The Physician-Focused Payment Model Technical Advisory Committee recently completed its two-day public meeting to deliberate and vote on three proposals for physician-focused payment models.
The full Committee voted to make the following recommendations to the Secretary of the Department of Health and Human Services:
- Project Sonar submitted by the Illinois Gastroenterology Group and SonarMD, LLC: recommend for limited-scale testing
- The COPD and Asthma Monitoring Project submitted by Pulmonary Medicine, Infectious Disease and Critical Care Consultants Medical Group Inc.: do not recommend
- The ACS-Brandeis Advanced APM submitted by the American College of Surgeons: recommend for limited scale testing
Lawrence Kosinski, MD, MBA, IGG managing partner, and President of SonarMD developed Project Sonar as an Intensive Medical Home model for patients with inflammatory bowel disease: Crohn's disease and ulcerative colitis. Project Sonar started in IGG in 2014 and has now expanded to five additional practices in the state.
In a support letter to PTAC back in January, Lawrence Kim, MD, chair of health policy for the Digestive Health Physicians Association, wrote that “In short, Project Sonar is a powerful tool in improving our patients’ quality of life and decreasing costs by reducing potentially avoidable complications, emergency department visits, and inpatient admissions.”
The support letter also states, “DHPA believes that Project Sonar will have benefits that extend beyond the immediate value it will provide for the care and management of patients with Crohn’s disease. To date, the opportunities for gastroenterologists and other physician specialists to participate in APMs have been extremely limited. Adoption of the Project Sonar Advanced APM will allow specialists to participate in value-based care outside of an ACO/MSSP/CRC+ model and to do so in connection with chronic diseases and conditions that are not triggered by a surgical procedure on an inpatient or outpatient basis.”
The next step is for PTAC to draft its report to the secretary transmitting its recommendations and rationales for those recommendations. The secretary will post his response to PTAC’s recommendations on the CMS website.
Project Sonar is best summarized as a patient hovering system, Dr. Kosinski said. It utilizes secure online patient portals and smartphones to allow and encourage patients to communicate with physicians beyond face-to-face visits. Physicians can assess a patient's condition on a continuous basis and uncover larger trends based on the data. Project Sonar allows clinicians to identify issues before they become complications that drive patients to the emergency room and result in hospitalizations.
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 for physician services, only 3.5 percent of the total spend was for gastroenterologist care. 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.
Due to Project Sonar's initial success, IGG became the first specialty group to enter into an agreement with Blue Cross Blue Shield of Illinois to create an intensive medical home.
In a statement to PTAC, Dr. Kosinski said patients actively participating in Project Sonar saved $6,000 annually through its agreement with Blue Cross Blue Shield of Illinois. Before Project Sonar, the payer charged on average $24,000 annually per procedure.
Minnesota- and New Jersey-based practices created similar intensive medical home agreements with their Blue Cross Blue Shield affiliates. Today, around 20 practices involving more than 600 physicians have adapted the Sonar platform.
Dr. Kosinski said the active participation numbers reflect "the hunger among most physicians to be part of the value-based transition."
PTAC did not immediately comment to Becker's ASC Review at the time of publication. This story will be updated if PTAC comments.
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