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VBCR - December 2014, Volume 3, No 6 - Health Economics
Phoebe Starr

Boston, MA­—The AIM FARTHER program developed at Geisinger Health System in Pennsylvania is a unique initiative designed to improve the quality of care for patients with rheumatoid arthritis (RA) and reduce costs. The program has been successful after 22 months. The cost of care for patients with RA was reduced by $1 million in 2014. “AIM FARTHER is a new value-based, population-care model,” explained Eric Newman, MD, Director of Rheumatology, Geisinger Health System and designer of AIM FARTHER. “We’ve improved the lives of more than 2300 RA patients, redefined the role of the rheumatologist to include a primary specialist role and provide management, advice, and be the steward of registry data.”

Starting with an RA Model
“This model can be adapted to other chronic conditions, including gout. We are starting a gout program at our center,” he said at a press conference during the American College of Rheumatology 2014 Annual Meeting. “We are setting ourselves up for the future, so no matter how the environment and regulations change, we will be able to handle it.”

Why choose RA for rollout of this model? RA is a complex, common, and costly condition that affects an estimated 1.3 million Americans. The disease is associated with an effect on employability, longevity, and quality of life.

The program has several objectives, including improving quality of care through a strategic approach, measuring disease activity and reporting, and reducing costs of care including variable use of biologics. The program also aims to integrate rheumatologists with primary care practices.

In addition, the new model incorporates several components, such as developing a registry; defining roles and attribution; integration of primary and specialty care; and creating a new strategic approach to RA care. The new program also seeks to establish RA quality measure bundle management, as well as task management and performance reporting, and a new financial incentive model.

The RA quality measure bundle comprises 8 measures: RA on disease-modifying antirheumatic drug (DMARD), active RA on DMARD, RA with Clinical Disease Activity Index measurement, RA at low disease activity, tuberculosis testing if on a biologic, influenza vaccine, pneumococcal vaccine, and low-density lipoprotein level checked.

As an example, he elaborated on the task management and performance reporting component, which is a 4-step process. (1) Programming of quality measures using a specialized software system that collects information from patients via a touch-screen questionnaire. The data are integrated with electronic records and stored in a database, and the nurse and physician to interact in real time. (2) Patient-level scorecard that lists specific quality measures in stoplight format: green = met; yellow= not yet met; red = not met. (3) Develop task management. The scorecard is presented at each visit to define care gaps and close them. (4) Develop performance reporting. Each patient is assigned to a specific provider. Quality reports are generated at the provider level and division level to help engage providers in reporting change.

Results of the New Model
Testing the new model involved all members of a multidisciplinary team who cared for patients with RA. “This moves team members from engagement in the process to ownership,” Dr Newman explained.

At 22 months, 40% of the 2378 RA patients tracked had achieved 100% of their applicable quality measures compared with only 22% at the beginning of the study in August 2012. Significant improvement was observed in all quality measures tracked, except active RA on DMARD, which was 92% at the beginning of the study and 93% at 22 months. “The improvement in quality measures at 22 months resulted in levels not achieved by any other group in the country,”
he stated.

“The difference in this program is that doctors are coming together to make quality improvement changes rather than MBAs,” said Monique Hinchcliff, MD, Feinberg School of Medicine at Northwestern University of Chicago, IL. “The rheumatology team involves everyone who participates in the process.”

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