The Illinois Gastroenterology Group partnered with Blue Cross Blue Shield of Illinois on a medical home for Crohn's disease patients, and early results are promising, according to an AIS Health report.
The medical home was formed in late 2014. Here are five things to know:
1. Since forming the medical home, Illinois Gastroenterology Group lowered the cost of care by 10 percent and showed a 57 percent hospitalization payment reduction.
2. The medical home led to a 53 percent drop in emergency room payments during the first 10 months of the program.
3. The focus on a medical home for Crohn's disease was partially driven by lower colonoscopy reimbursement; colonoscopy generally drives 75 percent of gastroenterologist revenue and with the pay declining the group leadership sought innovative ways to generate new revenue.
4. The group, and managing partner Lawrence Kosinski, MD, found that 24 percent of the practice involved Crohn's disease and ulcerative colitis treatment. He brought data on 21,000 Crohn's payments to Blue Cross Blue Shield of Illinois to begin the project.
5. The bill for Crohn's patients was around $11,000 per year over two years. To begin the program, 50 patients enrolled and received clinical support tools — the app know known as SonarMD — and were able to connect with the right physician and non-physician personnel for their care.
6. Illinois Gastroenterology Group provides Blue Cross Blue Shield of Illinois with full patient claims data once per month and the group receives shared savings from the program. Each patient pays an upfront per-member per-month fee.
7. After the initial visit and assessment, the group assigns a nurse case manager to each patient who connects with the patient at least monthly. The patients also record their medical symptoms on the Sonar Score to gauge severity. The cloud-based platform and text message system receives 80 percent or better response rate, according to the report.