San Diego, CA, May 24, 2016—Project Sonar—a care-managed infrastructure developed via a partnership between Blue Cross/Blue Shield Illinois and the Illinois Gastroenterology Group—has provided clinicians with a unique opportunity to manage the care of patients with irritable bowel disease (IBD) through a successful combination of claims data, clinical data, a Cloud-based platform, and patient support tools, and was detailed here at Digestive Disease Week 2016.
Project Sonar is a community-based registry and disease management program developed by Lawrence Kosinski, MD, MBA, AGAF, FACG and colleagues that was designed to improve both clinical and economic outcomes in patients with irritable bowel disease (IBD) via a Cloud-based platform. To do so, the program combines health-related quality of life (HRQoL) information and clinical data to deliver Clinical Decision Support tools for patients. These data are then combined with payer provided claims data from the Intensive Medical Home with Blue Cross Blue Shield Illinois’ database.
“We needed a sonar system to ‘ping’ patients in between their face-to-face visits because less than one-third of patients who went into a hospital for a complication had any evidence of a doctor encounter in the 30 days before they were admitted. And over one-half the cost of care in that patient population was for these complications,” explained lead author Dr. Kosinski, managing partner, Illinois Gastroenterology Group, Elgin, IL, and member of the governing board of the American Gastroenterology Association. “We needed to know that they were deteriorating even before they realized they were.”
Dr. Kosinski and colleagues included 185 patients from Project Sonar who were continuously enrolled since December 1, 2014, and had full claims data available from January 1, 2014 to September 30, 2015. They normalized physician services with CPT Code Payments based on the 2015 Prospective Payment System, normalized inpatient hospital payments as referenced with Medicare DRG Payments, which were calculated with a base rate derived as the sum of the Operating Base Payment and the Capital Base Payment; normalized diagnostic payments using the 2015 Clinical Diagnostic Laboratory Fee Schedule; and normalized infusible biologics payments using office-e-based payment rates.
They then determined specific Crohn’s claims with the 555 category ICD-9 Codes and any additional cost specific for Crohn’s symptoms. Dr. Kosinski and colleagues compared the study period (December 1, 2014 through September 30, 2015) to a similar period (January 1, 2014 through October 31, 2014).
Payments for Crohn’s-related services, they found, differed according to where the infusion was performed, with an 18% overall difference in cost; there was a difference of $85/unit if the infusion was done in-office, compared with $158/unit for infusion in a hospital outpatient department (HOPD).
“Project Sonar is a partnership between Blue Cross/Blue Shield Illinois and the Illinois Gastroenterology Group. Project Sonar is built into the name; it’s a sonar system for patient engagement using a Cloud-based platform that utilizes cell phone technology to send a set of structured questions to patients on a monthly basis to bring back a SONAR score,” explained Dr. Kosinski. “Our team of nurses monitor the patients on the basis of their scores, and we intervene with the patients before they even realize they need to be intervened with. We’ve lowered the cost of care in the process.”
They found a 9.87% decline in cost of care in this patient population, related Dr. Kosinski, and over 50% decrease in hospitalization costs, over 50% decrease in emergency room costs. A slight increase in biologic expenditures was seen, which in turn, raised pharmaceutical costs.
“But in the end, that’s probably what we should be doing. We should be focusing on applying the right therapy to the right patients at the right time, to decrease the complications, decrease the morbidity, decrease the costs,” he said.
Patient satisfaction is also high, added Dr. Kosinski.
“The patient response has been fantastic. When we first started Project Sonar, we were using our patient portal. We could never get more than 27% participation rate using the portal. But now that we’re using the Cloud-based platform, we have a sustained 80% response rate with the patients. Patients love it because we don’t intrude in their lives. We hover over them without intruding. By having their own nurse care managers, they basically have their own customer service representative, by name, that they can go to.”
Ultimately, Project Sonar was a success for both clinicians and patients.
“We succeeded because we used published guidelines, used a team-based approach to care, and we engaged the patients. The bottom line is, we can’t sit back and wait for the patients to call us, and expect that they are going to know the appropriate time to call us. We need to engage them so that we can get to them before their disease does,” concluded Dr. Kosinski.
This study was funded by Takeda Pharmaceuticals U.S.A., Inc.