois Gastroenterology Group, based in the Chicago area, and SonarMD developed Project Sonar, an intensive medical home model to care for patients with Crohn's disease. The model, applied across the 20-physician specialty group since 2014, has since gathered data to prove efficacy and applied the model in other geographies across the country. The group submitted Project Sonar to the Physician-Focused Payment Model Technical Advisory Committee as an alternative payment model for chronic disease management; on Dec. 30, the PTAC opened the proposal to comment.
Comments are open through Jan. 20, 2017.
Lawrence Kosinski, MD, MBA, IGG managing partner, and his colleagues at IGG partnered with SonarMD to tackle chronic disease, specifically Inflammatory Bowel Disease: Crohn's disease and Ulcerative Colitis. Project Sonar utilizes secure online patient portals and smartphone technology for patients to communicate with physicians beyond the face-to-face visits. Physicians assess the patient's condition on a continuous basis and uncover larger trends about their condition in addition to catching issues before they become complications that drive patients to the emergency room and hospitalization.
"This model is really appropriate for ASC owners because it allows us to bundle the cost of our services provided in ASCs and thereby help us remain competitive with the management of patients with chronic disease. If we have to do all of these procedures in inpatient centers, we aren't going to be competitive in a value-based environment. This allows us to stay in the game."
Data collection and analysis was a huge part of building this initiative; Illinois Gastroenterology Group reported their initial cost per patient with Crohn's disease was $11,000 in 2011, with the overall hospitalization rate at 17 percent. Although half of the expenditures incurred were for the inpatient care and one-third of the spend was for physician services; only 3.5 percent of the total spend was for gastroenterologist care. Most importantly, the group found two-thirds of the patients admitted to the hospital for Crohn's disease-related complications didn't have identifiable contact with providers in the 30 days before the admission.
On the basis of a pilot program implemented in 2013, which provided patients a Sonar Score based on structured questions about their condition, the group was able to decrease hospitalization to 5 percent for the 50 patients in the initial pilot study. IGG then enrolled 185 patients in a study in partnership with Blue Cross Blue Shield of Illinois. During the first year of their initiative, there was a net cost decrease of 9.87 percent and a 57.14 percent decrease in inpatient costs.
Patient engagement was critically important to the project's success; among those who responded to at least 50 percent of the "pings" with questions about their condition, there was an 18 percent drop in cost while those who didn't respond to the "pings" reported a 23 percent increase in cost.
"Now that we have data and outcomes, we are working on predictive modeling," says Dr. Kosinski. "We are moving toward appropriate risk assessment of patients and developing predictive modeling tools allowing us to use artificial intelligence to determine which patients need more intense focus than others."
Based on IGG's application and comments forthcoming, the 11-member PTAC will decide whether to recommend Project Sonar to HHS as an APM for 2018. However, during that time President-elect Donald Trump will assume office and the Republican Congress is eager to make changes to healthcare legislation.
"We are hopeful that this will be favorably viewed by Trump," says Dr. Kosinski. "If gastroenterologists can have a vehicle to become APMs without having to do it through a hospital system, that's really a plus for us. The model is applicable to hospitals as well that are trying to play in the value-based space. Any new administration looking to move away from regulation, and turn the private sector loose to generate the solutions for the future, should embrace this model."
The APMs are part of the Medicare Access and CHIP Reauthorization Act, which has bipartisan support in Congress and largely thought to be safe from ACA repeal Mr. Trump. Project Sonar could be especially effective at filling the gap in chronic disease treatment to lower healthcare costs, but there are challenges.
"The success of Project Sonar relies on physicians being willing to change the way they approach patients with chronic disease," says Dr. Kosinski. "Most physicians right now deal with one patient at a time. The SonarMD Platform encourages them to look at an entire population of patients with a specific disease to better understand how the decisions they make are impacting the ultimate outcome."
In the places across the country where the SonarMD Platform is in place, physicians are positive about their involvement; there are now more than 600 physicians using the platform and engaging their patients. Once the physician is bought in, the challenge becomes engaging the patient.
"We spend a lot of time and energy to control reimbursements and how providers are paid; few of us focus on the patient as part of the solution," says Dr. Kosinski. "Project Sonar brings the patient into the project with the providers and both are focused on the outcome. That has been a challenge, but is a good solution."
The third element to Project Sonar's success is data transparency. BCBS of IL provided IGG with full data information on their patients; if it becomes an APM, Dr. Kosinski hopes CMS would do the same.
"I believe if providers can see the data, if there is transparency in the cost of care, I'm confident physicians will make the right decisions and find areas to improve," he says.